As medical services provided by the four public health funds under the National Health Insurance Law decrease compared to those available on the private market, the number of people who take out supplementary health insurance policies from their health fund is growing. Of 7,133,000 residents with National Health Insurance, 5,001,000 pay an average of NIS 269 to NIS 348 annually per person for supplementary coverage. These statistics are provided by the Health Ministry's first-ever annual report on supplemental health services, released for publication on Tuesday and covering 2006. It was prepared by ministry officials and private accountant Dafna Ravid-Barzilai. Health fund members with supplementary insurance use it mainly to choose their own surgeon (in public or private hospitals) or for a second-opinion consultation. Supplemental policies also offer policy holders subsidized medications not included in the official basket of health services, improved organ transplant services abroad and other benefits. The health funds - Clalit Health Services, Maccabi Health Services, Kupat Holim Meuhedet and Kupat Holim Leumit - are not permitted by law to have any annual deficit in their supplementary health insurance arrangements, and any surplus income must be used by the health funds to expand and improve their supplementary health insurance for the next year, with ministry approval in advance. The health funds spend only 75 percent (Leumit) to 89% (Maccabi) of their income from supplementary health insurance policies on additional members' services. Thus Maccabi claims that it invests the most in its supplementary health insurance policy holders and - because it spends the least on overhead - is the most efficient provider. Clalit offers the cheapest supplementary policy, averaging NIS 269 per person per year (depending on the age of the member), while Maccabi's average price is NIS 344, with NIS 297 collected by Meuhedet and NIS 348 by Leumit. But these policies are not uniform, and the more expensive policies may (or may not) offer additional benefits (with ministry permission). The varied policies were intended by the government to increase competition among the health funds, although only a small minority of residents switch health funds in any one year.