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What should health insurance cover? A comparison of Israeli and US approaches to benefit design under national health reform

Published online by Cambridge University Press:  22 January 2018

Rachel Nissanholtz Gannot ,
David P. Chinitz  and
Sara Rosenbaum
Rachel Nissanholtz Gannot*
Affiliation:
Department of Health System Managements, Ariel University, Ariel, Israel Myers-JDC-Brookdale Institute, Jerusalem, Israel
David P. Chinitz
Affiliation:
Braun School of Public Health - Department of Health Policy and Management, Hebrew University, Hadassah, Jerusalem, Israel
Sara Rosenbaum
Affiliation:
Milker Institute - School of Public Health, George Washington University, Washington, DC, USA
*
*Correspondence to: Rachel Nissanholtz Gannot, Ariel University, Ariel, 40700, Israel. Email: [email protected]
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Abstract

What health insurance should cover and pay for represents one of the most complex questions in national health policy. Israel shares with the US reliance on a regulated insurance market and we compare the approaches of the two countries regarding determining health benefits. Based on review and analysis of literature, laws and policy in the United States and Israel. The Israeli experience consists of selection of a starting point for defining coverage; calculating the expected cost of covered benefits; and creating a mechanism for updating covered benefits within a defined budget. In implementing the Affordable Care Act, the US rejected a comprehensive and detailed approach to essential health benefits. Instead, federal regulators established broadly worded minimum standards that can be supplemented through more stringent state laws and insurer discretion. Notwithstanding differences between the two systems, the elements of the Israeli approach to coverage, which has stood the test of time, may provide a basis for the United States as it renews its health reform debate and considers delegating decisions about coverage to the states. Israel can learn to emulate the more forceful regulation of supplemental and private insurance that characterizes health policy in the United States.

Type
Articles
Information
Health Economics, Policy and Law , Volume 13 , Issue 2 , April 2018 , pp. 189 - 208
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Copyright
© Cambridge University Press 2018 

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