Welfare Regime, Ethno-Class and Inequalities in Health: The Israeli Case

The Israeli welfare system is considered as a case of the Mediterranean welfare regime, the latter characterized by relatively late industrialization, labor market rigidity and segmentation, significant shadow economies, lower social spending than in social-democratic and corporatist countries, limited ability on the part of the welfare state to overcome socio-economic gaps and the centrality of family and religion for welfare. Israel's health-care system, however, historically matched the corporatist regime; having been central in the nation-building process and characterized by relative decommodification and status differences. During the 1990s, a paradoxical process took place, by which within a general tendency of recommodification of welfare, the health-care care system underwent a double process of transition from a Bismarckian to a universal model, together with the emergence of a flourishing private health-care sector. This complex interaction between the characteristics of the welfare system as a whole and the health-care system, is made more complex because of the role of the welfare system in reproducing Israel's ethno-class stratification structure.

The combination of the characteristics of Israel's economy, citizenship and welfare regime resulted in a stratified three-tiered ethno class structure, where Israeli Arabs occupy the lowest echelon, Israeli Jews from European or American origin the highest one, and Israeli Jews from Asian/African origin the middle one. The present paper shows how this ethno-class stratification is expressed in health inequalities (with significant differences in health indicators such as infant mortality and life expectancy), and the ways in which the organization of welfare, and especially of the health-care system, contribute to those inequalities.