Policy Making at the Margins of Government: The Case of the Israeli Health System

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This book explores this question through the prism of Israel s unique not-for-profit health system, drawing heavily on unpublished archival sources and interviews with key players.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.