Policy Making at the Margins of Government

The Case of the Israeli Health System

By Yair Zalmanovitch

Subjects: Israel Studies
Series: SUNY series in Israeli Studies
Paperback : 9780791451861, 276 pages, January 2002
Hardcover : 9780791451854, 276 pages, January 2002

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Table of contents



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




Archival Sources
List of Interviews
Primary Sources
Secondary Sources



Traces the almost century-long struggle between Israel's largest healthcare provider, Kupat Holim, and successive Israeli governments.


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This book explores this question through the prism of Israel's unique not-for-profit health system, drawing heavily on unpublished archival sources and interviews with key players.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

Yair Zalmanovitch is Senior Lecturer of Political Science at the University of Haifa.


"A detailed and comprehensive history of the development, institutionalization, and reform of the Israeli healthcare system. " — Leslie C. Eliason, Monterey Institute of International Studies