Needs, expectations and public knowledge concerning services outside the medical basket: a lesson from Israel

Quality of and access to medical care are strongly related to the medical basket, the set of services covered under the national health insurance system. Various health systems offer institutional solutions to cover services that are not included in the basket in rare cases. In Israel, patients whose medical needs are not covered under the medical basket may apply to committees for exceptional cases which are run by all health funds. The article presents the findings of a cross-sectional telephone survey which was conducted to explore the public's familiarity with the committees for exceptional cases and their workings, eligibility, and reporting of treatment required outside the basket. Almost 25% of respondents reported that during the past ten years they or their close relatives needed medical care, physical examination, or drugs that were not included in the medical basket. The survey demonstrates the public's unfamiliarity with the committees and uncertainty as to entitlement of services which are out of the basket, as well as a tendency to prefer self payment and private insurance. Familiarity with committees is strongly related to education, race (nationality) and socio-economic status. The treating physician is the major source of information on the committee. In case of a need, preference is given to private purchase of drugs/services.