Israel Health Care System:

Development and Challanges

Nadav Davidovitch, MD, MPH, PhD
Department 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 nancing 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 Healths dual role as service
provider and regulator
vague nancing 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
Households Government Year
25 75 1995
25.5 74.5 1996
29.2 70.5 1999
30.8 65.5 2001
31.5 65.7 2002
29.8 59.4 2003
30.8 57.8 2004
32.4 55.9 2005
33.5 54.5 2006
33.4 54.3 2007
32.1 54.3 2008
Co-payment as percentage of sick funds' income
Co-payment percentage of
sick funds' income
Year
5.7 1995
5.3 1996
5.6 1997
6.2 1998
7.6 1999
8.1 2000
8.8 2001
9.6 2002
7/11/2014
National Health Insurance Law
1994
National Health Insurance
according to this Law is
based on the principles of
justice, equality and
solidarity
7/11/2014
Age adjusted Odds Ratio of Death
of Women by Education & Time Period In Israel
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+
Y
e
a
r
s

o
f

e
d
u
c
a
t
i
o
n
IMR
Data: Israeli Ministry of Health, 2005
Mortality rate per 1000 live births
Y
r
s

e
d
u
c
a
t
i
o
n

X 3.5
Infant Mortality by Maternal
Education
1996-1993
7/11/2014
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
National South
Hospital beds (general)
2.0 1.4
Hospital beds
(mental health)
0.47 0.30
Geriatric beds (rates for
age 75+)
2.8 2.0
Rehabilitation beds
0.1 0.04
Dialysis
0.09 0.05
Emergency room
0.15 0.09
Gaps in health services Southern District
(rates per 1000 population)
South/
national rate
70%
64%
71%
40%
56%
60%
National South
Total 15.0 11.2
Dentists 0.8 0.4
Nurses 5.2 4.2
Doctors 3.2 2.5
Gaps in health care personnel Southern District
(rates per 1000 population)
South/
national rate
75%
50%
81%
78%