Nurse injecting patient. Tomer Appelbaum
Nurse injecting patient. Photo by Tomer Appelbaum
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With the social protest reaching a crescendo, Deputy Health Minister Yaakov Litzman has proposed a comprehensive reform in the realm of nursing-care insurance. The proposed reform includes a gentle increase of 0.5 percent in the health tax that is currently paid through one's monthly salary, in return for an increase in the number of hours for which one is eligible for nursing care at home and a broadening of the eligibility for admission to a public frail-care facility.

Under the proposed reform, nursing-care eligibility will be increased by up to 50 percent. For example, severely disabled individuals who receive income supplements and are currently eligible for 22 hours of nursing assistance a week would see that number increased to 33 hours under Litzman's program. Above-average earners who are today eligible for up to 11 nursing-care hours a week will see that limit rise to 15.5 under the reform.

Regarding admission to a nursing-care facility, the excess charge ceiling for this would drop from NIS 9,300 to NIS 7,000 per month. Furthermore, the income evaluation criteria for eligibility for admission to a public nursing-care facility would no longer consider the incomes of the individual's family members, including his or her children, as is the case today. All that would be taken into account would be the salaries of the individual who requires the nursing care and his or her spouse, excluding their assets.

While the health tax hike would amount to just 0.5 percent, the Finance Ministry is opposed to raising taxes under the current circumstances. According to Litzman, however, alternative budgetary sources may be found.

With a green light from the coalition, Litzman's program has already been approved on first reading as a private-member bill submitted by MK Haim Oron (New Movement-Meretz ), before his retirement earlier this year. The proposal will now be submitted for additional approval by the government and Knesset.

"The reform entails a great deal of money and numerous elements, and should begin with boosting the community hours and increasing coordination between the National Insurance Institute and the health maintenance organizations, who are familiar with the insured party from a medical perspective," said Health Ministry director general Prof. Roni Gamzu.

"In its second stage, a year down the line, responsibility for the issue of nursing care will pass from the Health Ministry into the hands of the health maintenance organizations, so as to ensure a treatment continuum," Gamzu continued. "And in the third stage, the issue of hospitalization of frail-care patients will pass from the Welfare Ministry into the hands of the HMOs."

Health Ministry officials view the reform as a gradual process to be implemented over a three-year period. They estimate its cost at some NIS 1.2 billion.

Litzman says the program is "a social reform par excellence that helps the elderly." According to the deputy minister, "The ministry is looking out for them, and that is good news. If up until now, money was being taken from the children, that wasn't right. For someone who earns NIS 9,000 a month, the health tax increase would amount to just NIS 30 per month."

Gamzu added that, "Today, one-third of the public does not receive any public funding for nursing care, despite paying Health Insurance and National Insurance for years. And we are talking about the middle-class in particular. We are facing a tsunami in the increase in the number of elderly people in Israel, and we have to adapt public resources to this population."

Ken Lazaken (an organization working for elderly rights ), the Association for Civil Rights in Israel and other social welfare organizations have expressed support for the reform. "This is a reform whose basic premise is to make the state responsible for a field that has been abandoned to private bodies in recent years," said attorney Yifat Solel, legal advisor to Ken Lazaken.