Israel’s health system is among the most unequal in the OECD, ranking alongside countries such as Turkey and Mexico, according to an internal health ministry report released yesterday.According to the report, Israel’s health system is in the OECD group of the highest level of inequality, at 0.50 (before National Health Insurance transfers are made to the poor, or 0.38 after such allocations are received). This puts Israel in the “high group” together with Turkey and Mexico when measured by the division of expenditure for healthcare among the national population.The OECD average is 0.31 to 0.36. The “middle lower group” includes Western European countries such as Switzerland, Belgium, France and Germany, as well as Australia, with a rating of 0.27 to 0.30, while the lower groups with ratings of 0.23 to 0.27 have Denmark in first place, followed by Sweden, Austria, Finland, Luxembourg and Norway.The 89-page report on Inequality in the Health System was written by Dr. Tuvia Horev, a dentist and ministry deputy director-general for economics, and ministry economist Nir Kedar.In a press release put out along with the report, the Health Ministry said the government is working on improvement through an investment that will reach over NIS 1 billion.The report was written and refers to the time before Yael German became health minister.The report said the ministry took a “strategic decision in recent years to struggle with inequality in healthcare using the tools it has at its disposal.... There is no magic solution to reduce the health gaps.”It continued that “a longterm struggle that must be joined by all the factors in the health system, including organizations and service providers. It’s not realistic to expect immediate improvements. Stubbornness, professionalism and patience are what are needed from all partners.” The authors noted that “constant monitoring of the gaps, reaching conclusions and finding solutions are needed to make it possible to reduce inequality in health over time. Effort must be made to prevent the gaps from widening.”Among the major partners in reducing the gap, they concluded, were the four public health funds.“We hope for a united effort and preserving a high level of determining, a struggle for reducing inequality and ensuring the quality of health services and advancing the wellbeing of all Israeli residents,” it concluded.Horev commented that the Israeli health system was recently cited by the OECD for making an effort towards reducing inequality.However, the report did not look forward, set explicit goals or explain how the severe inequality – despite implementation of the National Health Insurance Law since 1995 – would be reduced. That law declared that national health insurance would be “based on the principles of justice, equality and mutual assistance” – but since 1995, the social gaps have only widened due to growing privatization; commercial health insurance policies; and gaps among hospital services in various parts of the country.The failures of the ministry’s privatization of the School Health Service, which was responsible for many gaps in healthcare, was referred to in one paragraph by the authors.