[Updating the basket of health services]

The process by which services are added to Israel's basic basket of health services constitutes a unique effort to tackle the most difficult of ethical issues. In some years, since 1997, the Israeli government allocated an increment of about 1% to the national health budget for the purpose of expanding the basic basket of health services provided under national health insurance. A public committee has been created for this purpose of deciding which of hundreds of potential entrants, should be added within the above budget constraint. The committee integrates available scientific evidence on effectiveness with social values to come up with a ranking. The process has attracted a great deal of public attention, most notably in the printed media, which usually focuses on the plight of specific individuals whose "desired drug" has not been added to the basket. In addition, the courts have, on occasion, intervened to reverse decisions of the committee in the contexts of suits brought by individuals seeking coverage for a treatment not currently included in the basket. Thus, Israel's brave attempt to cope with the necessity of health care rationing needs to be fine-tuned in terms of the information provided to the public about the process and the balance of scientific, economic, judicial and political inputs into the process.