Abstract
The Israeli health care system is looked upon by some people as one of the most advanced health care systems in the world in terms of access, quality, costs and coverage. The Israel health care system has four key components: (1) universal coverage; (2) ‘cradle to grave’ coverage; (3) coverage of both basic services and catastrophic care; and (4) coverage of medications. Patients pay a (relatively) small copayment to see specialists and to purchase medication; and, primary care is free. However, during 2011 the Israeli Medical Association (IMA) spent 5 months on a strike, justifying it as trying to ‘save’ the Israeli public health. This paper describes some aspects of the Israeli Health Care System, the criteria for setting priorities for the expenditures on health care and values underlying these criteria. The paper observes that the new agreement between the IMA and the government has given timely priority to problematic areas of specialization (in which there is an acute shortage of physicians) and to hospitals in the periphery of the country. Yet weak points in the health system in Israel remain. Particularly, the extent to which national health care expenditures are being financed privately—which is rising—and the parallel decline in the role of government financing.
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Notes
Presently, as a result of the network of general hospitals developed by the State, the Ministry of Health is in effect the owner of approximately half of the acute care hospital beds in the country. These hospitals, together with hospitals built by Clalit (historically the first health plan) and voluntary and religion-based hospitals, provide services to the members of all the health plans on the basis of reimbursement rules established by the State.
In 2005 was formed a “technical subcommittee” consisting of representatives of the Ministry of Health, the Ministry of Finance and the health plans. This subcommittee reviews and refines the Ministry of Health staff’s projections regarding the prices of proposed new medications and other technologies, along with the volumes likely to be consumed. This eliminates the need for the full committee’s involvement in various technical disagreements - and allows it to focus on the more 'fundamental' issues (Rosen and Merkur 2009).
From time to time the health plans and others have called for the removal of certain services from the benefits package or, notably, for reductions in the number of treatments covered for particular services, such as in vitro fertilization. These proposals have met with strong public (political) opposition and none of them has been adopted. Moreover, none of these proposals has been formally considered by the public committee (personal sources).
There is in Israel today a ratio of 3.36 doctors for every 1,000 people (In industrialized nations, the average ratio stands at 3.1 doctors to 1,000 citizens).
During the second half of the twentieth-century John Rawls (1971) designed a hypothetical contract situation in which rational people will agree behind a ‘veil of ignorance’ what is fair. Behind the veil we conceive of ourselves as potential constructors of a just society, while being ignorant of our racial, social and economic position within that society. Rawls took away all items of information he considered to be irrelevant to questions of justice and left only two lexically ordered principles of justice, equal basic liberties, equal opportunity and inequalities only if they work to the maximal advantage of those who are worst off. Daniels (1996) extended Rawls theory to health care.
References
Callahan, D. 2003. Should age count in allocating health care resources? http://www.sagecrossroads.net/files/transcript06.pdf. Accessed 10 May 2012.
CBS. 2009. Infant mortality. Central bureau of statistics http://www.health.gov.il/Download/pages/MoCrtality2.pdf.
CBS. 2010. Israel in Figures Central Bureau of Statistics http://www.cbs.gov.il/publications/isr_in_n10e.pdf. Accessed 22 February 2011.
Chinitz, D., et al. 1998. The second phase of priority setting. Israel’s basic basket of health services: The importance of being explicitly implicit. British Medical Journal 317: 1005–1007.
Chinitz, D., and A. Israeli. 1999. Rationing: How and why? Journal of the Israel Medical Association 1: 210–214.
Daniels, N. 1996. Justice and justification cambridge. Cambridge: Cambridge University Press.
Gross, R. 2003. Implementing health care reform in Israel: Organizational response to perceived incentives. Journal of Health Politics, Policy and Law 28: 659–692.
Hammerman, A., and D. Greenberg. 2009. Estimating the budget impact of new technologies added to the national list of health services in Israel: Stakeholders’ incentives for adopting a financial risk-sharing mechanism. Health Policy 89: 78–83.
IMA. 2011. Achievements for the public health care system. The Israeli medical association [Hebrew] http://www.ima.org.il/Heskem/default.aspx. Accessed 20 October 2011.
Kirkwood, T. 1999. Time of our lives. London: Weidenfeld & Nicholson.
Kirkwood, T. 2001. The end of Age. ‘The Reith Lectures 2001’, BBC. http://www.bbc.co.uk/radio4/reith2001/Accessed, 10 May 2012.
Ministry of Health. 2008. 60 years of health in israel. ICDC Report. Accessed 20(7): 2011.
Rabinovich, M., F. Wood, and J. Shemer. 2007. Impact of new medical technologies on health expenditures in Israel 2000–2007. International Journal of Technology Assessment in Health Care 23: 443–448.
Rawls, J. 1971. A theory of justice. Cambridge: Cambridge University Press.
Rosen, B., and S. Merkur. 2009. Israel: Health system review. Health Systems in Transition 11: 1–226.
Shmueli, A. 2009. Economic evaluation of the decisions of the Israeli public committee for updating the national list of health services in 2006/2007. Value Health 12: 202–206.
Shmueli, A., and E. Nissan-Englcin. 2008. Economic examination of the 2006/2007 update of the Israeli national list of health services [Hebrew]. Harefuah 147: 488–492.
Siegel-Itzkovich, J. 2007. Doctors take on ministry health basket. Jerusalem Post on line November 20 http://www.jpost.com/Israel/Article.aspx?id=82615. Accessed 20 July 2011.
Simonstein, F. 2004. Self-evolution. The ethics of redesigning eden. Tel-Aviv: Yozmot.
The patient’s right Act. 1996. Available online at: http://waml.haifa.ac.il/index/reference/legislation/israel/israel1.htm. Accessed 20 July 2011.
Zimmerman, J. 2009. Israel as a model for health care. News and views of reform jews July 30 http://blogs.rj.org/reform/2009/07/israel-as-a-model-for-health-c.html. Accessed 26 July 2011.
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I would like to thank two anonymous reviewers for invaluable comments on a previous version of this paper.
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Simonstein, F. Priorities in the Israeli health care system. Med Health Care and Philos 16, 341–347 (2013). https://doi.org/10.1007/s11019-012-9421-9
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DOI: https://doi.org/10.1007/s11019-012-9421-9