Health Insurance

Hadi Rabee Reem Sawafta

Health Insurance

• Difintion • Risk pooling\ risk sharing

History of health insurance

* Germany 1883 * Britain 1911 * France** Palestine 1994

The objectives of health insurance:

• 1) remove the financial barrier between the patient and access care

• 2 ) social trust • 3)Improve the level of medical

services . • 4 ) the provision of financial

resources

Types of health insurance :

1)The government health insurance:

USA Medicaid \\ S-CHIP

2) The private health insuranceEmployer-sponsored

insurance

Health Insurancein PALESTINE

1)The government health insurance.

2) The private health insurance.3) UNORWA insurance .

Types of health insurance

GHI

1993 19980%

10%20%30%40%50%60%70%80%90%

100%

Insured familes

Insured55%-60%

not insured 40%

2010117125 family - WB

Includes : Family members :

wife, husband, children below 18 ,

Single daughters ,university students below

26 years and parents over 60 years old.

*** Add of memb increase the payment .

Types of participation in GHI:

• 1) Compulsory participation for the government and municipality employees \ 5% of the their basic salary , 40-75 NIS .

• 2)Voluntary participation for all self-employed people , pay a fixed premium of NIS 75 per month .

• 3) Workers in Israel \ special compulsory insurance .

Cont.…

• 4) Contracts insurance to the self-employed groups who are affiliated to occupational societies or associations .

• 5) Hardship cases are covered by the supplement services of the Ministry of Social Welfare, who pays NIS 40 .

• 6) Al aqsa GHI : for unemployed people after the second intifada , but the number now declines coz of restriction by MOH .

Cont… .

• 7) Ministry of Prisoners affaires .

• 8) fore the university students !!! and for the recently graduated doctors .

 

Problems : political, financing problems and administrative inefficiency problems .

Services Services included : all services present in the MOH buildings ….

Services that are not included :- plastic surgery .-Treatments of infertility .-traffic accidents and work accidents …

Free -Handicapped, - Thalassemia,- Hemophilia patients, - Children below 3 years ,

- Vaccinations- High risk pregnancy .

Private health insurance

General insurance companies as a part of their insurance program \ only 3% of pop .

It costs more than the GHI .

Any person can participate by his own fees , even the one who is insured by the GHI .

e.g : An Najah National University insure at Ala’lmyeh for insurance .

UNRWA : For any person who carries the

card of UNRWA . Must cover all the services in any

hospital freely , but now they cover only 70 % of the health service

• Escaping from responsibility !!.

Prposed law for health insurance reform:

Goals : 1.separate healthcare pro\ purch . 2. compulsory participation _

sustainability 3.improve acces to healthcare

services .

Objects • Equity \ autonomous .• Basket of sevices including

puplic health services .• Free of charge : children (5

years) pregnant women , tx for : cancer \ comm dse \ mental illness \ drug addic & substance abuse

Financing : • 1.premiums .• 2.co-payments .• 3.donations • 4. MOL – unemployed .• 5. MOSA – poor . 

Participation : mandatory for the entire Palestinians \ enforced through salary deductions and employer taxes ….

Health Insurancein ISRAEL

The MOH is responsible for the development of health policy, operation of the nation's public health services and management of the governmental health care budget

Medical services and insurances are provided through four health insurance companies, known as sick funds : clalit \ Maccabi \, Meuhedet \ Leumit . They are globally known as HMO : health maintenance

organization .

HMO•Type of MCO : manage care organizasion in USA and some other contries .

•Members select a primary care physician (PCP)

•Preventive care for a lower copayment or for free, in order to keep members from developing a preventable condition .

References..

. 1 .WHO website

2 .Dr.Fahd Al-sayed.

3 .The Palestinian Independent Commission For Citizen’s Right .

نابلس. – .3 الفلسطينية الصحة مديرية