By Bruce Rosen
Director, Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel
Gur Ofer
The Hebrew University (Emeritus), Jerusalem, Israel
Miriam Greenstein
Myers-JDC-Brookdale Institute, Jerusalem, Israel
Yair Birnbaum
Hadassah Medical Organization, Jerusalem, Israel
and Jonathan Halevy
Shaare Zedek Medical Center, Jerusalem, Israel
Debate continues in Israel on whether or not to allow patients in public hospitals to choose their physician in return for an additional, out-of-pocket payment. One argument against this arrangement (known in Israel as "Sharap") is that only the rich will be able to af ford private care. The objective of this article is to assess the extent to which the private care programs in Jerusalem’s public hospitals were financially accessible in 2001.The study is based on the records of all (37,106) operations performed in the three major voluntary, non-profit hospitals in Jerusalem in 2001.Of them, roughly 5,800 (16%)were performed privately. We retrieved data on the prices charged by the hospitals for private operations, and then analyzed these in conjunction with external information on the prevalence of supplemental insurance coverage and the extent to which it covered private care. For the Hadassah hospitals, we also compared private care prevalence rates by neighborhood, using information on neighborhood socio-economic status from the Jerusalem Statistical Yearbook. The average amount charged by a hospital for a private operation was NIS 10,214 (NIS 6,086 at Shaare Zedek, NIS 9,493 at Hadassah Mount Scopus, and NIS 12,796 at Hadassah Ein Kerem). Differences in department mix and case mix accounted for approximately 40%of the price differences among the hospitals. For two-thirds of all private operations, and approximately 90% of those performed at Shaare Zedek,the charge was less than NIS 10,000.In 2001, almost 70%of Israel's population had supplemental and/or commercial health insurance, which usually covered between 65%and 100%of the fees for private care. The use of private care at the Hadassah hospitals was above average among residents of neighborhoods ranked in the highest socio-economic quartile, well below average among residents of neighborhoods ranked in the lowest quartile, and about average among residents of neighborhoods ranked in the second and third quartiles. In conclusion, private care appears to be financially accessible to persons with moderate income. This seems to be due in part to the increase in supplemental insurance coverage. However ,private care still appears to be beyond the financial reach of most low-income families, many of which lack supplemental insurance.