Heath Care System in Israel

Presented by: Kamilah Fernandez, Kareem Austin, Tenille Ramkissoon, Coryse Cazoe and Juilen Marshall.

Israel- Introduction Country Profile• The State of Israel was established in

1948. Israel is a small country at the eastern end of the Mediterranean.

• In 2000 Israel had a population of 6.3 million, 78% were Jews and 22% non-Jews ( mainly Muslim Arabs) and currently it stands at 7.8 million.

• It is densely populated with 288/km2 and 60% of the population live along the Mediterranean Sea..

• Israel’s three largest cities are Tel Aviv , Jerusalem and Haifa.

• It has two official languages Hebrew and Arabic.

Israel- Introduction Population Demographics• Israel is a young society; 27.1% of the population are under age 15

and only 10.5% are over age 64. 0-14 years: 27.1% (male 1,084,748/female 1,035,525)15-24 years: 15.7% (male 628,205/female 599,871)25-54 years: 37.8% (male 1,508,860/female 1,443,898)55-64 years: 10.7% (male 333,453/female 352,302)65 years and over: 10.5% (male 368,318/female 466,670) (2014 est.)

Israel- Introduction Population Demographics• Its total fertility rate (2.95 per woman) has been accompanied by

phenomenal growth in the absolute number of elderly people. • Immigration plays an important role in the demographics of Israel since

it was declared a state in 1948 and it account for it population growth in the 1950’s, 1970’s and 2000. The current population growth is 1.46% and the net rate is 1.68 migrant(s)/1,000 population.

Israel- Introduction Population Demographics

GOVERNMENT & ECONOMY• Israel is a democratic state and, there is also a Local government operate as independent authorities providing local services. Israel is a developed, industrialized country .The 1999 GDP per capita income was US $PPP 18 600, $36,200 (2013)

Israel- Health Status• In 1999 life expectancy at birth was 76.6 for males and 80.4 for

females• In 2000 the infant mortality rate was 5.4 per thousand live births ; it

has declined by 50% over the past decade• The crude mortality rate in 1999 was 6.1 per 1000 population, down

from 6.6 per 1000 population in 1985. The leading causes of death were heart disease, malignant neoplasms, cerebrovascular diseases, diabetes and accidents, accounting for two thirds of all deaths from 1995 to 1997.

• Lifestyle factors: a low level of alcohol consumption and lower levels of cigarette smoking.

Israel- Historical Background• Health care services in Israel have been developed by voluntary health

plans (sick funds), non-profit institutions, the government and the British Mandatory regime (before 1948).

• Workers’ associations established the first health plan in 1911 to provide care to workers and their families and to employ immigrant doctors.

• Hadassah Medical Organization began its medical activities in Israel in 1913 by establishing the Tipat Halav system (“well-baby” clinic).

• Government hospitals, over 50% of all acute beds in the country and most psychiatric facilities, consist primarily of hospital established by the State of Israel in British Mandate hospitals and in buildings abandoned by British Army camps.

Israel- Historical Background of Health Care• By 1980s, 95% of the population were insured in one of the four competing

health plans; Clalit, Maccabi, Meuhedet and Leumit.• The 1980s due to increasing consumer dissatisfaction the government

developed a State Commission of Inquiry into the functioning and efficiency of the health care system,

The Netanyahu Commission was a major turning point in history of Israeli health policy. The commission emphasized the following problems in the Israeli health care system:

1. inadequacies in the services provided to the public2. the Ministry of Health’s dual role as service provider and regulator3. vague financing and budgeting procedures4. sub-optimal organization of the system and lack of managerial tools low

levels of employee satisfaction and motivation.

Israel- Historical Background of Health Care• The majority report of the Commission presented the following

recommendations .1. legislation to introduce NHI2. reorganization of the Ministry of Health3. regionalization, decentralization and enhanced competition4. a centralized financing system and capitation payment5. introduction of private medical practice in public hospitals6. financial incentives for increased productivity, along with enforcement of

the principle of equal pay for equal work.The Minister of Health, then established a task forces to deal with the

reconstitution of government hospitals as freestanding for-profit entities, the reorganization of the Ministry of Health, preparation of the NHI law and health care system economics

Israel- Organizational Structure and Management• In Israel the parliament (Knesset) determines laws and budgets and has

passed important health care laws such as “the NHI Law”1995 and “the Patients’ Rights Law” 1996.

• The key parliament committees related to health are the Finance Committee, the Labour, Social Affairs and Health Committee.

• The Ministry of Finance and its powerful budget Division play a critical role in drafting the budget

The Ministry of Health• The Ministry of Health has overall responsibility for the health of the

population and the effective functioning of the health care system.• It is headed by the Minister of Health, who is a member of the

Government and appoints a physician as Director-General, the Ministry’s senior health care professional

Israel- Organizational Structure and Management• Israel’s Ministry of Health also plays a major role in the direct provision of

care. 1. It owns and operates 50% of the nation’s acute hospital beds,

approximately two thirds of the psychiatric hospital beds and 10% of the chronic disease beds.

2. It operates the majority of the nation’s mother and child preventive health centres.

• The Ministry of Health receives important input from various advisory bodies. These include;

1. the National Health Council ( advise the ministry on NHI law) 2. a series of standing national councils appointed to advise the Director-

General on both long-term goals and pressing issues requiring an immediate policy response

Israel- Organizational Structure and Management• Other key government bodies involved in health1. The Ministry of Finance2. The National Insurance Institute3. The Israel Defence Force

• Key nongovernmental actors1. Heath Plans (Clatit -55%, Maccabi- 24%, Meuhedet-11%, Leumit-10%)2. Hospitals3. Health Care Unions4. Magen David Adom (“Red Star of David)5. Voluntary Organization

Israel- Organizational Structure and ManagementThe health care system since 1990• The major organizational problems identified by the 1990 Netanyahu

Commission report were that:1. the health care system was overly politicized due to the political

affiliations of some of the health plans; 2. there was no comprehensive legal framework for the activities of the

health plans;3. the Ministry of Health’s dual role as regulator and provider led to

conflicts of interest and inefficiencies.• Israel’s NHI law (1995), addressed the first two of these problems to a

significant extent but was unsuccessful in addressing the third problem.

Israel- Organizational Structure and Management

The primary organizational changes since 1990;• Prior to 1995 individuals paid their health insurance premiums directly

to the health plans on a voluntary basis. Since the introduction of NHI these payments are collected by the NII on a compulsory basis as a health tax then the NII redistributes it to the health plans.

• Employers’ tax was abolished in 1997 and replaced by an increase in general tax revenue.

Israel- Organizational Structure and ManagementPlanning• In 1990 the Ministry of Health sponsored a planning process involving

key health care system actors in order to develop a Health for All 2000 document ( achievements was not evaluated).

• External commissions (e.g. Netanyahu Commission) have as strong impact on planning and policy development as the Ministry of Health or any permanent planning entities because they are more objective, professional and less political.

Regulation• Since the introduction of NHI and the Patients’ Rights Act in the mid-

1990s, the Ministry of Health has developed new capabilities in the regulatory area.

• There is also consideration of regulating the number of health care personnel

Israel- Organizational Structure and ManagementDecentralization• Despite the fact that the Ministry of Health’s Public Health Division

operates through regional and district offices, they have little power.• The regional and district offices serve primarily to implement the

policies and strategies both in the public health area and in the regulation of long-term and psychiatric care.

• The health plans have regional administrations, but authority rests with their national headquarters.

• The NHI law called for reducing the role of government in service provision in three key areas of activity: personal preventive care, long-term care and mental health care.

Israel- Organizational Structure and ManagementIn the past decade the Israeli health care system has undergone:1. Some deconcentration of central government authority to lower

administrative levels of central government, particularly in the case of the government hospitals;

2. No significant devolution of authority to regional or local governments;

3. No significant delegation of responsibilities to quasi-public organizations(on the contrary, NHI constitutes a process of transfer of authority from the health plans to the government);

4. Various attempts at privatization (transferring responsibilities for service provision from the government to the voluntary sector) have been successfully implemented to date.

ReferencesWebsites• http://www.goisrael.com/Tourism_Eng/Tourist%20Information/Discove

r%20Israel/Pages/Population.aspx• https://www.cia.gov/library/publications/the-world-factbook/geos/is.ht

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