In the Israel's National Health Care System (NHS), four Sickness Funds (resembling health maintenance organizations) are the structures that disseminate the majority of health care services to its citizens. Alongside the Sickness Funds, but not a part of them, is the nationwide program providing preventive care to pregnant women, children under six years old and their mothers (Tipat Halav or Drop of Milk); and in a very short period of time, the Tipat Halav is destined to be subsumed under the four Sickness Funds. The Sickness Funds and Tipat Halav function very differently.
The Sickness Funds operate under the neoliberalism approach, condensing services to reduce unneeded spending and targeting services on citizens. Neoliberalism is a problematic approach for disease prevention and health promotion services possess the agenda is to minimize the government's involvement and hegemony over services (Glasdam, Oeye, & Thrysoee, 2015). Health care delivery methods that streamline care by reducing duplication and targeting services to the "majority" are maintained and other services targeting specific citizen population groups in need may be eliminated to reduce costs. The neoliberalism approach considers market-based strategies when weighing health care options (Glasdam, Oeye, & Thrysoee, 2015; Ruckert & Labonte, 2017). Traditionally, this approach has resulted in centralized services leading to an increase in service inequities by eliminating services designed for ethnic, racial and cultural minorities and other vulnerable populations (Baum et al., 2016; Slater, 2015).
Tipat Halav operates on the public health approach. The public health approach focuses on health outcomes and targets the elimination of inequities. The emphasis is on population needs and the availability on the full spectrum of health care (promotion, prevention, treatment, rehabilitation) for all residents. The public health approach extends health care to everyone, not solely citizens. It does not use the medical model, and is not restricted to treatment of a diagnosed disease. It takes into account major changes in population, such as demographics (e.g., ageing population) and neighborhood-based needs of specific population groups (e.g., inner city poverty). For the public health goal to be realized, a wide variety of stakeholders (e.g., businesses, public sector, and volunteers) must work together. Yet, Tipat Halav only works with pregnant and parenting women, and children under six. The program does not provide health preventive/promotion services to teenagers, adults or older adult populations.
Methods:
Neither program is ideal for the provision of health prevention/promotion services. A new NHS structure (called the Public Health Authority or PHA) is crucial to ensure a strong, consistent approach at providing disease prevention and health promotion services for all population groups (World Health Organization, 2012: World Health Organization, 2017). At the foundation of this newly, designed and updated structure is an understanding of the functions of the Ministry of Health and the Sickness Funds. The Ministry of Health is the regulator, the expert in the criteria and standards of health care throughout the country. It already has an infrastructure throughout the nation, a budget to provide community-based services, and operates via geographic areas and districts. This existing geographic infrastructure will be used to support the new PHA.
Results:
The PHA's main functions will be to: (1) oversee and convene two collaborative committees designed to engage individuals with public and private sectors (e.g., all relevant Ministries) and community leaders from all walks of life to identify preventive health care needs (the collaborative committees); and (2) administer and ensure the maintenance of standards of care, to identify and address special needs of preventive care within each geographic area and its population age- and subgroups (called: the executive department).
Conclusion:
The World Health Organization (WHO) recommendations for public health systems are to provide the full spectrum of care (i.e., health promotion, health prevention, and treatment) to all residents no matter age, religion, citizenship status, etc. The proposed PHA will make this recommendation a reality for Israeli citizens and residents.