Chapter 4 (Settlement between hospitals and health maintenance organizations for the years 2026 to 2030) (excluding section 16) from the Economic Efficiency Bill (Legislative Amendments to Achieve Budget Goals for the 2026 Budget Year) 5786-2026 [Split pursuant to section 84(b) of the Rules of Procedure]

The law establishes new rules for the financial settlement between public hospitals and health maintenance organizations (HMOs) for the years 2026 to 2030. The goal is to streamline the healthcare system, ensure fair payment for health services, and prevent uncontrolled expenditure growth. The settlement will be based on service prices as determined by the Law on Supervision of Prices of Commodities and Services, but with new adjustments and ceilings. Consumption ceilings are set for each type of service, calculated based on 2025 data, with real annual additions and rate updates. Consumption floors are also established, ensuring minimum payment for certain services. Public hospitals whose activity was exceptionally affected in 2023 (e.g., due to war or population evacuation) will receive special consideration in the calculation of ceilings and floors. The law also addresses cases where a public hospital provides private or differential medical services and sets reduced payments for services consumed beyond the consumption ceilings. Additionally, new rules are set for payment for day hospitalization services in internal medicine departments, as well as an additional payment for hospitals that meet quality-of-service improvement benchmarks. The law allows public hospitals and HMOs to enter into private agreements, under certain conditions, which will allow for greater flexibility in settlement while maintaining the principles of the statutory arrangement. The law does not apply to certain health services, such as services for victims of hostilities, foreign workers, soldiers, or health services purchased under special arrangements. Regulations for the implementation of the law will be enacted by the relevant ministers. The law commences on January 1, 2026, with some provisions applying retroactively from January 1, 2026.

Source: חומר רקע