Health reform and rationing in Israel.

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Rationing of health care services as a means for controlling health spending is receiving increasing attention in most health care systems today. Explicitrationinghasbecomeanissuenotonlyin the United States, which spends the highest proportion of gross national product (GNP) on health in the world, but also in countries that traditionally have controlled health spending more successfully. Rapid developments inmedicaltechnology andincreasingdemandsderivingfromchangingtastesanddemographictrendsstrainhealthcarebudgets. Israel, in the context of its recent health system reform, has made rationing explicit by defining a detailed “basic basket of services” to which all citizens would be assured access through a system of universal insurance, and by creating a process for updating the basket. Although experience is still limited, Israel’s experiment provides a unique opportunity to examine how rationing might evolve in the context of structural arrangements under consideration in a number ofcountries. What follows is a discussion of the Israeli health care system, the recent reform, and its implementation. We then focus on the evolution of the processes for determining and updating the basic basket of services and provide a case study involving the addition of a new drug to the basket. Next we consideroptions for the future. We conclude by pointing out how the Israeli experience is relevant for