## Facts

- Maccabi Health Service and three other health funds operating under Israel’s National Health Insurance Law petitioned the Supreme Court of Israel sitting as the High Court of Justice (HCJ).
- The National Health Insurance Law establishes universal health coverage through health funds and defines a state-funded “basket” of health services and medicines that insured residents are entitled to receive.
- The statute sets funding arrangements intended to keep the public financing of the health basket current over time, including an indexation/update mechanism (often described as updating the “health index”).
- The National Health Council, a statutory advisory body, unanimously recommended increasing the national health budget by updating the index to reflect factors such as population growth, rising medical technology costs, and additional services added to the basket.
- The Minister of Finance refused to grant the additional funding and did not substantively address the Health Council’s recommendation, stating in general terms that the request was denied for budgetary reasons.
- The health funds argued that freezing or declining to update the index would impair their ability to provide the basket of services required by law to their members.
- The petition sought public-law relief, including a declaration that the minister’s refusal was invalid because it did not properly apply the statutory scheme and was reached without a reasoned consideration of the relevant factors.

## Issues

1. Whether the Minister of Finance may refuse to update the health-budget index and deny additional funding for the statutory health basket on the basis of general budgetary considerations, without addressing the statutory mechanism and the Health Council’s recommendation.
2. Whether the refusal was unlawful under administrative-law duties to consider relevant considerations and provide a reasoned decision within the powers granted by the National Health Insurance Law.
3. What remedies, if any, the HCJ should grant when a dispute concerns implementation of a statutory funding arrangement that affects nationwide resource allocation.

## Decision

- The HCJ treated the dispute as justiciable in principle, because it arose from statutory duties created by the National Health Insurance Law rather than from a purely political disagreement.
- The Court described the National Health Insurance Law as a comprehensive legal arrangement (a codifying statute) that reshaped the rights of insured persons and the relationships among insured persons, health funds, and the state; government actors must act within that statutory arrangement.
- The Court accepted that the Minister of Finance is not automatically bound to adopt the Health Council’s recommendation, but the recommendation and its stated grounds are considerations that must be taken seriously within the statutory scheme.
- At the same time, the Court emphasized the breadth of governmental discretion in nationwide budget-setting and the limits of judicial intervention in setting the level of public expenditure.
- The Court declined to order a specific increase in the health budget or to compel adoption of the Council’s proposed update, and the petition did not result in a judicially imposed funding level.

## Legal Principles

- Statutory social-welfare schemes can create enforceable legal duties; budget context does not by itself remove a dispute from judicial review.
- The National Health Insurance Law operates as a binding legal structure governing: (1) health fund–member relations, (2) health fund–state relations, and (3) insured person–state relations; executive decisions on funding must be made within that structure.
- Even where the executive has discretion, administrative law requires a decision-making process that takes relevant considerations into account and responds to the statutory purpose, not only to generalized fiscal constraints.
- Recommendations of statutory advisory bodies are not automatically binding, but they cannot be dismissed without genuine consideration when the statute assigns them a defined role in the decision process.
- Courts will generally refrain from dictating specific nationwide allocations and will not substitute their own budget choices for those of the political branches absent clear illegality.

## Conclusion

*Maccabi Health Service v. Minister of Finance* concerned a challenge by Israel’s health funds to the Finance Minister’s refusal to update the statutory funding mechanism for the national health budget after the National Health Council recommended an increase based on population growth, technology costs, and additions to the health basket. The HCJ treated the matter as legally reviewable and framed the National Health Insurance Law as a binding, comprehensive statutory arrangement that constrains executive action, yet it exercised restraint on remedies and did not impose a specific budget increase or compel adoption of the Council’s recommendation.


Maccabi Health Service v. Minister of Finance, HCJ 2344/98, 54(5) PD 729 (2000)