Israeli Health Care: A Model for the U.S.?

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JERUSALEM, Israel - As a close friend and ally of the United States, Israel may have a few tips to offer the U.S. in the ongoing debate over health care.

Despite Israel's location in the one of the world's most volatile regions, this small country - with its population of 7 million - has a lower infant mortality rate and a longer life expectancy rate than America.

So, from a medical perspective, the Jewish state must be doing something right.

Some would say comparing the U.S. and Israeli systems is like comparing apples and oranges because the U.S. population is 40 times higher than Israel's.

But with the healthcare debate raging in the U.S., the Israeli system is worth looking into, especially since polls show that at least 80 percent of Israelis are satisfied with the medical care they receive.

'Mixed Bag'
 
While most refer to Israel's healthcare system as socialized medicine, some say it's actually a mixed bag.

Dr. Bruce Rosen, director of the Smokler Center for Health Policy Research in Jerusalem, spoke with CBN News about Israel's health care system.
 
"Most of the financing [is] coming from the government and that's good because that makes sure that the system is equitable and everybody has access," Dr. Rosen said.

But the system works, Rosen says, because there is market-style competition. Each citizen chooses from four non-governmental providers, called a kupat cholim (literally, "sick funds," the U.S. equivalent of "health care" providers).

By law, the kupat cholim must provide a benefits package that covers hospitalization and doctors' visits. The co-payment for most drugs is nominal. Procedures ranging from in vitro fertilization to liver transplants are provided to anyone in the system, usually without a long wait.

Israeli System Preferred

The system is paid for mostly through income taxes. Even though Israelis pay much higher taxes than Americans, many who have received care under both prefer the Israeli system.

"I was in America the past three years and I'm a lot more satisfied with the health system here, especially [since] I have three kids and I visit doctors for all different reasons. I find them easy to access, very easy to get to," Havi Simmering told CBN News.

Dennis Gordon agreed.

"It's great. It controls prices. It has really good standards of care. Everything is really based on best care, best practices and you get what you need. You don't necessarily get nice waiting rooms, but you get everything else," he said.

Mandated Health Coverage

Health care developed here even before Israeli statehood, but it wasn't until 1995 that the national health insurance law mandated universal coverage and specified the benefits.

Prof. Shlomo Mor-Yosef, director-general of Hadassah medical organization, said statistics show that the Israeli health care system is cheaper and provides better overall care than the American system.

"Every citizen is insured [and it] doesn't matter if he has money or doesn't have money. Everyone has to pay health tax, which is around 5 percent of his salary. But if he has no income, he still gets the same service," the professor said.

"For Americans who have good insurance, the service in many places is better than the average in Israel. But if you compare - on a national level - the service in the U.S. and Israel and you measure outcome not just process, the outcome here for sure is better and the cost is less," he said.

Some Problems

Mor Yosef also heads the Israel National Institute for Health Policy and Health Services Research, which recommends improvements to the health care system.

He said the Israeli system does have its problems. For instance, medical care is better in cities than in rural areas. Professionals are forecasting a shortage of doctors and nurses, and there is never enough money.

Dr Elisha Waldman, a pediatric oncologist at Hadassah Hospital in Jerusalem, worked at Sloan Kettering in New York before moving to Israel two years ago. He said low salaries for doctors are causing many of them to consider leaving the country.

"I think it's a serious problem that this country is going to have to deal with, and this is probably the Achilles heel of the socialized medical system here," Dr. Waldman said. 

But Waldman, who also spent time in a private practice, said Americans have their problems, too.

"People don't like to hear this and people don't like to think about this, but medicine is a business. The same way as the guy who runs the corner stores needs to have a profit margin on selling milk and bread, private, medical offices need to have a margin of profit," he said.

Learning from Israel's Program

Despite the challenges with Israel's health care, medical professionals from the U.S. are consulting Rosen's institute to see what they can learn from the Israeli program.

"For example: our system of electronic health records. For example: how we do primary care in an effective way. How we keep people out of hospitals unnecessarily. How our health plans are mostly there helping the doctors do a better job and not getting in their way with bureaucracy," Dr. Rosen said.

Rosen believes the main message Israel has to offer is that a health care system can give good care and not leave the poor behind.

*Originally published July 15, 2009

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