Israel transformed its healthcare system in 1995 with a national health insurance law. The law guarantees citizens access to government-funded medical services delivered through four competing, nonprofit health plans (HMOs). The HMOs work to contain costs while improving quality and promoting equitable access to care. Services are paid for through compulsory health taxes on income. Israel's system is ranked among the most efficient and healthiest in the world.

1. ISRAEL HEALTHCARE
SYSTEM
Financial management
1

2. FOREWORD
Israel's National Health Insurance Law of 1995 transformed its healthcare system. The law
guaranteed all of the country's citizens access to a government-funded "basket" of services,
delivered by four, competing, nonprofit health plans (HMOs). and this has produced different
orientations –
from the decidedly socialist origins of Clalit to the strong free market bent of Maccabi. However,
all have demonstrated both willingness and ability to adjust to the new requirements of the 1995
law. Moreover, they all share the challenge of containing costs and providing care to a
population that demands high levels of healthcare access and quality.
Israel's reforms produced a nationwide effort to measure and monitor quality, to emphasize
primary care, to develop community-based alternatives to hospital care, to implement
sophisticated ambulatory-care HIT systems for evidence-based decision making and utilization
review.
Israel have also health basket that includes a range of subsidized medical services, drugs,
equipment and devices for permanent residents of the State of Israel. The health basket was
established in its current form in 1994 as part of the National Health Law.
2

3. MEDICAL RESEARCH
Israel is a world leader in 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. Among other areas of medicine, Israel is
a leader in stem cell research, with the largest number of articles,
patents and research studies per capita, as well as research into
regenerative medicine and medical marijuana.
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4. HUMANITARIAN AID
Israel adopted an official humanitarian aid agenda, providing vital relief to more than 140 countries.
Among those countries receiving aid are nations that do not maintain diplomatic relations with Israel.
Since 1959, Israeli doctors have been offering eye camps to treat ocular diseases to people throughout
the developing world.
In 1970 Israel started opening its doors to the world's refugees. It has saved people in distress and those
seeking refuge from countries such as Lebanon, Egypt, Iran, Vietnam, Bosnia, Kosovo, Eritrea and
Sudan.
Since 1995 Israeli doctors acting through Save a Child's Heart have been giving kids from around the
world, including from the Palestinian Authority (PA), Iraq, Jordan and other Arab nations free life-saving
heart operations. Since the organization first started 2,300 children have been treated, and almost half
are from the PA, Jordan and Iraq.
IDF aid missions help thousands around the world: Over the last 26 years, Israel has sent out 15 aid
missions to countries struck by natural disasters. Immediately upon arriving in these countries, IDF
doctors set up field hospitals. Overall, medical care was given to more than 2,300 people in afflicted
areas, and 220 were saved from certain death.
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5. Services are provided through four main health maintenance
organizations, known in Israel as kupot holim, which compete
for patients. Beyond the basic government-guaranteed
services, the HMOs also offer enhanced insurance plans for
additional fees.
ISRAEL BIG IDEA
HOW THE SYSTEM WORKS
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6. KUPOT HOLIM
6
The Israeli four main health maintenance organizations.
1/12/2020
100
%
53% 26% 12% 7%
Total Clalit Maccabi Meuhedet Leumit
Kopat holim Membership percentages
Clalit 5,133,059 53.639%
Maccabi 2,530,515 26.443%
Meuhedet 1,177,652 12.306%
Leumit 728,408 7.612%
TOTAL 9,569,633 100%

7. ISRAELI HEALTH PLANS MANAGE CARE
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Israeli health plans manage care with regard to three key
organizational objectives:
 cost containment.
 quality improvement.
 equity promotion.

8. cost containment was the first to engage the attention of health plan managers. it is important to note that the health plans
also engage in other types of efforts to control costs, including:
 Utilization review of hospital care
 The development of community-based alternatives to hospital care
 Discounted bulk purchasing
 Creation of a network of primary care providers throughout the country
Health plan efforts to control costs through the management of the care provided by their own physicians include the
following:
1. Devolvement and clear assignment of accountability for staying within budgets.
2. Implementing systems for monitoring utilization and expenditures at the individual physician level.
3. Enhancing physicians' interest in, and commitment to, controlling costs.
4. Providing physicians with the information and skills needed to contain costs.
5. Prior authorization requirements.
8
COST CONTAINMENT

9. QUALITY IMPROVEMENT
Systemic efforts to improve quality that largely transcend the frontline practitioners include:
 Improving access to care, through such measures as:
● Transporting patients in outlying areas to specialized clinics and diagnostic facilities
● Eliminating co-payments for certain key services
● Promoting cultural responsiveness through staff training, staffing assignments, adaptation of printed materials, etc.
 Changing the broader cultural/social context (beyond the clinic), through such measures as:
● Working with cultural and religious leaders to encourage various types of healthseeking and health-promoting behaviors
● Working with municipalities to create walking routes and other health promoting environments.
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10. Efforts to improve quality that primarily involve working with or through frontline physicians parallel those outlined above
with regard to cost containment and include:
1. Devolvement and clear assignment of accountability for providing high quality care
2. Systems for monitoring quality at the level of the individual physician
3. Increasing physicians' motivation to invest energy in improving quality
4. Providing physicians with the infrastructure, information, skills and support staff needed to promote quality
of care
10

11. EQUITY PROMOTION
In this area of activity, most of the health plan initiatives to date have been at organization levels that transcend the
individual physician. These include:
 Adopting equity (i.e., the narrowing of disparities) as a key organizational objective
 Measuring and monitoring the extent of the disparities
 Analyzing the causes of the disparities
 Targeting resources on those regions and clinics where the needs are greatest
At the same time, the health plans are involving individual physicians and small groups of physicians in efforts to reduce
disparities by:
 Placing some of the responsibility for narrowing disparities on mid-level managers and frontline professionals, and
 Developing targeted and tailored intervention programs.
It remains to be seen how health plan/physician interactions in this new area of activity will evolve over time 11

12. MINISTRY OF HEALTH BUDGETS
In 2019, the budget of the Ministry of Health was NIS
37,984,845,000.
After budget transfers, the budget was NIS 38,742,575,000
Together with deductibles of NIS 80,453,000, the total expenses
under this item are NIS 38,823,028,000.
Ministry of Health budget is divided by main types of expenditure:
• Salary: NIS 1,437,921,000 (3.7%)
• Supports and transfers: NIS 31,251,416,000 (80.5%)
• Purchasing and shopping: NIS 6,001,090,000 (15.46%)
In 2018 it stood at NIS 34,438,325,248
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13. MINISTRY OF HEALTH BUDGETS
13
1,497,193,000
Public health
services
1,520,000
Estate funds
305,815,000
Training and
instruction
1,530,464,000
main office
31,174,000
Mental health centers
2019 budget
38,823,028,000
4,048.5 4,410,741,000 30,734,501,000311,620,000
Medical centersAnnual Avg of the
Budget per person
Purchase health
services
HMOs and hospitals
Government funding:
37,984,845,000
Self-income:
80,453,000

14. ISRAEL’S HEALTH BASKET
In addition to the health budget in Israel (NIS 39b). In 2019, the
total value of the Health Basket stood at approximately NIS
53.7b. Last year, the Health and Finance Ministries raised the
health basket budget by NIS 460m.
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15. REQUIRED FUNDING
The costs are covered mainly by a national health tax: Wage-
earners and self-employed individuals pay 3.1 percent of their
monthly salary up to 5,804 shekels (about $1,600), and 5 percent
on everything earned beyond that. Women who do not work
outside the home are exempt, while students, retirees and others
who do not earn a fixed salary are required to pay a small fee of
about $25 a month in exchange for coverage. All children are
covered free of charge through the army.

16. 16
CONCLUSION
Healthcare in Israel is universal and participation in a medical insurance
plan is compulsory. All Israeli residents are entitled to basic health care
as a fundamental right. The Israeli healthcare system is based on the
National Health Insurance Law of 1995, which mandates all citizens
resident in the country to join one of four official health insurance
organizations, known as Kupat Holim (‫חולים‬ ‫קופת‬ Sick Funds) which are
run as not-for-profit organizations and are prohibited by law from denying
any Israeli resident membership.
Israelis can increase their medical coverage and improve their options by
purchasing private health insurance. In a survey of 48 countries in 2013,
Israel's health system was ranked fourth in the world in terms of
efficiency, and in 2014 it ranked seventh out of 51. In 2015, Israel was
ranked sixth-healthiest country in the world by Bloomberg rankings and
ranked eighth in terms of life expectancy.

17. THANK
YOU
Wael Molla
Wael.molla45@gmail.com