Impact of copayment requirements on therapy utilization for children with developmental disabilities in Israeli Jewish and Arab Bedouin populations

Under Israeli law, national health insurance covers basic health care for all of the nation’s residents, but health services users
have to copay for medications and therapy. This study examined whether the requirement to copay for therapy services among
certain subpopulations influences their compliance with meeting rehabilitation therapy appointments for their children with
intellectual and other disabilities. The study population included 6,249 Israeli Jewish children and 2,255 Arab Bedouin children from
southern Israel, who were scheduled for appointments at the Zussman Child Development Center (ZCDC) in Beer-Sheva during
the period from January 1995 to December 1999. Data were examined to determine the relationship between “rate of noncompliance”
and the patients’ ethnicity, the rehabilitation service offered, and the periods 1995–97 (prior to copayment requirement) vs. 1998–
99 (after the requirement of copayment). A 37% increase in risk for noncompliance with therapy appointments was found for the
Arab Bedouins, in comparison with the rate of noncompliance with therapy among Israeli Jews. The results indicate that the
legislation requiring copayment appears to have had a negative impact on the use of rehabilitation services for children with
disabilities, as cultural and economic condition factors were not taken into consideration with the copayment requirement.