Satisfaction with and access to community care of the chronically ill in Israel's health system

One goal of Israel's National Health Insurance Law was to improve services for vulnerable populations. However, it was feared that this goal would not be reached for the chronically ill, due to the regulations governing health plan reimbursement and to amendments to the law that authorize additional co-payments for services. Objective: To examine the satisfaction with and organizational and financial access to services of chronically ill patients, and compare them to those of healthy consumers. Methods: In autumn 2001, telephone interviews were conducted with a random sample of 1790 permanent residents of Israel over age 22, 512 (28%) of whom reported having a chronic illness. Results: No significant differences were found between chronically ill and healthy respondents in satisfaction with services, and few differences were found in organizational access to services. However, differences were found in financial access to services. Specifically, chronic illness had an independent positive effect on the burden of co-payments for health services and the likelihood of forfeiting care or medication due to cost. Conclusions: Increased co-payments for services may restrict access to care. To lighten the burden on vulnerable populations, it is necessary to consider discounts and lower ceilings on co-payments.