Although the directors-general of the country's four health funds are responsible for a total of five percent of Israel's Gross Domestic Product, a lack of adequate reporting to the public on their activities can harm their ability to serve the public, according to a new report issued Monday by the Taub Center for Social Policy Studies in Jerusalem. The 39-page report was written by Prof. Dov Chernikovsky, a leading health economist at the Taub Center and Ben-Gurion University; with Dr. Shalom Mizrahi and lawyer Zvi Frankel, who are experts in economics, law and public policy. The independent Taub Center, headed by Prof. Ya'acov Kop, was founded by the Joint Distribution Committee. They contend that the non-profit health funds do not adequately report to the public about their activities and do not bear enough responsibility for them. At present, a deputy director-general in the Health Ministry is charged with supervising the health insurers, mostly from a financial vantage point. The Taub Center researchers recommended three options for bolstering the health funds' public accountability through the election of their boards of directors. First, the government could appoint these bodies; second, it could appoint a majority of the board members and the chairmen, while health fund members could vote for the rest of the members; third, health fund members could choose most of the board of director members and the chairmen, while the rest would be selected by the government. Today, health fund members have almost no say in the running of their health funds. The authors favor the third option because it would reduce politicization of the health funds and prevent the concentration of power in the hands of politicians. They also oppose efforts by the Treasury to force structural changes on the health funds through the annual Arrangements Bill attached to the Budget Bill. Until 1995, when the National Health Insurance Law came into effect, two of the health funds - Clalit Health Services (the largest) and Kupat Holim Leumit (the smallest) were owned by labor federations, which did some supervision of their health funds, the authors wrote. But then the connection was severed between the labor federations and the two health funds, nothing satisfactorily replaced them as supervisors, and no major supervisory mechanism was established for the other health funds, Maccabi Health Services and Kupat Holim Meuhedet, as well. The government's supervisory powers over the health funds are relatively weak, the authors wrote, while the health funds' managements and unions are very powerful. But the public, who chose their health fund on a voluntary basis, do not have much of a voice, they continued in the report. "Paradoxically, this situation allows the government - which significantly dictates the health funds' behavior - to avoid taking responsibility for them, while it would be bound to take responsibility for supervision if it participated in the appointment of the health fundsâ€š boards of directors."