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Risk-adjusted capitation. The Israeli experience
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
Summary
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.
- 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.