Israel Health Care System:Development and Challanges

Nadav Davidovitch, MD, MPH, PhDDepartment of Health Systems Management

Ben Gurion University, Israel

Background – Israel Demography

• Israeli population (2003)• Total population 6748400• Jews 5,165,400• Muslims 1,072,500• Christians 142,400• Druses 110,800• Religion Unclassified 254,600• Working Force 2,810,000

CBS, Israel, 2001

Immigration to Israel

Netanyahu Commission Recommendations

• legislation to introduce NHI;• reorganization of the Ministry of Health;• regionalization, decentralization and

enhanced competition;• centralized financing system and

capitation payments;• introduction of private medical practice in

public hospitals;

Netanyahu Commission (1988-1990) – Defining the Problems• Inadequacies in the services provided to

the public• Ministry of Health’s dual role as service

provider and regulator• vague financing and budgeting procedures• suboptimal organization of the system and

lack of managerial tools• low levels of employee satisfaction and

motivation.

Health Expenditure Per Capita – International Comparison (2008)

Number of General Hospital Beds per 1,000 People in Israel in the Last Decade

Number of Hospital Beds per 1,000 Persons – International Comparison (2008)

National health expenditures in Israel by financing sector % contribution to national expenditure

YearGovernmentHouseholds19957525199674.525.5199970.529.2200165.5 30.8200265.7 31.5200359.429.8200457.830.8200555.932.4200654.533.5200754.333.4200854.332.1

Co-payment as percentage of sick funds' income

YearCo-payment percentage of sick funds' income

19955.719965.319975.619986.219997.620008.120018.820029.6

04/28/2304/28/23

National Health Insurance National Health Insurance Law 1994Law 1994

“National Health Insurance according to this Law is based on the principles of justice, equality and solidarity …”

04/28/2304/28/23

Age adjusted Odds Ratio of Death Age adjusted Odds Ratio of Death of Women by Education & Time Period In of Women by Education & Time Period In

IsraelIsrael

0

0.5

1

1.5

2

45-69 45-69 70-89 70-89

13+ 9-12 0-8

Manor et al

1983-1992 1995-2001 1983-1992 1995-2001

13.4

11.8

9.3

6.3

5

3.8

0 5 10 15

1-4

5-8

9-10

11-12

13-15

16+

Year

s of

edu

catio

n

IMR

Data: Israeli Ministry of Health, 2005

Mortality rate per 1000 live births

Yrs

educ

atio

n

X 3.5

Infant Mortality by Maternal Education1996-1993

04/28/2304/28/23

Infant Mortality by Maternal Education 2002 -2000

12.8

9.5

7.7

5.4

3.8

2.8

0 2 4 6 8 10 12 14

1-4

5-8

9-10

11-12

13-15

16+

X 4.6

Years of education

Data: Israeli Ministry of Health, 2005

Mortality rate per 1000 live births

SouthNational

1.42.0Hospital beds (general)

0.300.47Hospital beds (mental health)

2.02.8Geriatric beds (rates for age 75+)

0.040.1Rehabilitation beds

0.050.09Dialysis

0.090.15Emergency room

Gaps in health services – Southern District) rates per 1000 population(

South/national rate

70%

64%

71%

40%

56%

60%

South National

11.215.0Total

0.40.8Dentists

4.25.2Nurses

2.53.2Doctors

Gaps in health care personnel – Southern District) rates per 1000 population(

South/national rate

75%

50%

81%

78%