Kupat Holim
Health Maintenance Organization (HMO)
Kupat Holim, is a place where Israelis receive their day-to-day medical services.
It's a concept that is an integral part of the lives of all citizens of Israel, in every sector and every segment of the population, without distinction of race, gender, or religion. There isn't an Israeli man or woman who doesn't visit a Kupat Holim—once every few months or once every few years, depending on their health status and how much time and thought they dedicate to it.
The child is coughing? You go to the pediatrician at the Kupat Holim.
Need an injection? A hand bandage? You go to the Kupat Holim nurse.
Blood tests? An X-ray? There’s a Kupat Holim lab.
A broken hand? An orthopedic doctor at the Kupat Holim will put it in a cast, alone or with the nurse.
Need a sick note to be absent from work? You get a note from the family doctor at the Kupat Holim.
And if the situation is serious and you need to be hospitalized—you go through the Kupat Holim to get the organization's commitment to cover the cost of the hospitalization.
It’s very simple and very easy.
So much so that it seems self-evident—you receive the required service and don't even give a second thought to the fact that these are some of the most advanced healthcare services there can be, services that are unmatched in most countries around the world.
True, it's not free. We Israelis pay a fixed monthly amount for "health insurance" as part of the "National Insurance," and the cumulative investment doesn't always cover the service we received.
And yes, sometimes there’s bureaucracy in getting the service—booking an appointment with a doctor, a nurse, for an X-ray or an MRI, waiting for long minutes until you're called for treatment, and dealing with paperwork and phone calls.
But in the end, it's about what's most precious to us: our health. Sometimes it's a matter of quality of life; sometimes it's a matter of life and death. And in general, the very knowledge that there is a Kupat Holim, and if you feel unusually unwell you can go and get quick treatment for free, contributes to a person's peace of mind.
The term Kupat Holim is synonymous with accessible healthcare services, but behind the two words stand four powerful organizations that each provide all healthcare services to Israeli citizens who pay them a fixed monthly amount.
The average citizen doesn't really know the general and organizational framework or how it works. They know the concept—from the day they are born until the day they die, they are registered as a member of one of the organizations and go to one of its branches to receive service when they feel the need.
The branch itself can be an entire floor in a fancy office building with many rooms and service desks, or it can be a small building with dedicated rooms—it depends on the area where the branch is located and how many people need its services. Even in a small kibbutz or village with a few hundred families, there is a dedicated building with one or two rooms, and outside, a sign reads: "Clinic" (Mirpa'a), which is essentially a branch of one of the Kupat Holim organizations.
Israel's healthcare services are considered among the most advanced in the world and preserve Israel's foundations as a welfare state.
We reached this achievement thanks to the idea of a Kupat Holim—a socialist idea that has existed here for over 100 years and is based on medical insurance for those who pay for it. The idea has been refined over the years and received its final seal of approval with the enactment of the "National Health Insurance Law," which leaves no Israeli citizen without access to healthcare of any kind.
This is the last symbol left of Israeli socialism; it is stable and has no intention of relinquishing its place in the Israeli experience because, more than anything else, it symbolizes Israel's status as a "welfare state," at least in the health of its citizens.
Concepts related to Kupat Holim and common in Israel:
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Tofes 17 (Form 17) – The most famous bureaucratic form in Israel. Today it is simply called a "commitment," which is exactly what it is: a commitment from the Kupat Holim to pay for your hospitalization, or for a unique professional treatment not available at the Kupat Holim branches, such as an MRI, heart tests, and more. Anyone who arrives for treatment without a Tofes 17 will not be admitted or will have to pay a lot of money out of their own pocket.
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Bituach Mashlim (Supplementary Insurance) – An arrangement between the Kupat Holim and its members. This plan allows for additional services beyond the standard ones, for an additional monthly fee, of course.
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Sal Briut (Health Basket) – Expensive medicine funded by the state.
The Kupot Holim organizations are obligated to provide a basket of basic services. They cannot fund especially expensive drugs and services. This is where the state comes in and determines a more extensive basket of services that it pays for to the Kupot Holim, so they can provide it to those who need it. -
SHARAP (Private Medical Service) – A track that bypasses the Kupot Holim. It is intended for people in the upper decile who forgo a Tofes 17 and are willing to pay for treatment and hospitalization at a business-class level.
Historical bits
The Kupat Holim is the last symbol left of Israeli socialism, which existed here for almost the entire 20th century.
The first Kupat Holim organizations (Kupot Holim) in the Land of Israel were founded at the beginning of the 20th century. They were established by the heads of workers' organizations, who copied the model from countries in Europe.
Each organization had a network of doctors and nurses who provided healthcare services based on the idea of insurance—each member paid a monthly membership due, and together they funded the cost of the entire medical network.
It was called Arvut Hadadit (mutual responsibility)—a shared fund for all workers who were responsible for one another. One person is sicker, one is less so... the fund pays for whatever is needed. And for there to be enough money in the fund, all workers were required to pay the monthly membership dues. (They called it "Kupat Holim" – kupa = fund, holim = ills).
Over the years, the workers' organizations merged into one large organization: the General Organization of Workers in the Land of Israel, or in short: the Histadrut.
The medical networks also merged and became "Kupat Holim Clalit" (Hebrew for "General Sick Fund"), under the control of the Histadrut. The idea of a Kupat Holim for everyone was integrated with the socialist principles of cooperation that developed in the Hebrew Yishuv. It became one of its symbols, proved its success over the years, and its influence is evident to this day.
It is the basis on which the healthcare system of the State of Israel was established.
When the state was founded in 1948, the Histadrut was a dominant and all-powerful body.
The immense workers' organization gained influence in all areas of the economy, held many assets, influenced government policy, and was a partner in all the important decisions that determined the fate of the Israeli economy.
Anyone who wanted to be a member of the Histadrut was also required to be a member of its Kupat Holim. And the opposite was also true: anyone who wanted to receive Kupat Holim healthcare services had to be a member of the Histadrut and pay its membership dues. Thus, the Kupat Holim effectively became the healthcare provider for most of the state's citizens.
There were a few other small Kupot Holim (funds), belonging to other workers' organizations that were established on a party or economic basis, but none of them could compete with the largest of them all.
The Kupat Holim of the Histadrut spread branches and reached every corner of the country.
Its doctors and nurses served the rich and the poor, the urban and the rural, the new immigrants and the veterans, the residents of public housing projects and the inhabitants of immigrant camps.
A Kupat Holim clinic in a ma'abara (immigrant transit camp) in the 1950s
In 1977, the government in Israel changed, and all the cards on the healthcare table were shuffled.
The ruling socialist hegemony was moved aside, and the Histadrut lost its power. The small Kupot Holim gained new members and a lot of power, but "Clalit," with its millions of members, remained active and dominant.
Over the years, the Histadrut membership dues were separated from the monthly payment to the Kupat Holim, until the two were completely disconnected, and "Clalit," with its strong base, relying on the country's older veterans, continues to lead the table, far ahead of the others.
The competition between the organizations led to excellence in Israel's healthcare service system—each organization offered quality services, from shortening waiting times to immediate connections between doctor and patient.
In 1995, the "National Health Insurance Law" was enacted, which was based on the existing situation in those years and moved the healthcare system to a more advanced stage.
Under the law, every citizen in Israel is entitled to basic medical service and is required to pay a monthly insurance premium as part of the "National Insurance." Rules were also set for the conduct of the Kupot Holim and for the state's support for especially expensive medical services as part of the "health basket."
As the state celebrates its 75th anniversary, there are four main Kupot Holim (funds) that each provide all healthcare services:
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Clalit Health Services (formerly called "Kupat Holim Clalit") – The largest. It serves about half of the residents of the State of Israel. It is also the only organization that owns 14 hospitals and rehabilitation institutions throughout the country.
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Maccabi Health Services – The second largest. It serves about a quarter of Israel's residents.
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Meuhedet Health Fund – The third largest.
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Leumit Health Services – The smallest organization.
The idea of medical insurance remains as it was a hundred years ago—you pay into a shared fund and receive service.
The service has advanced, and all the organizations use the best medical technologies of the 21st century.
The connection between the organization and its members is tightening and becoming more sophisticated—the wait for an appointment still exists, but the notebooks and forms have disappeared, and in their place, communication is conducted through magnetic cards, internet applications, telephone response, and Zoom or video calls.
This is part of "The Israeli Story 1948-2025" project.
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