PA02.06 Access to Care: Israel

Abstract

The defining characteristic of the health system in Israel is its governance by the National Health Insurance Law (1995). This law ensures health coverage to every resident of Israel and defines the government's responsibility to provide health services to every person without discrimination. In other words, health insurance is mandatory, and all residents of Israel must be insured. Citizens pay a healthcare tax – 4.8% of income. Private Health Services Patients have the option of seeking private medical care from a physician of their choice, and at their own expense. There are four health funds, where each fund has branches throughout the country and provide its members with all mandated services. The Basket of Health Services, consists of a range of essential medical services, including treatments, medications, and equipment which each health fund is obligated to provide to its members. Its contents are defined by law, but are subject to periodic revision. Therefore, a treatment or medication that was covered at one point may be discontinued, or new items may be added. Every end of a year, new treatments and technologies are submitted to be included to the new health basket. First the physicians rate the proposed new treatments and technologies, then the top ones enter the basket debate, where eventually only some every year enter the health system. In the past years new treatments and technologies could be added until the sum of 300 million NIS, that equals, 80 million dollars. This year the basket fund was increased to 146 million dollars. The problem is that there are many new treatments and that the oncology rating is among all oncological diseases. Last year, four new lung cancer drugs were proposed to the health basket. The Israel Lung Cancer Foundation, advocated in the Israeli Kneset (house of parliament), attended meetings, raised awerness in digital and written media. Eventually 3 new lung cancer drugs were approved including OPDIVO, TAGRISSO and ALECTINIB. This end of year, KYTRUDA and OPDIVO for larger indications were submitted in addition to foundation 1 diagnosis test. This year, the foundation submitted to the health basket the lung cancer screening test, LDCT to be included for population at risk. Clinical studies take place in Israel, although as a very small country with only 8 million people, the number of clinical trials is not large. Companionate programs exist as well. Overall, Israel has a very good health system with good access to targeted therapy and immunotherapy. Drugs for mutations such as ALK and EGFR are approved including immunotherapy for NSCLC. health system, access, funds, services