Private and public psychotherapy in Israel 5 years after the ‘mental health insurance reform'

BACKGROUND: In 2015, Israel implemented a mental health insurance reform aiming to increase availability of mental health services in the public sector. However, little is known about the private sector. AIM: To characterize the differences between private and public psychotherapy sectors following the reform. METHODS: Data was collected in December 2020 via an internet survey among a representative sample of 4,688 Israeli adults and included questions about patients’ characteristics, treatment seeking, choice of provider, and patient experience. RESULTS: 400 participants (8%) reported receiving psychotherapy treatment in the community in 2020. Of those, 49% were treated privately. Logistic regression showed that ultra-Orthodox Jews (95% CI 1.7-15; OR = 5), individuals with higher education (1.7-4.4; 2.7) and women (1.3-3.4; 2.1) were more likely to be treated privately, while Arabs (0.17-0.95; 0.4), individuals over 60 (0.2-0.6; 0.3), and those receiving psychiatric care (0.2-0.4; 0.3) were less likely. Private treatment was characterized by shorter waiting times (50% waited < 2 weeks vs. 25% in the public sector; p < 0.05), longer treatments (44% treated > 1 year vs. 28%; p < 0.05), and higher patient experience score (9.1 vs. 8.3 out of 10; p < 0.05). The leading causes for choosing private care were the ability to choose the therapist and shorter waiting times. 20% of those treated privately had sought public treatment before opting for private care. CONCLUSIONS: Following the insurance reform, private psychotherapy is still used by half of the patient population. The study highlights the existence of a population interested in receiving public care but not receiving it, and of differences in quality of care between the two sectors. Other countries considering publicly financed mental health care should consider scenarios where private care remains advantageous, and the public service is not responsive enough. KEY MESSAGES: • Despite the right to publicly funded care, half of the patients in Israel use private care. Patients who sought public care but turned to private providers suggest unmet needs in the public sector. • Differences in treatment characteristics and in patient experience between the private and public sectors suggest differences in quality.