Socio-Economic Implications of Health Disparities International Council on Social Welfare - ICSW Tuvia Horev Taub Center for Social Policy Studies in Israel December 2007

The National Health Insurance Law in Israel “State health insurance under this Law shall be grounded in principles of justice, equality, and mutual aid.”

Distribution of Israel’s National Budget, 2006 Total budget: 309 billion NIS, 2006

Distribution of Expenditure on Social Services, 2006

Infant Mortality, International Comparisons Central Bureau of Statistics 2007 Yearbook, Israeli statistics based on WHO 2006 Israel Rate of infant mortality per 1,000 live births, 2005

Longevity in Men, 2005 Israel years

Physicians Israel Rate per 1,000 population

Per Capita Health Expenditure, 2004 PPP, US$

National Health Expenditure as a Percent of GDP, Expenditure was NIS44 Billion (in 2000 terms) Central Bureau of Statistics, 2007 Yearbook

Public Health Expenditure: International Comparison Israel Public expenditure as a percent of National health expenditure 2004, 2005

Percent of Private Funding Out of Total National Health Expenditure, Central Bureau of Statistics 2007 Yearbook

Health Expenditure and Population Growth: since the National Health Insurance Law was passed, expenditure has not kept pace with population growth Index 1994=100

Respondents Who Have Refrained from Obtaining Essential Medical Treatment in the Past Year Due to Cost Taub Center Survey – July 2006 Rate among those age % Overall average – 21.2%

Household Expenditure on Health, % of household expenditure on these needs

Prevalence of diabetes among Ethiopian immigrants as a function of length of time in Israel Various sources: see Epstein, Horev 2007

Infant Mortality by Geographic Locale rate per 1,000 live births

Infant Mortality and Mother’s Education, X 4.6 Years of education Health in Israel, Ministry of Health, 2005 Infant mortality per 1,000 live births

Longevity by Place of Residence The Social Health Profile of Israeli Locales,

Household Expenditure on Health, by type of expenditure and income level, 2005 Household Expenditure Calculations, CBS Percent of total household expenditure spent on health

Why Do We Need to Bridge Gaps in Health Systems? Moral Values Equity Social Solidarity Social Cohesion Economic Aspects

A Draft of a National Plan to Narrow Health Disparities Acknowledging the existence of a problem and a national commitment to deal with the issue Setting measurable targets and choosing main areas for action Dealing with barriers on the supply side: investing in the infrastructure in the periphery, reorganizing the system of existing incentives, training professionals to be “culturally appropriate” Dealing with barriers on the demand side: reorganizing the issue of co-payments, culturally sensitive explanatory materials

Conclusion Narrowing of health inequalities should be a basic obligation of the State towards its citizens Reasonable accessibility to health services is a natural right of all Part of the problems of inequalities in health stem from factors that are outside of the health system The State should recognize the existence of the problem of inequalities and its responsibility to address the issue The health system has a key role in narrowing gaps The plan’s implementation requires building coalitions between “interested parties” in the health system and various government bodies, mainly the Ministry of Finance and the Ministry of Health

A Healthy Debate The contribution of health system policy to social integration and social cohesion Differences between countries in the amount of obligation that they express (policy statements, legislation, budget allocations, etc) Priority setting within the basket of social services Achievements and challenges in narrowing inequalities in health in other countries