Although the main principle of the National Health Insurance Law of 1994 was the provision of egalitarian health services to the whole population, a majority of 103 health system and governmental decision makers interviewed by a team of Jerusalem researchers conceded that the system displays significant inequity. The study, to be formally presented at a May conference organized by the Myers-JDC-Brookdale Institute's center for health policy, was conducted by Prof. Leon Epstein, Dr. Baruch Rosen and other health policy researchers. Its main aim was to examine the place of inequality in health services, the views and actions of health system and government leaders and identify ways of reducing inequality in Israeli health services. The researchers conducted face-to-face interviews with hospital and health fund administrators, academics and others in the health field as well as others in government but outside the health system. They also examined professional literature published abroad on health service inequality. Most of those interviewed conceded that despite the lofty ideals of the National Health Insurance Law, which went into effect January 1995, the system was pervaded by inequality. "They were surprised by the degree of inequality," the researchers said. Most of the respondents regarded inequality in health as an important subject that deserved high priority in allocation of resources, not only because of its harmful effects on individual patients who could not afford the better health care enjoyed by the economically advantaged, but also because of the risks it posed to the social fabric, the researchers wrote. No comment was available by press time from the Health Ministry, even though the report was sent to the spokesman's office by The Jerusalem Post on Tuesday before noon. Dr. Baruch Rosen, of the Myers-JDC-Brookdale Institute said that even though there are differences in lifestyles and how people take care of themselves or abuse their health, the health system nevertheless has a role in minimizing inequality and educating weaker elements. It doesn't mean, Rosen added, that doctors are bad or don't want to help, but they need more training in promoting healthful lifestyles and encouraging poorer, less educated patients to take care of their diabetes or high blood pressure or overweight, for example. "Israel Medical Association heads told us they agreed with our conclusions and wanted to know what they needed to do. That is very encouraging. Prof. Epstein has already been invited to speak about the report to the heads of over 15 different organizations involved in health care. They are open to it and realize that what is needed is not just more of the same, but doing smart things," Rosen said. Most of those interviewed said that doctors and health funds should receive specific incentives for reducing inequity in the provision of health services and promotion of good health. Government programs in Britain, Sweden, Holland and other countries have been launched with the same aim. The decision makers stressed that poor health has major economic implications on Israeli society in general, loss of work days, for example, and on the health system due to the costs of treatment. But most admitted that increasing egalitarianism in the health system did not appear to be high in national priorities, although the study was completed before the latest Knesset elections, in which the social agenda received many votes. Most of those interviewed called for intentional decision making at all levels of government and society to reduce inequality in general and specifically in health care services. Not only the Health Ministry is responsible for promoting egalitarianism in health services, but the Education and Environmental Quality Ministries, for example, are also involved, and decisions must be made by the prime minister, cabinet, Finance Ministry and Knesset, they said. Local authorities, which are generally aware of health problems of their residents, should also be involved, they said, and religious leaders, in the haredi and Muslim sectors, should use their influence to minimize inequality. Most of those queried said they thought the health system could and should do more to minimize the gap in health between the rich and poor.