Sharing in the financing of health care: government, insurance and the patient.

The health care systems of all countries have faced the problems of rising expenditures. In those countries with well developed social security health insurance financing, cost issues have been tackled without the threat of a major decrease in revenues. In Israel, revenues have declined dramatically in recent years. The major cause was the steep decrease in government participation, linked first to political and currently to economic factors. Since the level of government participation in the health insurance budget was not guaranteed by statute, the present system is confronted with a large and growing deficit, and by uncertainty to the point of threatening the viability of public health services in Israel. To understand the scope and issues in the sharing of financing between government, insurance contributions and the patient in other countries, this paper describes the situation in France, West Germany, Belgium, Luxembourg and the Netherlands as compared to Israel. In summary, the decline and instability in government support in Israel differentiates that country from the others and raises questions as to the recognition by government of the role of social security financed health care.