Health care in Israel

Beilinson Hospital in Petah Tikva, Israel

Safra Children's Hospital at Tel HaShomer

Health care in Israel is universal and participation in a medical insurance plan is compulsory. Health care coverage is administered by a small number of organizations, with funding from the government. All Israeli citizens are entitled to the same Uniform Benefits Package, regardless of which organization they are a member of, and treatment under this package is government-funded for all citizens regardless of their financial means. Additional coverage for non-essential treatments can be arranged for a fee, which is generally shared between a citizen and their employer. Generally, health care in Israel is of high-quality and is delivered in an efficient and effective manner.

History

Pharmacy in Petah Tikva, 1930s

Hadassah nursing students, 1948

With the start of the British Mandate for Palestine, measures were taken to improve public health in the area. In Jerusalem, accumulated refuse heaps were removed, public rubbish bins were installed; the entire population was vaccinated against smallpox, and pools and cisterns were covered with mosquito repellent as part of the campaign to eradicate malaria. In 1929, the Zionist Commission and the British authorities sent the Jewish epidemiologist Gideon Mer to Rosh Pina to establish a laboratory for malaria research. Mer's laboratory was instrumental in eradicating the disease. The public health care system in Israel was built on the foundations of the system introduced at this time.

Health insurance is administered by the Health maintenance organizations (Hebrew: קופת חולים, kupat holim, lit. sick fund, derived from the German Krankenkasse), most of which were set up by the labour unions before the founding of the State. These Health Maintenance Organizations are membership-based. Originally, the members paid membership fees to these funds^{[citation needed]}, and received in return a set guarantee of health services.

In 1973 a special law was enacted which forced all employers in Israel to participate in the medical insurance of their workers, by means of a direct payment to the Health Maintenance Fund in which the workers were members. The duty of participation was eventually changed and diminished as part of the arrangements law (חוק הסדרים במשק המדינה) f 1991.

In 1988 the government appointed a Commission of Inquiry to examine the effectiveness and efficiency of the Israeli health care system. The commission handed in the final report in 1990. The main recommendation of this report was to enact a National Health Insurance law in Israel.

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. That number was estimated to eventually rise to 520 with the opening of a fifth medical school, but still below the 900 graduates that will be needed in 2022. This caused concerns of a shortage of medical personnel, which would imperil the quality and speed of medical care in the country. As a result, Israel begin offering incentives to Jewish doctors to immigrate from abroad and practice medicine in Israel. Initially, it only absorbed about 100 doctors from the former Soviet Union annually, but has now also absorbed immigrant doctors from North America and Western Europe. An investigative committee looking into the issue also called for incentives to be offered to Israeli medical students who had not been accepted in Israel and had gone to study medicine abroad to return to Israel, and for a program that involves 150 international students studying medicine in Israel to be shut down. In addition, the Israeli Health Ministry announced the launching of a new nursing assistants' profession, and increased nursing education programs in colleges.

Health insurance law

Health care spending in Israel as a percentage of GDP

See also: Universal health care in Israel

In 1995 the National Health Insurance Law came into effect, which made membership in one of the four existing Health Maintenance Organizations compulsory for all Israeli citizens. The law determined a uniform benefits package (סל בריאות) for all citizens - a list of medical services and treatments which each of the Health Maintenance Organizations is required to fund for its members. Additionally, certain services were brought under the direct administration of the State, usually by means of the Health Ministry. In addition, the law set out a system of public funding for health care services by means of a progressive health tax, administered by Bituah Leumi, Israel's social security organization, which transfers funding to the Health Maintenance Organizations according to a certain formula based on the number of members in each fund, the age distribution of members, and a number of other indices. The Health Maintenance Organizations also receive direct financing from the states money.

Before enactment the Health Insurance Law, the only Health Maintenance Organization to accept members without discrimination based on age or medical situation was the Clalit HMO which was then in the ownership of the Histadrut labour federation. After enactment of the 1995 law, membership in any of the four Health Maintenance Organizations was guaranteed for all citizens, and Israelis were given the right to transfer between Organizations once per year.

The 1995 law also imposed a system of financial and medical oversight of HMOs by the State. In addition to the uniform benefits package provided to all citizens, which provides coverage for basic and essential health care, every HMO fund provides their members with the option to acquire "supplementary insurance" (ביטוח משלים), which includes services and treatments that are not covered by the publicly funded system.

The four nationwide HMOs are: Clalit (the largest with about 54% of the population belonging to it), Maccabi, Kupat Holim Meuhedet and Leumit.

Israel has maintained a system of socialized health care since its establishment in 1948, although the National Health Insurance law was passed only on January 1, 1995. The state is responsible for providing health services to all residents of the country, who can register with one of the four health service funds. To be eligible, a citizen must pay a health insurance tax. Coverage includes medical diagnosis and treatment, preventive medicine, hospitalization (general, maternity, psychiatric and chronic), surgery and transplants, preventive dental care for children, first aid and transportation to a hospital or clinic, medical services at the workplace, treatment for drug abuse and alcoholism, medical equipment and appliances, obstetrics and fertility treatment, medication, treatment of chronic diseases and paramedical services such as physiotherapy and occupational therapy.

Rights of the Insured under the National Health Insurance Law

Ministry of Health building on Jaffa Road, Jerusalem

• Every Israeli citizen is entitled to health care services under the National Health Insurance Law.
• Every resident has a right to register as a member of an HMO of his/her choice, free of any preconditions or limitations stemming from his/her age or the state of his/her health.
• Every resident has a right to receive, via the HMO of which she or he is a member, all of the services included in the medical services basket, subject to medical discretion, and at a reasonable quality level, within a reasonable period of time and at a reasonable distance from his/her home.
• Each member has a right to receive the health services while preserving the member’s dignity, privacy and medical confidentiality.
• Every Israeli resident has the right to transfer from one HMO to another.
• Each member has a right to select the service providers, such as doctors, caregivers, therapists, hospitals and institutes, from within a list of service providers who have entered into an agreement with the HMO to which the member belongs, and within the arrangements in place for the selection of the service providers, and which the HMO publishes from time to time.
• Each member has a right to know which hospitals and institutes, and other service providers, are included in the agreement with the HMO, and what are the selection processes at the HMO.
• Each member has a right to see and to receive a copy of the HMO regulations.
• Each resident has a right to receive from the HMO complete information concerning the payment arrangements in place in the HMO for health services as well as the HMO’s plans offered for additional health services (CIP).
• Each member has a right to complain with the Public Inquiries commissioner at the medical institute that treated the member, to the person in charge of investigating member complaints at the HMO of which s/he is a member, or to the complaints commissioner for the national health insurance law in the Ministry of Health.
• Each member has a right to file suit at the district labor court.

Safety and quality

Israel has one of the most technologically advanced and highest-quality healthcare systems in the world. Hospitals in Israel are equipped with modern facilities and high-quality medical technology. Medical staff are trained from four to six years in one of the country's five university medical schools, or are immigrants who have been trained abroad and accredited in Israel. The country is a world leader in advanced infrastructure of medical and paramedical research, and bioengineering capabilities. Biotechnology, medical, and clinical research account for over half of Israel's scientific publications, and the industrial sector uses this extensive knowledge to develop new pharmaceuticals, medical equipment, and treatment therapies.

Seven Israeli hospitals have received accreditation from the Joint Commission International, an organization that sets safety standards for medical care: Soroka Medical Center in Beersheba, HaEmek Medical Center in Afula, Meir Hospital in Kfar Saba, Rabin Medical Center in Petah Tikva, Kaplan Medical Center in Rehovot, Carmel Medical Center in Haifa and Assuta Medical Center in Tel Aviv.

Health care providers

A first responder unit of Magen David Adom in Jerusalem's Old City

Providers in the Israeli healthcare system consist of a mixture of private, semi-private and public entities. Generally, family and primary medicine facilities are run directly by Clalit for its members while the other HMOs operate their own family practice clinics in the larger cities and contract with privately operated family practice clinics in smaller communities. As with primary practice, Clalit tends to provide specialty and outpatient care in their own clinics while the other HMOs generally contract with outside, private care physicians and facilities for this sort of service. In addition to these, the ministry of health in conjunction with various local authorities also runs a network of public well care and prenatal and infant care clinics throughout the country.

Doctors

In 2010, there were 25,542 doctors in Israel - 3.36 doctors for every 1,000 people. This ratio is one of the highest of all industrialized countries.

Emergency services

Emergency medical services in Israel are provided by the Magen David Adom (MDA) organization, which staffs approximately 1,200 emergency medical technicians, paramedics, and emergency physicians, and 10,000 volunteers. The organizations operates 95 stations and a fleet of over 700 ambulances. The majority of the fleet consists of Basic Life Support ambulances. There are also smaller numbers of Advanced Life Support ambulances and Mobile Intensive Care Units. For air ambulance services, MDA relies primarily on Unit 669 of the Israeli Air Force. There are also four MBB Bo 105 utility helicopters staffed with MDA paramedics owned by Lahak Aviation operating as air ambulances throughout the country. Non-emergency and repatriation air ambulance services are normally provided by private charter carriers.

Magen David Adom armored mobile intensive care unit

Magen David Adom is supplemented in some areas by Hatzalah, an emergency ambulance services network serving Jewish communities worldwide, and ZAKA, a series of community emergency response teams staffed by Orthodox Jews, who in addition to providing medical services and evacuation, also aid in the identification of terrorism victims and gather spilled blood and body parts for burial. The Palestine Red Crescent Society also provides services to Arab neighborhoods in Jerusalem. It gained access to Jerusalem after signing a 2005 Memorandum of Understanding with Magen David Adom.

The ambulance system, for the most part, conforms to the Franco-German model of EMS care, and the presence of physicians at high-acuity emergencies is not uncommon. In addition, emergency ambulance services is bolstered by a variety of private carriers tasked with interfacility transfers only.

Medical tourism

Main article: Medical tourism in Israel

Clalit clinic in the Bedouin Arab village of Tuba-Zangariyye

Gaza residents being transferred for medical treatment in Israel through Erez Crossing

Israel is emerging as a popular destination for medical tourists. In 2006, 15,000 foreigners travelled to the country for medical procedures, bringing in $40 million of revenue. As of 2010, up to 30,000 foreigners come to Israel every year for treatment, mostly from Russia.

Medical tourists choose Israel for several reasons. Some come from nations such as Romania and Cyprus where certain procedures are not available. Others come to Israel, perhaps most commonly from the US, because they can receive quality health care at a fraction of the cost it would be at home, for both surgeries and in-vitro fertilization procedures.

Other medical tourists come to Israel to visit the Dead Sea, a world-famous therapeutic resort. The Israel Ministry of Tourism and several professional medical services providers have set out to generate awareness of Israel's medical capabilities.

Palestinian medical tourism

A significant number of residents of the Palestinian territories seek medical treatment in Israel, often for sophisticated tests or treatments not available at Palestinian hospitals. Their treatment is paid for under a financial arrangement with the Palestinian Authority, or in some cases, at their own expense. Medical treatment for Gaza Strip residents is paid for by the Palestinian Authority or organizations such as the Peres Center for Peace.

Palestinians who apply for medical treatment in Israel must obtain a humanitarian entry permit from Israel, of which thousands are issued annually. In January 2009, during the Gaza War, the Palestinian Authority temporarily canceled financial coverage for all medical care for Palestinians in Israeli hospitals, including coverage for the chronically ill and those in need of complex care not available in the Palestinian territories.Palestinian officials stated that they wished to send the patients to neighboring Arab countries instead, accusing Israeli officials of using Palestinian patients, some injured in Israeli airstrikes, in PR campaigns to improve Israel's tarnished image during the Gaza War. In 2012, The Palestinian Authority's Ministry of Health reported spending approximately $42 million in 2011 to finance medical coverage of Palestinians in Israeli hospitals and the Arab World. Arab citizens of Israel belong to the same health care system as that of all other citizens of the country.

Gaza Strip resident giving birth to quadruplets at an Israeli hospital, 2008

The quality of medical care in Israel is significantly better than anywhere in the West Bank and Gaza. Irwin Mansdorf, a member of Task Force on Medical and Public Health Issues, Scholars for Peace in the Middle East wrote about routine care that Palestinians continue to receive in Israeli hospitals and from Israeli physicians.

Saving Children, established by the Peres Peace Center, enables hundreds of Palestinian children to receive free medical care, in particular cardiac surgery, from Israeli surgeons.

"Save A Child's Heart" is a program in which any child with heart problems can receive free medical attention and surgery from select doctors and hospitals within Israel. From 1996 to 2007, 4,591 children had been examined world wide, of the 1848 children treated 828 (45%) were Palestinian.

Hospitals and medical centers

Main article: List of hospitals in Israel

There are around 60 hospitals and medical centers in Israel. In addition to general hospitals, there are a number of specialized hospitals throughout the country. Most of the hospitals are government-owned and operated by the Ministry of Health, although some are fully private. Most of the private hospitals in Israel belong to nonprofit or charitable organizations. Many of the private hospitals are run by Clalit Health Services.

Medical research

Israel is one of the world leaders in stem cell research, with the largest number of articles, patents and research studies per capita.

See also

• Health care compared
• Helena Kagan
• Science and technology in Israel
• Gideon Mer

External links

• Cohen, Nissim (2012) “Policy entrepreneurs and the design of public policy: Conceptual framework and the case of the National Health Insurance Law in Israel” Journal of Social Research & Policy, 3 (1): 5-26.
• The Health Care System in Israel - An Historical Perspective Israel Ministry of Foreign Affairs. June 26, 2002.
• The Israel Project: Podcast describing the Israeli Health System
• State of the Art healthcare in Israel - If they can do it, then why can't we? examiner.com August 3, 2009.
• Health Care Stories: Jerusalem, Israel
• Israel as a Model for Health Care
• Health and Zionism: The Israeli health care system, 1948-1960, Shifra Shvarts