Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 11, Issue 4, 2008. Pages: 201-208
Published Online: 10 December 2008

Perpectives
The Israeli Mental Health Insurance Reform

Bruce Rosen,^1* Nurit Nirel,² Revital Gross,³ Shuli Brammli-Greenberg,² Noa Ecker⁴

¹DSc, SmoklerCenter for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel
²MA, SmoklerCenter for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel
³PhD SmoklerCenter for Health Policy Research, Myers-JDC-Brookdale Institute and Bar-IlanUniversity, Jerusalem, Israel
⁴SmoklerCenter for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel

* Correspondence to: Dr. Bruce Rosen, Director, Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, P.O.B. 3886, Jerusalem 91037, Israel.
Tel.: +972-2-655 7460
Fax: +972-2-561 2391
E-mail: bruce@jdc.org.il

Source of Funding: None declared.

Abstract

Israel's mental health system functions separately from its physical health system in terms of financing, planning, organization and practice setting. The government is responsible for the provision of mental health care, while the country's four, competing, non-profit health plans are responsible for physical health care. A reform effort is underway to transfer legal responsibility for the provision of mental health care from the government to the health plans. This paper summarizes the key components of the reform, its objectives, and the concerns that it has raised. It demonstrates that two elements of the reform - the application of managed care principles to mental health and the integration of mental and physical care – are central both to the reform's objectives and to the concerns that have been raised about the reform. These same two elements are relevant to many countries considering reforms in their mental health systems.

Background: At present, Israel's mental health system functions separately from its physical health system in terms of financing, planning, organization and practice setting. The government is responsible for the provision of mental health care, while the country's four, competing, non-profit health plans are responsible for physical health care. A reform effort is underway to transfer legal responsibility for the provision of mental health care from the government to the health plans.

Aims: The main objectives of this paper are to summarize the key components of the reform, its objectives, and the concerns that it has raised. The paper also seeks to foster interactions between experts from Israel and other countries about the Israeli reform.

Methods: The analysis is based on official government documents, the scholarly literature about the Israeli reform and the relevant international literature about mental health care in other countries, participation in key public meetings related to the reform, discussions with leaders of the reform effort, and discussions with leading mental health experts in other countries.

Results: Two elements of the reform - the application of managed care principles to mental health and the integration of mental and physical care -- are shown to be central both to the reform's objectives and to the concerns that have been raised about the reform.

Discussion: These same two elements are relevant to many countries implementing or considering reforms in their mental health systems.

Conclusions: The architects of the Israeli reform could learn a great deal from the experience with mental health care and related reforms in other countries. At the same time, the Israeli reform could offer important insights and lessons for other countries.

Implications for Policy: The Government of Israel should work with the international mental health care professional community to create frameworks that would facilitate cross-national learning.

Implications for Further Research: It will be important to monitor the implementation of the reform and evaluate its impact, in order to assess the extent to which the objectives are met and the extent to which the concerns materialize. Cross-national research collaborations could be very helpful.

Received 14 November 2007; accepted 8 September 2008