## Facts

- Israel’s National Health Insurance Law establishes a statutory “health basket” of covered services and technologies, updated through recommendations of the Committee for Expansion of the Health Basket within a limited budget.
- The health basket covered cochlear implant surgery on different terms by age: minor children received the procedure without a co‑payment, while adults were required to pay a large co‑payment reported as 70%.
- Victoria Yisraeli was an adult with low income; she was a single mother and worked as a teacher.
- Yisraeli was progressively losing her hearing, and cochlear implant surgery was medically indicated to preserve hearing and allow her to continue working.
- Because she was an adult, Yisraeli was subject to the 70% co‑payment, which she could not afford, effectively preventing her access to the procedure.
- Yisraeli petitioned the Supreme Court of Israel sitting as the High Court of Justice (HCJ) against the Committee for Expansion of the Health Basket and related public authorities, seeking (1) correction of the children/adults funding gap and (2) full coverage for her surgery through her health fund.

## Issues

1. Are health-basket coverage terms and co‑payment rules subject to judicial review in the HCJ under public-law standards such as equality and reasonableness, despite budget limits?
2. Is a rule that fully funds cochlear implants for children while imposing a 70% co‑payment on adults lawful, particularly where it blocks access for a low‑income adult with severe hearing loss?
3. What relief may the HCJ grant—individual relief to the petitioner, a direction to reconsider the policy, or both—without replacing the committee’s allocation role?

## Decision

- The HCJ held that decisions about inclusion, eligibility, and co‑payments in the health basket are reviewable under Israeli public law; they are not immune merely because they involve allocation of public funds.
- The Court found the sharp age‑based funding distinction for cochlear implants raised serious equality and reasonableness concerns, especially where it operated as a practical denial of treatment for an adult with severe disability and limited means.
- Rather than setting a new national benefits package itself, the Court ordered the responsible authorities to reexamine and justify the adult co‑payment policy and to reassess Yisraeli’s case in a way that gave real weight to the impact of the co‑payment on access.
- The petition was granted in part: the Court directed reconsideration aimed at a lawful and reasoned resolution, including steps to ensure the petitioner could receive the surgery without the prohibitive barrier created by the 70% co‑payment.

## Legal Principles

- Health-basket priority setting involves policy and budget choices, but it remains subject to administrative-law review for equality, rationality, and reasoned decision-making.
- A categorical eligibility line (such as age) must be supported by relevant reasons connected to the goals of the health-insurance scheme; cost alone does not end the inquiry when the rule denies meaningful access to an essential intervention.
- When a benefit rule predictably prevents access for those unable to pay, the state must confront the real-world effect of the rule and provide a reasoned justification or a lawful adjustment.
- Courts may require reassessment and adequate reasons from health authorities while still leaving primary allocation choices to the statutory bodies charged with managing the health basket.

## Conclusion

In HCJ 2974/06, Yisraeli challenged a health-basket policy that provided cochlear implants free to children but imposed a 70% co‑payment on adults, which barred her access as a low‑income teacher going deaf. The HCJ treated the policy as reviewable and found the age-based disparity and its access-blocking effect raised equality and reasonableness problems, granting partial relief by directing the authorities to reconsider and resolve the policy and the petitioner’s request through a properly reasoned process that could remove the prohibitive barrier to treatment.


Yisraeli v. Committee for Expansion of the Health Basket, HCJ 2974/06 (2006)