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Risk-adjusted capitation. The Israeli experience.

A Shmueli1, D Chinitz

  • 1Department of Health Management, Hebrew University School of Public Health, POB 12272, Jerusalem 91120, Israel. ashmueli@md2.huji.ac.il

European Journal of Public Health
|June 26, 2001
PubMed
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Israel implemented National Health Insurance (NHI) in 1995, shifting to a regulated market. This reform impacts the competitive health insurance landscape, with sick funds now managing risk-adjusted capitation payments for mandated benefits.

Area of Science:

  • Health economics
  • Public policy
  • Healthcare reform

Background:

  • Israel's health system underwent significant structural reform in the 1990s.
  • The reform centered on principles of public contracting and regulated markets.
  • This period saw a global trend towards similar health system restructuring.

Purpose of the Study:

  • To analyze the effects of the National Health Insurance (NHI) Law on Israel's competitive health insurance market.
  • To discuss key policy challenges arising from the NHI implementation.
  • To evaluate the impact of risk-adjusted capitation payments on sick funds.

Main Methods:

  • Analysis of the Israeli health insurance market post-NHI enactment.
  • Examination of the regulatory framework established by the National Health Insurance Law.

Related Experiment Videos

  • Review of the financial mechanisms, including risk-adjusted capitation payments.

    • Main Results:

    • The National Health Insurance Law, enacted in 1995, fundamentally altered Israel's health insurance market.
    • Sick funds now operate under a system of risk-adjusted capitation payments, assuming full financial risk for mandated benefits.
    • The reform has created a more regulated and competitive environment within the health insurance sector.

    Conclusions:

    • The NHI has reshaped Israel's healthcare financing and delivery.
    • Ongoing policy discussions are crucial for navigating the complexities of the reformed system.
    • The Israeli model provides insights into managed competition within national health insurance frameworks.