By A.M. Goldstein

HAIFA —The severe economic crisis that embroiled large numbers of kibbutzim in recent years is preventing them from taking full responsibility for their members' health care as they once did.

A study by the University of Haifa's Institute for the Study of the Kibbutz and the Cooperative Idea reveals that kibbutz spending for health has been decreasing from year to year.  The collectives are also transferring overall responsibility for health care to the families and to the individuals living on the kibbutz.

The researchers point to a drastic reduction in personnel involved in the health-care area on the kibbutzim.  In 2000, for example, 90% of the kibbutzim had a role in managing the health care system.  By 2004, this had dropped to two thirds of the kibbutzim.

There was a doctor who lived on kibbutz in a quarter of the kibbutzim in 2000; by 2004, only 16% of the kibbutzim had a resident physician.

The University of Haifa Kibbutz Institute researchers, who surveyed 78 kibbutzim from 2000-2004, attribute this shedding of responsibility to the desire of kibbutzim to adjust to the health service system provided in the State health insurance law.  The kibbutzim themselves have also been undergoing structural changes, introducing measures of privatization to save on costs.

In addition to the decrease in resident physicians, the proportion of nurses supplying health services on kibbutzim has also dropped.  Along with this, the researchers point to fewer emergency services provided by the kibbutzim.

"There is a new and striking phenomenon," the researchers state, "and that is the solution to emergency services [being supplied] by people from outside the kibbutz, especially by companies that supply services to subscribers.  There is such a service on 50% of the kibbutzim."  Symptomatic of the situation, perhaps, is the growing absence of their own ambulances on the kibbutz.

The number of kibbutzim that cover all or most of their members' medical expenses has also dropped.  In 2004, only 31% of the collectives provided coverage for supplementary health insurance, while 69% of the kibbutzim left it up to their members to finance this expense.  Israel's health insurance law provides for a basic basket of services.  The Israeli equivalent of the HMOs, the Sick Funds, offer supplementary insurance as do private insurers.  In 2000, 87% of the kibbutzim covered the cost of supplementary medical insurance for their members. 

Still another cutback by the kibbutzim was for special health needs for children.  Fully 91% of the kibbutzim paid for this in 2000, whereas 58% still did so in 2004.

Non-prescription drugs were covered by 88% of the kibbutzim in 2000, but 54% in 2004; genetic testing was paid for by 81% of the kibbutzim in 2000, but only by 38% of them in 2004; inoculations not covered by the basic basket were funded by 77% of the kibbutzim in 2000, and 30% in 2004.  Alternative medicine is also seen as a luxury, as 67% of the kibbutzim covered alternative drugs in 2000, but just 12% continued to do so in 2004.

Summing up the situation, Dr. Gila Adar, a kibbutz member herself who has headed the University of Haifa's Kibbutz Institute, said that "the general tendency on most kibbutzim is to be linked to the basket of health services provided by the State's health insurance law and to limit the public [that is, the kibbutz's] budget in accordance with this basket."  The additional expenses for health care, she continued, "are imposed on the members' own budget."

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Dealing with poverty

It obviously takes money to overcome poverty.  But it takes knowledge to deal with the situation as best as one can while trying to emerge from it.  And this is where the university comes in. 

Scores of families in northern Israel are now learning how to deal with the many problems stemming from the poverty in which they are now living, thanks to a program developed at the University of Haifa .

"The uniqueness of the program," says Dr. Irit Keynan, adviser to the University's president on social responsibility, "lies in its involving students in working personally with distressed families, providing guidance and helping them with welfare services.  The program is a model of cooperation between the civil society and State institutions by assisting these families."

The program, now aiding some 80 families to plan their families' limited budget, is operated by the University in conjunction with the National Insurance Institute, which is Israel 's Social Security administration, and the Ministry of Welfare.

Basically the families are taught how to receive help in the best way from existing community services and how to solve problems created for their children in the school system.  Such tools, Keynan believes, are vital in order to make it easier for these families to contend with the various difficulties that poverty creates in all areas of everyday life. 

She also feels that the students bring a refreshing image to these families, creating trust and constituting a model of emulation for the younger generation in the family.  Importantly, too, the students do not represent the establishment.

Each participating University of Haifa student works with only one family, which is another advantage she cited.  Welfare workers ordinarily deal with a large case load.

The consultant said that the combination of academic and community-social activity marking the program achieved high added value through bringing these two areas closer together.

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Cooperating Dolphins

If you want to know why people cooperate with one another, go ask the dolphins.

That in a sense is what University of Haifa psycho-biologist Dr. Richard Schuster and graduate student Amir Perlberg did.  After studying how dolphins behave in pairs, they questioned the assumption about selfishness being the exclusive motivation for any act. 

The researchers observed dolphins in the dolphin reef in Eilat.  They were amazed at the extent of cooperation between pairs of these underwater mammals, which tend naturally to do things together—from hunting to courting, to protecting themselves from preying fish.

Even when the dolphins swam by to be petted by divers, they did so in pairs.  Schuster pointed out that this required a great deal of effort and coordination so that each could be petted at almost the same time and for the same amount of strokes.  It would have been easier for them to swim by one at a time.

"The reason for this cooperation," the University of Haifa psychologist concluded, "was not only the material 'profit.'"  It was also—and sometimes only—the pleasure from the very fact of performing this cooperative and coordinated act.

"The dolphins cooperate because they enjoy doing things together, even if the price is more effort and less petting received."

His research on dolphins has implications for cooperation between human beings, he believes. "Both dolphins and human beings," Schuster explains, "are intelligent species and very sensitive to social relations."  Human beings, he continues, derive much pleasure from doing things together, just as animals do. 

"People enjoy hunting together, dancing together, playing together without receiving any reward for such acts, except for the momentary pleasure (of togetherness)," Schuster states.

"Our research shows that cooperative behavior itself can be rewarded only by undertaking a joint act even if the immediate benefit is small or even does not exist," Schuster comments.  "In such cases, cooperation pays off in the distant future as a result of strengthening social relations between those who have learned to work together in order to achieve cooperative results."

A.M. Goldstein is the English language editor for the University of Haifa's Department of External Affairs.