Nissanholtz Gannot Rachel, Chinitz David P, Rosenbaum Sara
1Department of Health System Managements,Ariel University,Ariel,Israel.
3Braun School of Public Health - Department of Health Policy and Management,Hebrew University,Hadassah, Jerusalem,Israel.
Health Econ Policy Law. 2018 Apr;13(2):189-208. doi: 10.1017/S1744133117000287. Epub 2018 Jan 22.
What health insurance should cover and pay for represents one of the most complex questions in national health policy. Israel shares with the US reliance on a regulated insurance market and we compare the approaches of the two countries regarding determining health benefits. Based on review and analysis of literature, laws and policy in the United States and Israel. The Israeli experience consists of selection of a starting point for defining coverage; calculating the expected cost of covered benefits; and creating a mechanism for updating covered benefits within a defined budget. In implementing the Affordable Care Act, the US rejected a comprehensive and detailed approach to essential health benefits. Instead, federal regulators established broadly worded minimum standards that can be supplemented through more stringent state laws and insurer discretion. Notwithstanding differences between the two systems, the elements of the Israeli approach to coverage, which has stood the test of time, may provide a basis for the United States as it renews its health reform debate and considers delegating decisions about coverage to the states. Israel can learn to emulate the more forceful regulation of supplemental and private insurance that characterizes health policy in the United States.
医疗保险应涵盖和支付的内容是国家卫生政策中最复杂的问题之一。以色列与美国一样依赖受监管的保险市场，我们比较了两国在确定健康福利方面的方法。基于对美国和以色列的文献、法律及政策的审查与分析。以色列的经验包括选择定义保险范围的起点；计算承保福利的预期成本；以及在既定预算内创建更新承保福利的机制。在实施《平价医疗法案》时，美国拒绝了对基本健康福利采取全面而详细的方法。相反，联邦监管机构制定了措辞宽泛的最低标准，这些标准可通过更严格的州法律和保险公司的自由裁量权加以补充。尽管两国制度存在差异，但以色列经受过时间考验的保险范围确定方法的要素，可能为美国重新展开医保改革辩论并考虑将保险范围决策下放给各州提供一个基础。以色列可以学习效仿美国医保政策中对补充保险和私人保险更有力的监管。
