Health care in Israel is universal and participation in a medical insurance plan is compulsory. Health care coverage is administered by a small number of organizations, with funding from the government. All Israeli citizens are entitled to the same Uniform Benefits Package, regardless of which organization they are a member of, and treatment under this package is funded for all citizens regardless of their financial means. Generally, health care in Israel is of high-quality and is delivered in an efficient and effective manner. Partly as a result of this, at an overall 82 years, Israelis enjoy the fourth-longest life expectancy in the world as of 2010.
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Starting with the British mandate of Palestine in 1917, measures were taken to improve public health in the area. In Jerusalem, accumulated garbage heaps were removed, public trash cans were installed; the entire population was vaccinated against smallpox, and pools and cisterns were covered with mosquito repellent as part of the campaign to eradicate malaria. [1]
The public health care system in Israel was built on foundations of the system introduced during the British Mandate. Health insurance is administered by the Health maintenance organizations (Hebrew: קופת חולים, kupat holim, lit. sick fund, derived from the German Krankenkasse), most of which were set up by the labour unions before the founding of the State. These Health Maintenance Organizations are membership-based. Originally, the members paid membership fees to these funds , and received in return a set guarantee of health services.
In 1973 a special law was enacted which forced all employers in Israel to participate in the medical insurance of their workers, by means of a direct payment to the Health Maintenance Fund in which the workers were members. The duty of participation was eventually changed and diminished as part of the arrangements law (חוק הסדרים במשק המדינה) of 1991.
In 1988 the government appointed a Commission of Inquiry to examine the effectiveness and efficiency of the Israeli health care system. The commission handed in the final report in 1990. The main recommendation of this report was to enact a National Health Insurance law in Israel.
In 1995 the National Health Insurance Law came into effect, which made membership in one of the four existing Health Maintenance Organizations compulsory for all Israeli citizens. The law determined a uniform benefits package (סל בריאות) for all citizens - a list of medical services and treatments which each of the Health Maintenance Organizations is required to fund for its members. Additionally, certain services were brought under the direct administration of the State, usually by means of the Health Ministry. In addition, the law set out a system of public funding for health care services by means of a progressive health tax, administered by Bituah Leumi, Israel's social security organization, which transfers funding to the Health Maintenance Organizations according to a certain formula based on the number of members in each fund, the age distribution of members, and a number of other indices. The Health Maintenance Organizations also receive direct financing from the states money.
Before enactment the Health Insurance Law, the only Health Maintenance Organization to accept members without discrimination based on age or medical situation was the Clalit HMO which was then in the ownership of the Histadrut labour federation. After enactment of the 1995 law, membership in any of the four Health Maintenance Organizations was guaranteed for all citizens, and Israelis were given the right to transfer between Organizations once per year.
The 1995 law also imposed a system of financial and medical oversight of HMOs by the State. In addition to the uniform benefits package provided to all citizens, which provides coverage for basic and essential health care, every HMO fund provides their members with the option to acquire "supplementary insurance" (ביטוח משלים), which includes services and treatments that are not covered by the publicly-funded system.
The four nationwide HMOs are: Clalit (the largest with about 54% of the population belonging to it), Maccabi, Kupat Holim Meuhedet and Leumit.
Israel has maintained a system of socialized health care since its establishment in 1948, although the National Health Insurance law was passed only on January 1, 1995. [2] The state is responsible for providing health services to all residents of the country, who can register with one of the four health service funds. To be eligible, a citizen must pay a health insurance tax. Coverage includes medical diagnosis and treatment, preventive medicine, hospitalization (general, maternity, psychiatric and chronic), surgery and transplants, preventive dental care for children, first aid and transportation to a hospital or clinic, medical services at the workplace, treatment for drug abuse and alcoholism, medical equipment and appliances, obstetrics and fertility treatment, medication, treatment of chronic diseases and paramedical services such as physiotherapy and occupational therapy.[3]
Israel has one of the most technologically advanced and highest-quality healthcare systems in the world. Hospitals in Israel are equipped with modern facilities and high-quality medical technology. Medical staff are trained from four to six years in one of the country's five university medical schools. The country is a world leader in advanced infrastructure of 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.[4]
Seven Israeli hospitals have received accreditation from the Joint Commission International, an organization that sets safety standards for medical care: Soroka Medical Center in Beersheba, Ha'emek Hospital in Afula, Meir Hospital in Kfar Saba, Rabin Medical Center in Petah Tikva, Kaplan Hospital in Rehovot, Carmel Medical Center in Haifa and Assuta Medical Center in Tel Aviv.[5]
Providers in the Israeli healthcare system consist of a mixture of private, semi-private and public entities. Generally, family and primary medicine facilities are run directly by Clalit for its members while the other HMOs operate their own family practice clinics in the larger cities and contract with privately operated family practice clinics in smaller communities. As with primary practice, Clalit tends to provide specialty and outpatient care in their own clinics while the other HMOs generally contract with outside, private care physicians and facilities for this sort of service. In addition to these, the ministry of health in conjunction with various local authorities also runs a network of public well care and prenatal and infant care clinics throughout the country.
In 2010, there were 25,542 doctors in Israel - 3.36 doctors for every 1,000 people. This ratio is one of the highest of all industrialized countries.[6]
Emergency medical services in Israel are provided by the Magen David Adom (MDA) organization, which staffs approximately 1,200 emergency medical technicians, paramedics, and emergency physicians, and 10,000 volunteers. The organizations operates 95 stations and a fleet of over 700 ambulances. The majority of the fleet consists of Basic Life Support ambulances. There are also smaller numbers of Advanced Life Support ambulances and Mobile Intensive Care Units. For air ambulance services, MDA relies primarily on Unit 669 of the Israeli Air Force. There are also four MBB Bo 105 utility helicopters staffed with MDA paramedics owned by Lahak Aviation operating as air ambulances throughout the country. Non-emergency and repatriation air ambulance services are normally provided by private charter carriers.
Magen David Adom is supplemented in some areas by Hatzalah, an emergency ambulance services network serving Jewish communities worldwide, and ZAKA, a series of community emergency response teams staffed by Orthodox Jews, who in addition to providing medical services and evacuation, also aid in the identification of terrorism victims and gather spilled blood and body parts for burial. The Palestine Red Crescent Society also provides services to Arab neighborhoods in Jerusalem. It gained access to Jerusalem after signing a 2005 Memorandum of Understanding with Magen David Adom.
The ambulance system, for the most part, conforms to the Franco-German model of EMS care, and the presence of physicians at high-acuity emergencies is not uncommon. In addition, emergency ambulance services is bolstered by a variety of prviate carriers tasked with interfacility transfers only.
Israel is emerging as a popular destination for medical tourists.[7] In 2006, 15,000 foreigners travelled to the country for medical procedures, bringing in $40 million of revenue.[7] As of 2010, up to 30,000 foreigners come to Israel every year for treatment, mostly from Russia.[8]
Medical tourists choose Israel for several reasons. Some come from nations such as Romania and Cyprus where certain procedures are not available. Others come to Israel, perhaps most commonly from the US, because they can receive quality health care at a fraction of the cost it would be at home, for both surgeries and in-vitro fertilization procedures.
Other medical tourists come to Israel to visit the Dead Sea, a world-famous therapeutic resort.[7] The Israel Ministry of Tourism and several professional medical services providers have set out to generate awareness of Israel's medical capabilities.[9]
A significant number of residents of the Palestinian territories seek medical treatment in Israel, often for sophisticated tests or treatments not available at Palestinian hospitals. Their treatment is paid for under a financial arrangement with the Palestinian Authority, or in some cases, at their own expense. Palestinians who apply for medical treatment in Israel must first obtain a humanitarian entry permit from Israel, of which thousands are issued annually. In January 2009, following the Gaza War, the Palestinian Authority canceled financial coverage for all medical care for Palestinians in Israeli hospitals, including coverage for the chronically ill and those in need of complex care not available in the Palestinian territories.[10][11] Arab citizens of Israel belong to the same health care system as that of all other citizens of the country.
There are around 60 hospitals and medical centers in Israel.[12] In addition to general hospitals, there are a number of specialized hospitals throughout the country. Most of the hospitals are government-owned and operated by the Ministry of Health, although some are fully private. Most of the private hospitals in Israel belong to nonprofit or charitable organizations. Many of the private hospitals are run by Clalit Health Services.