 The recommendation was promoted by Health Minister Haim Ramon and the National Health Insurance Law was passed by the Knesset in 1994 and came into effect on January 1, 1995.After enactment of the 1995 law, membership in one of the four Kupot Holim became mandatory while acceptance into any of them was legally guaranteed, Clalit's linkage with the Histadrut was severed, and Israeli residents became entitled to the same minimum basic basket of services regardless of which fund they belonged to, and were permitted to switch between funds once a year.In the late 2000s, a future shortage of doctors and nurses became a concern, as the rate of doctors graduating from Israel's medical schools annually had dropped to 300, 200 less than needed, and many Soviet immigrant doctors and nurses began to retire.