Health System Leaders Demand Overhaul of National Health Insurance Law

Senior figures in Israel's health system are calling for significant changes to the National Health Insurance Law, enacted over three decades ago, to align it with current realities. Speaking at a conference marking 30 years of the law, hospital and health fund directors identified outdated mechanisms from the 1990s that they claim hinder competition, technological adoption, and the ability to address a growing shortage of medical personnel.

Professor Eli Shvartzman, CEO of Ichilov Medical Center, highlighted the gap between the digital revolution in other service sectors and healthcare. He argued that much of healthcare could be delivered remotely, citing a McKinsey survey suggesting 70% of common medical queries could be resolved without a physical patient visit. Shvartzman attributed the primary barrier not to technology but to regulation and the traditional division of authority, criticizing the continued paternalistic approach requiring in-person visits for prescriptions. He also contended that the healthcare workforce shortage should not solely be addressed by increasing the number of doctors and nurses, as this approach fails to adapt to modern realities.

Sigal Daden-Levi, CEO of Maccabi health fund, advocated for structural changes in workforce training, including potentially shortening medical studies and expanding the use of physicians abroad to serve Israeli patients. She also addressed the unique Israeli model of competition among four non-governmental, government-funded health funds, stating that current restrictions on advertising and recruitment hinder healthy competition, pushing some activities into less transparent channels. Daden-Levi proposed allowing patients to switch health funds at any time, with a mandatory one-year commitment to the new fund to prevent frequent transfers.

Former Ministry of Health Director-General Professor Nachman Ash pointed to the incentive for health funds to compete for more "attractive" populations, such as the young and healthy, and called for greater transparency. He also suggested re-examining the role of local authorities in healthcare provision. Rambam CEO Dr. Michal Makal discussed the need to bridge the gap between routine and emergency healthcare operations, noting the system's difficulty adapting to unforeseen scenarios like missile attacks from Iran, and stressed the importance of maintaining routine services even during prolonged emergencies.

The overarching message from the panel was not to abolish the National Health Insurance Law but to adapt its mechanisms to a dramatically changed landscape, including an older population, workforce shortages, advanced digital capabilities, complex competition, and the need to function simultaneously in routine and emergency modes.