Policy Making at the Margins of Government

Yair Zalmanovitch

Description

Who makes public policy in vital services that are paid for by the government but provided by autonomous non-governmental agencies? This book explores this question through the prism of Israel's unique not-for-profit health system, drawing heavily on unpublished archival sources and interviews with key players. Starting with the system's roots in Israel's pre-state period, it traces the almost century-long struggle between the country's largest healthcare provider, Kupat Holim, and successive Israeli governments for control of the tools of policy making: allocation, regulation, and restructuring. It analyzes how Kupat Holim acquired and exercised a veto over healthcare policy, and then, how, under the pressure of changing social developments and party politics, its veto was eroded and finally lost in the health reform of the 1990s. Entering the current debates on health reform and government by proxy, the author questions whether the reform actually improved healthcare, as promised, or allowed the government to renege on its responsibilities.

Tables

Preface

1. Policy Making from the Margin

Part I: The Informal Preventive Veto

2. Kupat Holim in Prestate Days: 1911-1947
3. The Formative Stage: 1947-1949
4. Health as a Political Resource: The First Two Decades of Statehood
5. The Informal Preventive Veto

Part II: The Formal Preventive Veto

6. Accommodation Under Labor: Vision of Supervised Autonomy
7. Expropriation of the Allocation Process
8. Regulating Through Parity in Joint Regulatory Bodies and Through Informal Agreements
9. Restructuring the Health System
10. The Formal Preventive Veto

Part III: The Obstructive Veto

11. Exclusion Under the Likud: 1977-1984
12. Government Allocation as a Means of Control
13. Regulation as a Means of Control
14. Restructuring: National Health Insurance to Establish Government Authority
15. The Obstructive Veto

Part IV: The Erosion of the Veto

16. Erosion of the Veto
17. Stateness in Health

Appendix: Israeli Currency and Approximate Dollar Exchange Rates

Notes

Bibliography

Archival Sources
List of Interviews
Primary Sources
Secondary Sources

Index

Sujets

• Israel
• History of the Middle East
• Central
• National

Informations

• Publié par: State University of New York Press
• Date de parution: 01 février 2012
• Nombre de lectures: 0
• EAN13: 9780791489604
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Policy Making at the Margins of Government

SUNY series in Israeli Studies

Russell Stone, editor

Policy Making at the Margins of Government

The Case of the Israeli Health System



Yair Zalmanovitch

s t a t e u n i v e r s i t y o f n e w y o r k p r e s s

Published by State University of New York Press, Albany

© 2002 State University of New York

All rights reserved

Printed in the United States of America

No part of this book may be used or reproduced in any manner whatsoever without written permission. No part of this book may be stored in a retrieval system or transmitted in any form or by any means including electronic, elec- trostatic, magnetic tape, mechanical, photocopying, recording, or otherwise without the prior permission in writing of the publisher.

For information, address State University of New York Press, 90 State Street, Suite 700, Albany, NY 12207

Production by Judith Block Marketing by Anne Valentine

Library of Congress Cataloging-in-Publication Data

Zalmanovitch, Yair. Policy making at the margins of government : the case of the Israeli health system / by Yair Zalmanovitch. p. cm. Includes bibliographical references and index. isbn0 – 7914 – 5185 – 2 (hc : alk. paper)—isbn0 – 7914 – 5186 – 0 (pbk. : alk. paper) 1. Medical policy—Israel. 2. Medical care—Israel. 1. Title. ra395.175z35 2001 362.1'095694—dc21 2001032206

10 9 8 7 6 5 4 3 2 1

I dedicate this book to my wife, Ofra, my son, Oded, and my daughter, Adi, who bore with me through the long years of its writing; to my parents, Avraham and Pnina Zalmanovitch, who brought me up to strive for excellence; to my motherinlaw Gilada Dori, and my late fatherinlaw, Tuvia Dori, who, when I was a young man courting his daughter, had more faith in me than I had in myself.

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Tables

Preface

Contents

Policy Making from the Margin

Part I The Informal Preventive Veto

Kupat Holim in Prestate Days: 1911 – 1947 The Formative Stage: 1947 –1949

Health as a Political Resource: The First Two Decades of Statehood

The Informal Preventive Veto

Part II The Formal Preventive Veto

Accommodation Under Labor: Vision of Supervised Autonomy Expropriation of the Allocation Process

Regulating Through Parity in Joint Regulatory Bodies and Through Informal Agreements

Restructuring the Health System

The Formal Preventive Veto

Part III The Obstructive Veto

Exclusion Under the Likud: 1977 –1984 Government Allocation as a Means of Control Regulation as a Means of Control

vii

ix

xi

1

21 30

37 57

63 68

79 89 97

103 114 143

viii

14.

15.

16. 17.

Contents

Restructuring: National Health Insurance to Establish Government Authority

The Obstructive Veto

Part IV The Erosion of the Veto

Erosion of the Veto Stateness in Health

Appendix: Israeli Currency and Approximate Dollar Exchange Rates

Notes

Bibliography Archival Sources List of Interviewees Primary Sources Secondary Sources

Index

162 179

189 207

221

223

235 235 236 241

251

Table 7.1

Table 7.2

Table 7.3

Table 7.4 Table 7.5

Table 7.6

Table 7.7

Table 12.1 Table 12.2 Table 12.3 Table 12.4

Tables

Allocation Formula for Government Support (Percentage to Each Sick Fund)

Percentage of Government Subsidies in the Sick Funds’ Total Revenues: 1970 –1977

Costs and Prices of Beds in Government Hospitals: 1966 –1977 Central Tax Bureau Expenditures and Fees: 1970 –1977 Percentage of Membership Dues in the Sick Funds’ Incomes: 1970 –1977

Distribution of Employer Participation Tax (Based on the 1974 Census) Income from Employer Participation Tax: 1970 –1977 (Percentage of Revenues Budget) First Budget Proposal

Second Budget Proposal

Third Budget Proposal

Single Tax Brackets and National Insurance Institute Ceiling

Table 12.5 Single Tax Rates: Percentage per Tax Bracket Table 12.6 Central Tax Bureau Expenditures and Collection Fees, 1978 –1985 Table 12.7 Reapportionment of the Single Tax, 1978 – 1984 Table 12.8 Independent Income: Percentage of Expenditures, 1978 –1984 Table 12.9 Government Support and Kupat Holim’s Deficit as a Percentage of Kupat Holim’s Expenditures: 1977 –1986

ix

71

72

73 75

75

77

77 120 121 122

127 128

128 129

129

130