Israel’s Health System and Health Status of the Population
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Israel’s Health System and Health Status of the Population TH Tulchinsky MD MPH Braun School of Public Health, Hebrew University-Hadassah, Jerusalem Nov 2010
description
Israel’s Health System and Health Status of the Population. TH Tulchinsky MD MPH Braun School of Public Health, Hebrew University-Hadassah, Jerusalem Nov 2010. The Past. Province of Ottoman empire to 1917 Rampant malaria, diarrhoeal, respiratory and other infectious diseases - PowerPoint PPT Presentation
Transcript of Israel’s Health System and Health Status of the Population
Israel’s Health System and Health Status of the
Population
TH Tulchinsky MD MPHBraun School of Public Health,
Hebrew University-Hadassah,
Jerusalem
Nov 2010
The Past
• Province of Ottoman empire to 1917
• Rampant malaria, diarrhoeal, respiratory and other infectious diseases
• High infant and child mortality rates
• Charitable and missionary hospitals in 19th C
New Beginnings
• 1911 - Hadassah nurses - MCH clinics– Milk Stations: New York Henry St Mission – Tipot Halav (Goutes de Lait)
• 1912 - Sick Funds – Central European origin– Political affiliations
• 1917-1947 British mandate – Colonial law– Civil administration
British Mandate 1917-1947
• British colonial law• Professional public health officers• Public health structure• Business licensing, zoning• Sanitation by municipalities• Public health laboratories• Professional licensing law - doctors, nurses etc. • Licensing of medical facilities• Food control laws and inspection• Malaria control• Annual public health reports
Basis of Israel’s Health System
• Tipot Halav established 1911• Sick Funds, established 1912• Modern hospitals from 1917• Voluntary health insurance - political Sick Funds• Ministry of Health, established 1948• National Health Insurance, 1995• 1948-58 establishment, absorption, settlement• 1958-78 development• 1978-2007 reaching world class
Tipot Halav (MCH)• Initiated 1912 as Milk Stations• Min Health (75%), Municipal (15%), Sick Funds
(10%) • Nursing staff and visiting MDs• Separates prevention from curative services• Located in every town, village, neighborhood• Parallel to primary care clinics of Sick Funds• Immunization, well child care, play with children• Growth and development • Vits A, D, routine iron supplements (4-12 months)• Pregnancy care• Care of the elderly• Tipot Halav, an Israeli institution to present time
State of Israel• Independence 1947-48• MOH established• Hospitals in old British army camps• Public health network expanded• Large scale war injuries • Large scale immigration – survivors of Holocaust
and from Arab countries• Lack of basic infrastructure and experienced
leadership• Improvisation • Tipot Halav for all• Sick Funds for all immigrants
Immigration and Settlement
• Massive immigration 1948-51• Population doubled in 3 years, • Sick fund coverage for all immigrants• Immigrant camps, new towns and settlements• Primary health care in all towns, villages,
settlements -Tipot Halav and Kupat Holim• Epidemics of polio, diphtheria, pertussis, measles• High infant mortality, diarrhoeal and resp diseases• Regional hospitals - governmental• Opening of nursing schools• Hebrew University medical school reopened
Stabilization, 1958-67
• Economic growth and stagnation• Control of infectious diseases• Immunization controls major childhood diseases• Sanitation improves• Standards of living increase• Nutrition with improved food supply• Improved research, • Medical, nursing other education• Medical/pharmaceutical industries developed
Consolidation, 1967-1994
• Six Day War – West Bank and Gaza under Israeli occupation and authority for civilian services
• Exposure to infectious disease entry from West Bank and Gaza - cholera, polio, measles
• Improved disease control in WB/Gaza• Growing sophistication of research with strong
science base• Medical schools – now 4 + 2• School of public health and 4 other MPHs• Medical/pharmaceutical industries - world class
National Health Insurance, 1995
• National health insurance law National Insurance Institute
• Compulsory employer/employee contribution• Competing Sick Funds - four• Universal coverage• Standard basket of services• Annual updating• Reduced political manipulation• Capitation payment to Sick Funds• No regional administrative structure
Major Trends
• Primary care emphasis• Reducing hospital supply and ALOS• Expenditures about 8% of GNP• Longevity among highest in world • Men>women compared internationally• Declining total mortality• Declining stroke, CHD and trauma mortality • Expanding immunization program• Improving nutrition
0
10000
20000
30000
40000
1995 2000 2005 2010 2015
IsraelRussian FederationEU members before May 2004 EU members since 2004 or 2007
Real gross domestic product, PPP$ per capita
0.75
0.8
0.85
0.9
0.95
1
1970 1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited Kingdom
UNDP Human Development Index (HDI)
5
6
7
8
9
10
11
12
1995 2000 2005 2010 2015
FranceIsraelRussian FederationUnited Kingdom
Total health expenditure as % of gross domestic product (GDP), WHO estimates
30
40
50
60
70
80
1970 1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited Kingdom
Total inpatient expenditure as % of total health expenditure
5
10
15
20
25
30
1970 1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited Kingdom
Live births per 1000 population
200
300
400
500
600
700
800
900
1000
1100
1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited KingdomEU members since 2004 or 2007
Acute care hospital beds per 100000
0
5
10
15
20
1970 1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited KingdomEU members since 2004 or 2007
Average length of stay, acute care hospitals only
60
65
70
75
80
85
1970 1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited KingdomEU members since 2004 or 2007
Life expectancy at birth, in years
0
5
10
15
20
25
1970 1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited KingdomEU members since 2004 or 2007
Infant deaths per 1000 live births
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100
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400
500
1970 1980 1990 2000 2010 2020
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SDR, ischaemic heart disease,all ages per 100000
0
100
200
300
400
1970 1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited KingdomEU members since 2004 or 2007
SDR, cerebrovascular diseases, all ages per 100000
10
20
30
40
50
1970 1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited KingdomEU members since 2004 or 2007
SDR, malignant neoplasm female breast, all ages per 100000
1
2
3
4
5
6
7
8
9
10
11
1970 1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited KingdomEU members since 2004 or 2007
SDR, cancer of the cervix, all ages, per 100000
0
50
100
150
200
250
300
1970 1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited KingdomEU members since 2004 or 2007
SDR, external cause injury andpoison, all ages per 100000
0
5
10
15
20
25
30
1970 1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited KingdomEU members since 2004 or 2007
SDR, motor vehicle traffic accidents, all ages per 100000
0
10
20
30
40
1970 1980 1990 2000 2010 2020
IsraelEU members before May 2004 EU members since 2004 or 2007CISCARK
SDR, suicide and self-inflicted injury, all ages per 100000
0
10
20
30
40
1970 1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited KingdomEU members since 2004 or 2007
SDR, chronic liver disease andcirrhosis, all ages per 100000
100
200
300
400
500
1970 1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited KingdomEU members since 2004 or 2007
Average amount of fruits and vegetables available per person per year (in kg)
20
25
30
35
40
1970 1980 1990 2000 2010
IsraelUnited KingdomEU members before May 2004 EU members since 2004 or 2007CISCARK
% of total energy available from fat
20
25
30
35
40
1980 1990 2000 2010 2020
FranceIsraelRussian FederationUnited KingdomEU members since 2004 or 2007
% of regular daily smokersin the population, age 15+
20
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Total inpatient expenditure as % of total health expenditure
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100
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1970 1980 1990 2000 2010 2020
IsraelKazakhstanNorwaySpainUnited Kingdom
Measles incidence per 100000
0
50
100
150
1970 1980 1990 2000 2010 2020
IsraelUnited KingdomEU members before May 2004 EU members since 2004 or 2007CISCARK
Tuberculosis incidence per 100000
0
1
2
3
4
5
6
7
1970 1980 1990 2000 2010 2020
IsraelUnited KingdomEU members before May 2004 EU members since 2004 or 2007CISCARK
AIDS incidence per 100000
0
50
100
150
1980 1990 2000 2010 2020
FranceIsraelKazakhstanUnited Kingdom
Female breast cancer incidence per 100000
0
10
20
30
40
50
1970 1980 1990 2000 2010 2020
IsraelUnited KingdomEU members before May 2004 EU members since 2004 or 2007CISCARK
SDR, malignant neoplasm female breast, all ages per 100000
10
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30
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60
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1980 1990 2000 2010 2020
FranceIsraelKazakhstanUnited Kingdom
Trachea, bronchus and lung cancer incidence per 100000
Ministry of Health
National Insurance Institute
Sick Funds
Sick Funds
Public Health
Mental Health
MentalHospitals
Clinics MDs
EmployeeEmployer Taxpayer
Per capita
Hospitals Ambulatory care
Israeli Health System
Tipot Halav
Additional Funding
Israel’s Health Achievements
• Universal health coverage and access to care• Strong MOH control over hospital sector• Strong traditions of public health• Control of infectious diseases• Control of non infectious disease e.g. CHD, stroke• Strong medical-pharmaceutical industry• Strong basic and clinical sciences • Strong epidemiology training and research
• Protective nutrition e.g. fruit/veg consumption
Problems Common to Industrial Countries
• Inequalities - poverty - 20% of population • Health cost control • Aging of population• Absorbing new technology and pharmaceuticals• Social and regional inequities • Cardiovascular diseases• Trauma• Nutrition • Diabetes, obesity and related conditions• Micronutrient deficiency conditions – iron, iodine,
FA, vits B, D, calcium, zinc, selenium
Dealing with Changing Health Needs
• Health targets
• Priorities
• Cost effectiveness analysis
• Reform in structure and content
• Health promotion
• Population-based health approach
• Performance indicators in place of norms
Summary • Strong tradition of primary care
• Increasing attention to prevention
• Universal access
• Adoption of leading world standards
• Research, teaching and service
• Basic sciences, technology, clinical applications
• Nutrition and health promotion
• Health as a national priority
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