Physicians, health-policy analysts and insurers from the US are learning from the Israeli example about how to provide universal coverage and excellent healthcare at low cost.
With President Barack Obama’s health care bill finally passed in the US, top US medical groups are looking to the Israel healthcare model to learn about the country’s success in ensuring that all its citizens receive quality primary medical care.
The US-based Jewish Healthcare Foundation (JHF) brought a group of physicians, health-policy analysts and insurers on a fact-finding visit to Israel as guests of the Myers-JDC Brookdale Institute, Israel’s leading social and health-policy think tank. The purpose: To find out how Israel achieves universal coverage and excellent health care at low cost.
A summary of the trip, titled ‘Israel Does it Right,’ has had a significant ripple effect. “Others have followed our lead and invoked Israel as a model of what a dedicated national commitment to universal coverage can yield,” Karen Wolk Feinstein, president and CEO of JHF and the Pittsburgh Regional Health Initiative, tells ISRAEL21c.
According to Feinstein, the US healthcare system does not have high quality overall, and it is far and away the most expensive on earth. “Israel’s per capita costs are half those of the United States and it provides better health care,” she says.
“Our system is very lean and efficient,” said Eli Defes, CEO of Israel’s largest health fund, Clalit Health Services, in an interview last month in Israel’s financial daily, Globes. And Israeli statistics beat out those for the US, with longer life expectancy (79.7 years) and substantially lower rates of both death from cardiovascular disease and infant mortality.
Israel as a model for low-cost, universal care
“In Israel, healthcare begins at birth. Everyone is covered. The national health care insurance system is predominantly publicly financed – through taxation linked to income and general revenue. It is regulated by the government,” Dr. Bruce Rosen, director of the Smokler Center for Health Policy (Myers-JDC Brookdale Institute) in Jerusalem, tells ISRAEL21c.
Rosen explained that Israelis choose among four medical insurance plans, referred to in Hebrew as “sick funds.” Each non-profit plan must provide its members with a benefits package that includes physician services, hospitalization (for procedures ranging from operations like appendicitis to in vitro fertilization to organ transplants) and outpatient oncology treatment. Dental health is not included.
Cost sharing for drugs, doctor visits and certain diagnostic tests are ‘embedded,’ and there was a time when the socialist-inspired system provided drugs for free, but it was later decided that nominal fees should be charged to generate some income. Each year, the government approves additions to the drugs and procedures covered in the health basket.
Despite the normal gripes about having to wait, especially for tests and surgery supplied in hospitals (it may take some weeks to schedule an operation and people sometimes have to travel to another city for an MRI), the system receives high satisfaction ratings. According to polls, 80 percent of Israelis are satisfied with their health plan and only one percent a year switches plans.
“It is worth noting that health fund managers still feel competitive pressures to give good service to draw in more members,” Rosen comments, adding that “Young adults and new immigrants choosing a plan for the first time are enough to keep the plans on their toes.
Learning from each other
Dr. Keith Kanel, chief medical officer for the JHF and the PRHI sees the emphasis on primary care as a major strength of the Israeli health system. “It is built upon the nation’s extraordinary core values of egalitarian and cultural cohesion,” he says.
Israelis also seem to have a stronger sense of their place in the community, says Kanel, and this view is supported by Dr. Linda Emanuel, director of the Buehler Center on Aging, Health & Society, Northwestern University School of Medicine, who was a member of the group that visited Israel: “Even the most ambitious people we met assumed that their personal success was the same as optimal health care systems for the whole. They assumed that the community matters,” she says.
Another edge Israel has, according to Rosen, is the use of digital medical records by primary care physicians. In Israel, a doctor can spot changes in blood tests and patients can access the test results on their home computers. In the US, only 30 percent of primary care doctors use IT.
However, Israel seems to be drifting toward an increase in personal expenditure for healthcare. In 1995, the public had to cover 33% of health expenditures with co-payments, while according to a recent report Israelis now pay for 43% of all health costs. Many pay extra for additional coverage (that can include discounts on drugs and options to see specialists); others opt to see specialists and seek surgery through high-cost, private insurance plans.
“Perhaps most interesting is how the systems have begun drifting ever so slightly toward each other,” concludes Kanel. “The US is expanding coverage, and Israel is offering more free-market choices to patients. So what we learn from each other is particularly timely.”