This document provides an overview of the Israeli healthcare system. It notes that healthcare is considered a fundamental human right and is provided through a universal healthcare system funded by taxes. All Israeli residents are entitled to a basic healthcare package through one of four nonprofit health funds. The health funds are responsible for providing primary care and purchasing secondary and tertiary care. The system aims to provide universal access to healthcare while controlling costs.

1. Manfred S Green MD,PhD
School of Public Health,
University of Haifa
19-8-15

4.  Population: ~ 8,000,000
 Jews: 75%, Arabs 20%, Others
5%
 Age: Over 65 – 10%, Under 15 –
28%
 Area – About 3% of Ukraine
 GDP: $35,800 per cap. (PPP)
 Government: Parliamentary
democracy
Israel

5. Life Expectancy at Birth - Selected Countries

6. 73.9
75.7
77
78.4
79.5
80.5
82.3 82.8
70.3
72.1
73.5
74.9 75.5
76.5
78.3 78.5
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
1975 1980 1985 1990 1995 2000 2005 2010
Women Men
Age
Ranked 16th in the world (CIA Factbook 2010)
Life Expectancy in Israel

7. Infant Mortality Rates

8. Health Expenditure as a Percent of GDP

9. Health Expenditure Per Capita (USD)

10. Practicing Physicians per 1,000 Population

11. Hospital Beds per 1,000 Population

12. MRI Units and CT Scanners

13. 201
2

14.  Health care is considered as a
fundamental Human Right and is
taken care of by the government
 National Health Insurance Law - 1995:
 All Israeli residents entitled to basic health care
 Based on equity and solidarity
 The law determines the medical services which
each of the four health funds is required to
provide for its members.
Health Care

15. Principles
 Health as a national priority
 Universal access
 Strong tradition of primary care and
prevention
 Increasing attention health promotion
 Adoption of leading world standards
 Research, teaching and service

16. Dealing with Changing Health
Needs
 Priorities
 Health targets
 Cost effectiveness analysis
 Reform in structure and content
 Population-based health approach
 Performance indicators
 Health promotion

17. Principal Components of the
Health System
 Primary health service delivery system
 Health workforce
 Leadership and governance
 Health systems financing
 Supply of medical products and
technologies
 Health information systems
 Households

18. The Israeli Health System
Ministry of
Health
Health Funds
Klalit
54%
Maccabi
24%
Meuhedet
12%
Leumit
10%
Hospitals
Acute Care 46
Beds: 14,582
Psychiatric 14
Beds: 4,240
Geriatric 310
Beds: 22,283
Ministry of
Finance

19.  Resources and Regulation – the State
 Responsibility for Personal Health -
Health Funds
 Suppliers of Services – Health Funds
and Others
 Primary care – Mainly HF
 Hospitals – HF, Governmental, Other
public
 Workforce – mainly salaried
Structure of the
Health Care System

20. National Health Insurance Law
1995
 Universal, compulsory, health insurance
 Financed by earmarked and general taxation
 Citizens pay a healthcare tax – 4.8% of income
 “Cost of the Basket of Services” :
 Based on previous expenditures of the health funds
 Updated yearly based on a health index
 If the taxes not sufficient, the government must
add to guarantee the basket of services

21. Special Fund for New
Technologies
 Special allocation of funds each year for
new technologies
 Recommended by national professional
councils and the drug industry
 Evaluated by an MOH committee headed
by a senior medical professional with
representatives from the public

22. Providers of Health Care

23. MOH Mother and Child Clinics
(Tipot Halav)
 Initiated in 1912 and run by MOH
 Immunization, growth and development
 Vits A, D, routine iron supplements
 Pregnancy care
 Parallel to clinics of Sick Funds
 Some subcontracted to health funds
 Located in every neighborhood
 Nursing staff and visiting MDs

24.  Every citizen is a member of an HMO
(Health Fund)
 Health funds provide a uniform, legally
defined basket of services for every citizen
 Citizens are free to choose and move
 There are public and private providers of
services
The Health Funds (HMOs)

25.  Supplies services - own facilities and outside
providers
 Selectively contracts with providers
 Free patient choice of physician
 Methods of payment to providers:
Physicians: Quarterly visits within global budget
Hospitals: Negotiated Caps
Other providers: Fee-for-service
Functions of the HMO

26.  Co-payments for medications, visits to
physicians and specialist clinics
 Services not currently covered by the
health funds include much of mental
health, long term nursing care, and dental
care for adults
 Health funds offer supplementary health
insurance for additional services
Extra Charges to Patients

27. Acute Care Hospital System
 11 Ministry of Health Hospitals 46.5% of beds
 8 Klallit Health Fund Hospitals 30.4% of beds
 7 Non-profit Hospitals 10% of beds
 2 Hadassah Hospitals 6.0% of beds
 6 Mission Hospitals 3.6% of beds
 11 Private for-profit Hospitals 3.4% of beds
 1 Meuhedet Hospital 0.1% of beds
Number of Beds = 14, 582 – 2.05 beds/1000

28. Characteristics of the Acute Care
Hospital System
 All hospitals have outpatient ambulatory services
 All public hospitals have Emergency Rooms
 Staffing linked to the number of beds in each
department
 Physicians are salaried employees of the hospital
 Hospital physicians may have private practices
and may contract with health funds as
independent doctors

29. Funding the Israeli Health Care
System
● Public and Private Financing
● Public and Private Healthcare
Services

30.  Budgeted by the state through a “Capitation
Mechanism” - Prospective budget = # of enrolled
capita weighted by age and residence location.
 Supply of healthcare services
 Primary care – supplied by the health funds’
personnel
 Secondary (Specialists’) care – supplied by
health funds’ personnel or purchased
 Tertiary (hospital) care – Owned or purchased
Budget and Function of the
HMO’s (“Health Funds”)

31.  1st level – Public + copayments
 2nd level – Semi private
 3rd level - Private
Financing Health Care

32.  Paid through taxation – about 5% of salary
 Discount to low income families.
 Minimum payment for unemployed
 Free Basic Package of services
 Defined by law and updated annually
 Co-payment for drugs ($4) and ambulatory
services (~$6). No co-payment for hospitals.
 Very wide coverage (incl. fertility, cancer,
transplantation etc.)
 Limited choice of suppliers
The 1ST level

33.  Cosmetic Plastic Surgery
 Dentistry for adults
 Non-conventional medicine
Services Not Supplied

34.  Semi-Private insurance
 Low cost, Based on age only (~20$ per month)
 No denial for any reason (by law)
 Managed by the health funds but
financially separated from basic insurance
 Coverage – 80% of the population
The 2nd level

35.  Private insurance
 Administered by private insurers
 Expensive ($100+/month) premium
 Very limited addition of services as compared to 1st
and 2nd levels
 Underwriting (Cost of premium related to the
insured health status)
 Owned by 42% of the population
The 3rd level

36.  I pay 10%-48% income tax
(14%) per month.
 In addition I pay 5%-15% of
my salary for social security
and the health tax
 I pay for supplementary
insurance to the health fund -
~20$ per month
 I can also add a private
insurance or to get it from my
work place
Let’s try to summarize how it works
1st
level
2nd
level
3rd
level

37. Computerization of the Healthcare
System
 Electronic Medical Record
 Every transaction computerized
 The Central Medical Record
 Electronic laboratory results, prescriptions
and consultations
 Telemedicine
 Alerts and Reminders
 Patient Website

38. Israel’s Health Achievements
 Universal health coverage and access to care
 Strong MOH control over hospital sector
 Strong traditions of public health
 Control of infectious diseases
 Control of non infectious disease e.g. CHD, stroke
 Strong medical-pharmaceutical industry
 Strong basic and clinical sciences
 Strong epidemiology training and research

39. 1. Eliminate ineffective and inappropriate services
2. Improve rational use of medicines
3. Allocate more to public health, primary and
outpatient specialist care at the expense of
hospital care
4. Invest in infrastructure that is less costly to run
– “invest to save”
5. Cut the volume of least cost-effective services
Focus on Health Systems’
Performance - WHO

40. Manfred S Green
Questions

41. Acknowledgements
 I wish to acknowledge the various people
who have made their presentations freely
available on the internet.

42. 200
300
400
500
600
700
800
900
1000
1100
1980 1990 2000 2010 2020
France
Israel
Russian Federation
United Kingdom
EU members since 2004 or
Acute care hospital beds per 100000

43. 0
5
10
15
20
1970 1980 1990 2000 2010 2020
France
Israel
Russian Federation
United Kingdom
EU members since 2004 or 2007
Average length of stay, acute care hospitals only

44. 0
100
200
300
400
500
1970 1980 1990 2000 2010 2020
France
Israel
Russian Federation
United Kingdom
EU members since 2004 or 2007
SDR, ischaemic heart disease,
all ages per 100000

45. 10
20
30
40
50
1970 1980 1990 2000 2010 2020
France
Israel
Russian Federation
United Kingdom
EU members since 2004 or 2007
SDR, malignant neoplasm female
breast, all ages per 100000

46. 0
50
100
150
200
250
300
1970 1980 1990 2000 2010 2020
France
Israel
Russian Federation
United Kingdom
EU members since 2004 or 2007
SDR, external cause injury and
poison, all ages per 100000

47. 0
10
20
30
40
1970 1980 1990 2000 2010 2020
France
Israel
Russian Federation
United Kingdom
EU members since 2004 or 2007
SDR, chronic liver disease and
cirrhosis, all ages per 100000

48. 20
25
30
35
40
1980 1990 2000 2010 2020
France
Israel
Russian Federation
United Kingdom
EU members since 2004 or 2007
% of regular daily smokers
in the population, age 15+