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  • The Workers' Health Fund in Eretz Israel: Kupat Holim, 1911-1937
  • Sandy Sufian
Shifra Shvarts . The Workers' Health Fund in Eretz Israel: Kupat Holim, 1911-1937. Rochester Studies in Medical History, no. 2. Rochester, N.Y.: University of Rochester Press, 2002. xvi + 340 pp. Ill. $85.00, £60.00 (1-58046-122-0).

This book is the English translation of the original Hebrew, Kupat Holim Clalit: Itzuva vehitpatchuta kegorem hamirkazi beshirutei habriut be Eretz Israel, 1911-1937 (General Health Fund: Its shape and development as a central factor in the [End Page 735] health services of Eretz Israel, 1911-1937), published in 1997. The book, consisting of ten chapters, focuses on the formative years of Kupat Holim, a health-care institution that eventually became the major medical provider-insurer of the state of Israel. Presenting its development as a sequence of starts, stops, and frequent delays, Shifra Shvarts charts the persistent issues of membership and recruitment, balancing ideological principles with fiscal responsibility, and negotiating institutional relationships. She shows that the organization proved flexible and responsive to the constantly changing social and economic conditions of the Jewish community in Palestine (Yishuv).

The work fits squarely into the scholarly literature on the Yishuv that investigates the interaction of Zionist ideas and the process of state-building.1 It can also be situated within a growing but still understudied literature on health issues in modern Jewish history, and it certainly contributes to that scholarship on health-care organizations and management. Head of Health Systems Management at Ben Gurion University, Shvarts is among no more than a dozen scholars who work on health issues during the late Ottoman and British Mandate periods of Palestine. She is considered a senior scholar in this cohort, an expert on the dynamics of public health and medical care in the Yishuv as well as their ramifi-cations in the state period of Israel. She explores the development of Kupat Holim not only as a historical case study but as one of contemporary import, used to understand the nature and politics of health-care delivery in Israel, its constraints and possibilities, at the turn of the twenty-first century.

One of the many public needs of Zionist laborers in the process of settlement was for medical services. To respond to this need despite political and ideological tensions, various nonpartisan health funds for Jewish rural workers were established in the early twentieth century, including the Health Fund of the Federation of Agricultural Workers in Judea, and later the health funds of the Galilee and Samaria. After World War I the funds were reorganized along Labor Party lines, but they eventually merged to become Kupat Holim in 1920. The organization's mission, as Shvarts explains, was to serve as the "emissary of the organized working public in the Federation of Labor in matters of health in Israel" (p. 1).

The health funds adapted both the Jewish diasporic tradition of linat tzedek (community responsibility for tending to the sick)—reworking it to fit the Zionist notion of self-sufficiency—and the European idea of compulsory insurance, to local conditions. The particular needs and profile of the pioneers during this time, Shvarts points out, distinguish the historical emergence of Kupat Holim from other European cases. As both an insurer and a provider of care, it extended its medical services to laborers and their family members. Bringing services to the sick person and stimulating mutual aid formed the ideological bases of the health fund, principles that reflected the social and political views of [End Page 736] the second Zionist wave of immigration. Their translation into practice was often difficult to fully achieve or uphold; this circumstance constituted one of the organization's many dilemmas.

Other dilemmas included continual deficits and governance woes. Membership dues were difficult to collect, and expansion efforts, including employer contributions and the parallel tax, repeatedly failed. The quintessential dilemma of balancing or minimizing expenditures without impairing the quality of service was repeatedly faced. Distinguishing between members and nonmembers for medical service also posed a consistent problem. Attempts to make members of the workers' federation (Histadrut) mandatory members of the health fund were not successful until 1937, which deeply...

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