Privatized services reduce kibbutz health care [pg.6]

By JUDY SIEGEL
The serious financial problems that have plagued many kibbutzim in recent years and forced the privatization of some services have significantly reduced the level of health care provided to members, according to a new study by the University of Haifa's Institute for the Study of the Kibbutz and the Cooperative Idea. The study shows that kibbutz spending for health has been decreasing annually, with kibbutzim transferring overall responsibility for health care to its member families and individuals. The number of doctors, nurses and other medical personnel on 78 kibbutzim surveyed between 2000 and 2004 has been drastically reduced. In 2000, for example, 90 percent of the kibbutzim had a role in managing the health care system, but four years later, this figure had dropped to only two-thirds. In 2004, a quarter of the kibbutzim had a doctor in residence, but only 16% had one by 2004. The researchers also noted that the kibbutzim provide fewer emergency services than they did before. The researchers attribute this shedding of responsibility to the desire of kibbutzim to adjust to the health service system provided in the National Health Insurance Law of 1994. The kibbutzim themselves have also been undergoing structural changes, introducing measures of privatization to save on costs. Dr. Gila Adar, a kibbutz member who has headed the kibbutz institute, said that "the general tendency on most kibbutzim is to be linked to the basket of health services provided by the National Health Insurance Law and to limit the [kibbutz's] budget in accordance with this basket." The additional expenses for health care, she added, are imposed on the members' own budget. "There is a new and striking phenomenon," the researchers said, "and that is the solution to emergency services [being supplied] by people from outside the kibbutz, especially by companies that supply services to subscribers. There is such a service on 50% of the kibbutzim." Symptomatic of the situation, perhaps, is the growing absence of their own ambulances on the kibbutz. The number of kibbutzim that cover all or most of their members' medical expenses has also dropped. In 2004, only 31% of the collectives provided coverage for supplementary health insurance, while 69% of the kibbutzim left it up to their members to finance this expense. In 2000, 87% of the kibbutzim covered the cost of supplementary medical insurance for their members. Still another cutback by the kibbutzim was for special health needs for children: Fully 91% of the kibbutzim paid for this in 2000, compared to only 58% in 2004. Coverage of non-prescription drugs was cut from 88% in 2000 to 54% in 2004; free genetic testing was supplied by 81% of the kibbutzim in 2000, but only 38% of them four years later. Vaccinations not covered by the basic basket were funded by 77% of the kibbutzim in 2000 and 30% in 2004. Complementary medicine is now seen in the kibbutzim as a luxury, as 67% of them covered complementary medicine drugs in 2000, but just 12% continued to do so four years later.