In 2003, Israel’s total per capita expenditure on health care was Intl $1839 (8.7 % of GDP).¹⁵³ Among the six MECC countries of the Middle East, this figure falls within a spending range of Intl $1839 in Israel (8.7 % of GDP) and Intl $153 in Egypt (3.9 % of GDP). At 3.9 % the smallest spending as a percentage of GDP is in Egypt (Tables 7 and 8).

The WHO overall health system performance score places Israel 28/191 countries. This composite measure of overall health system attainment¹⁵⁴ is based on a country’s goals relating to health, responsiveness, and fairness in financing. The measure varies widely across countries and is highly correlated with general levels of human development as captured in the human development index.

Tables 7 and 8 Total health expenditure (Intl $) per capita and as a percentage of GDP: Six MECC countries of the Middle East, 2003

Israel has a health care system based on health plans provided by four not for profit institutions; these were originally known as ‘sick funds’, and were established, from 1948, by workers’ associations (by which they were politicised by affiliation with different party factions). Until 1995, when the government National Health Insurance (NHI) law was introduced, people paid voluntary contributions into the health plan of their choice. Since 1995, contributions to the health plan of choice have been collected compulsorily as health tax: in exchange all Israeli citizens, irrespective of their income or age, are entitled to full medical insurance with a health benefits package from the health plans, stipulated by the NHI. Individuals can also pay additional Voluntary Health Insurance (VHI) for supplements to their basic benefits, which cover private medical provision and complementary therapies.

There are four health plans, known as Health Maintenance Organisations (HMOs); Clalit (the largest and oldest HMO, still insuring around 55% of the public), Maccabi (24%), Meuhedet (11%), and Leumit (10%).

The government role, from the Ministry of Health (MoH), is to provide services not covered by HMOs; most importantly this covers public health, including communicable disease control, mother and baby care, psychiatric care and long-term hospitalization. The MoH also subsidises some HMO activities, by a NHI per capita reimbursement system, as well as planning, supervising, regulating and licensing different aspects of health services. The MoH has developed, owns and operates government funded hospitals, which account for around half all the acute beds in Israel.¹⁵⁵

Currently, palliative care services are not a stipulated NHI benefit or an essential component of the health plans’ ‘basket of services’. Health funding for palliative care is discretionary from HMOs prepared to fund services either completely or, depending on whether the service is based within a health plan institution, in part alongside MoH funds or charitable monies.