Sunday, September 21, 2008

10-11th September, 2008 Tiberias, Israel
I was in Israel for a meeting of the International Advisory Board of the
Israel National Institute for Health Policy and Health Services Research and for the international conference that followed it. The conference was on the Public-Private mix in health care. The discussions were fascinating, reminding us of the many semantic difficulties in health policy. Specifically, could we agree on what we meant by public and private? This is of particular relevance in Israel, where the sickness funds are private bodies but operating within a statutory framework. Most of those representing them do not claim to be private organisations, rather seeing themselves as fulfilling a public role. Perhaps the only way to resolve the issue is to accept that some organisations have public and private dimensions and which predominates depends on the specific circumstances!
All health care systems are a product of history and, if one was starting from scratch it is unlikely that anyone would design them as they are now. Much of the discussion inevitably focused on issues facing the Israeli health system. Revital Gross provided a remarkably clear explanation of a highly complex financing scheme, where everyone is covered through the social insurance scheme yet where 80% purchase supplemental insurance from the sickness funds while 38% also pay for complementary private insurance. However, this was simplicity itself compared with the new Dutch insurance system, presented by Wynand van de Ven, which left many of us relieved that we didn’t have the choice that it offered, as the complexity of the many packages on offer seemed to test the comprehension of most of those present, that vast majority of whom had the benefit of tertiary education!
The conference was held in Tiberias, on the Sea of Galilee Its banks are steeped in history, from biblical times to the 20th century (it is overlooked by the Golan Heights). Over 200 m below sea level, the surroundings are beautiful and the warm water is fresh and clear (and I did manage to find some time to swim in it). Yet it also provides a warning. It is surrounded by jetties and harbours whose walls now tower over the stones that line its shores. Although it is difficult to tell, it seems to be about 8m lower than it once was, serving as a reminder that, ultimately, the survival of this region is dependent on one scarce commodity, water.

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