Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
Health Policy. 2010 Aug;96(3):217-25. doi: 10.1016/j.healthpol.2010.01.016. Epub 2010 Mar 1.
This paper has two objectives. The first is to examine the Israeli long-term care (LTC) system that is marked by rapidly increasing demands, and a multitude of public and private LTC arrangements. The second is to propose a reform to improve the system's efficiency and equity.
The paper studies the LTC services in Israel, and the private-public composition in funding, fund holding, and provision of LTC. It focuses on structural deficiencies in the organization of each of these functions separately, and in combination.
In many countries LTC has evolved in a patchwork fashion that at some point in time needs rethinking and rationalization. Israel is a case in point. In spite of numerous LTC arrangements supported by the state, in the absence of a comprehensive strategy, these have not generated a coherent system that can deal efficiently and equitably with existing and fast growing LTC needs, on the one hand, and the resources available to it, on the other. The current system is fragmented. It provides limited coverage and insufficient benefits in a troublesome fashion to public. The findings suggest that Israel can achieve at least in the short term, universal entitlement to LTC at lower financial and social cost, than the current costs of the system. In the medium and long term, the country will need to consider the trade between the burden of direct care on households or the tax burden of publicly supported and organized care.
To remedy the situation the paper suggests a two-planked reform. The first is integration of the current fragmented publicly supported system while deciding on LTC either as a "social endeavor" under a separate authority responsible for implementing the public LTC budget, or as a "medical endeavor", putting this responsibility under the Israeli sickness funds. The second plank, building on the first, comprises extension of universal entitlement to LTC. Such an extension would increase public spending in the long term; simultaneously, it would relieve the tax-paying population of a substantial privately borne burden of a fast aging population.
本文有两个目标。第一个目标是研究以色列的长期护理（LTC）系统，该系统的特点是需求迅速增长，以及众多公共和私人 LTC 安排。第二个目标是提出一项改革方案，以提高系统的效率和公平性。
本文研究了以色列的长期护理服务，以及公共和私人在资金、资金持有和提供 LTC 方面的组成。它侧重于分别和组合组织这些功能中的每一个的结构性缺陷。
在许多国家，长期护理都是以拼凑的方式发展起来的，在某个时候需要重新思考和合理化。以色列就是一个例子。尽管国家支持了许多长期护理安排，但由于缺乏全面的战略，这些安排并没有产生一个能够高效、公平地应对现有和快速增长的长期护理需求，以及它所拥有的资源的连贯系统。当前的系统是分散的。它以一种麻烦的方式向公众提供有限的覆盖范围和不足的福利。研究结果表明，以色列至少可以在短期内以比当前系统成本更低的财务和社会成本实现长期护理的普遍权利。在中长期内，该国将需要考虑在家庭直接护理的负担或公共支持和组织护理的税收负担之间进行权衡。
为了改善这种情况，本文提出了两项改革措施。第一项是整合当前分散的公共支持系统，同时决定将长期护理作为一个单独机构的“社会事业”负责实施公共长期护理预算，或者作为“医疗事业”，将这一责任交给以色列的疾病基金。第二项改革措施是在第一项改革措施的基础上，扩大长期护理的普遍权利。这种扩展将增加长期公共支出；同时，它将减轻纳税人口因人口快速老龄化而承担的大量私人负担。
