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Israel’s Health Care System

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Israel’s Health Care System
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Israel’s Health Care System
Health care is a fundamental right in Israel. When Israel was a part of Ottaman Empire in the 19th century, diseases like malaria, diarrhea, and typhus were quite common. The major providers of health care at that time were clinics established by European Jews. These clinics later became the birth places of major hospitals. The transformation of Israel from its poor health status to a nation with universal access to health care is an interesting story.
Once the British mandate for Palestine was implemented, various health measures like safe disposal of waste, anti-mosquito measures and vaccination against smallpox were institute. One of the major health insurance group Kupat Holim Clalit was established in 1911 by 150 immigrant workers. After Israel achieved independent nationhood in 1948, this concept was expanded to include more people. The Israeli government focused its efforts on socialized health care. In 1988, on the basis of the recommendations of Natanyahu commission the National Health Insurance law was enacted on January 1, 1995. This law is the basis of uniform access to health care via four companies (Cohen, 2012).
The approach followed by the Israel government has yielded positive results, and Israel ranks high in almost all health quality indicators. It’s infant mortality rate of 3.98 deaths/ 1000 population is among the lowest in the world. The Life expectancy of 81.28 years for the total population, being 83.

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61 years for females and 79.05 years for males is commendable. The maternal mortality rate of 7 deaths/ 100,000 live births and neonatal mortality rate of 2/ 1000 live births are also a reflection of the success of the Israeli system. Israel spends about 7.71% of its GDP on health care as per 2011 figures and has a doctor – population ratio of 3.11 per 1000 population and a hospital bed density of 3.4 beds per 1000 population (Ginzberg, 2003).
In spite of the much-touted achievements of the Israeli health care system the country is facing certain health issues. With increasing population and urbanization, resources are being stretched at their seams. Israel has to deal with public health issues like deteriorating air quality, scarcity of water along with deterioration of the quality of water and safe disposal of waste. These developments might lead to a resurgence of communicable diseases in the country.
On the other hand, United States is now facing the epidemic of lifestyle diseases like heart diseases, diabetes, cancer, and obesity. In 2013, the National Institute of Health, United States conducted a study on 17 high-income nations and concluded that United States compared unfavorably with regards to the prevalence of obesity, heart diseases, and infant mortality. Cardiovascular diseases are expected to cost the United States about 800 billion $ and Type 2 Diabetes about 500 billion $ (Gross, 2003).
Another issue that is common to both Israel and United States is the shortage of trained doctors and nurses. It is expected that by 2020, America will be short of 46,100 specialists and 45,000 primary care physicians according to estimates of Association of American Medical Colleges. At present according to 2011 data there are 2.5 doctors per 1000 population. In Israel, the situation is slightly better at 3.3 doctors per 1000 population but projections show that due to limited number of new doctors and anticipated retirements there will be a shortage in the near future (Rabinovich et al., 2007).
The most important issue in front of both these countries is an unequal distribution of health care services through the various sections of society. While Israel champions the cause of the socialized medicine and provides universal health care to all via four health maintenance organizations (HMO’s), the system has its own lacunae. The funding for the services provided by the ministry of health and funds allocated for HMO have become dependent on the political establishment. As a result, services related to geriatrics, mental health, well baby clinics and school health services have suffered.
The primary issue in United States is that health insurance is still not universally available to all and health care costs are one of the highest in the world. In 2012, in the age group of 19 – 64, 85 million people did not have health insurance according to the United States Census Bureau.
There are certain basic differences in the Israeli and U.S. health care systems. The concept of good for all is the underlying principle in Israeli health care and policies like National Health Insurance and subsidized medical education aim to provide health facilities at an affordable cost. According to the World Bank, Israel spent only 2601 US dollars per capita in health expenditure as compared to 9146 US dollars spent by United States during 2010 – 2014 whereas it ranks higher in almost all health care indicators.
This discrepancy can be explained by the fact that the health care system in U.S. functions as a market place where many players are in fray like Medicare, Medicaid, and CHIP and hence emphasis has shifted from ensuring health to managing diseases. This along with the extremely high cost of medical education has made health care unaffordable for the poor. Most doctors in Israel are salaried whereas in U.S. fee for payment predominates. Reforms are needed in Israel to ensure that both HMO’s and the Ministry of Health receive adequate funding. This will ensure a provision of health services even to the remote areas of the country. Budget allocation should accommodate rising costs and funds for research and innovation. Provision of more medical schools and incentives to immigrant doctors are steps that have already been instituted to address manpower shortage.
United States also needs to introduce certain basic reforms so that more people can get access to health care. Regulation of health insurance companies and premium caps has to be introduced to encourage more people to buy health insurance plans. The problem of unnecessary procedures and investigations, false claims need to be regulated. Since doctors mostly work on a fee for service basis, the introduction of salaries can secure them and encourage ethical care. In 2014, a Gallup- survey showed that 13.4 percent of U.S. adults are uninsured. More attention should be paid to preventive health. Reforms in medical education also need to be instituted in an effort to reduce a cost of medical education and increase number of doctors (Rosen, 2009).
WHO has defined health as not only absence of disease or infirmity but the ability to lead a socially and economically productive life. This must be kept in mind while formulating health plans for any country. There is no ideal health care system although a public, a private partnership seems to be the best working model. The United States must learn from Israel and introduce social equality and affordability to its health system, and Israel must learn from the problems being faced by the U.S. and strengthen its existing health infrastructure.

References
Cohen, Nissim. (2012). Policy entrepreneurs and the design of public policy: Conceptual framework and the case of the National Health Insurance Law in Israel. Journal of Social Research & Policy. 3 (1): 5-26.
Ginzberg E. (2003). The Moshe Prywes Lecture in Medical Education. Isr J Med Sci. 1987;23(3):53–156.
Gross, R. (2003). Implementing health care reform in Israel: Organizational response to perceived incentives. Journal of Health Politics, Policy and Law 28: pp. 659-692.
Rabinovich, M, Wood, F, Shemer, J. (2007) Impact of new medical technologies on health expenditures in Israel 2000–2007. International Journal of Technology Assessment in Health Care. 23: pp. 443-448.
Rosen, B, Merkur, S. (2009). Israel: Health system review. Health Systems in Transition .11: pp. 1-226

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