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.
Bentur
Netta
N
JDC-Brookdale Institute, Health Policy, P.O. Box 3886, Jerusalem 91037, Israel. bentur@jdc.org.il
Gross
Revital
R
Brammli-Greenberg
Shuli
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000191:economics / Q000628:therapy*; D003153:Community Health Services / Q000592:standards* / Q000706:statistics & numerical data; D017047:Cost Sharing; D017281:Cost of Illness; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D007557:Israel; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care; D014850:Waiting Lists