m in Israel,
I’m not familiar with the details of the Israeli system, but I spent last week with people in England who are intimately involved with the UK’s system. They have a cost-effectiveness criteria by which any procedure or drug that is below the threshold gets covered, and any that is over does not. My colleagues there were active in a controversy over a new treatment for which the drug company decided to charge an absolutely extortionistic price. The UK government (correctly) balked. I agreed with this decision because the new treatment had minimal efficacy over what had been available.
And that is true for many of the treatments that both private and government insurers don’t want to cover. There was a recent controversy here in America because the FDA refused to allow a particular cancer treatment for a particular cancer type because it had been proven not to extend life and not to improve quality of life. As a result, neither government or private insurers will pay for it. Yet people complained that the FDA was killing people! Frankly, a drug that has been proven to neither extend life nor to improve quality of life is about the first thing I would drop from coverage. Nevertheless people can still buy the drug and doctors can prescribe it.