Manfred 19 8-15 - israeli healthcare system - ukraine
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The Israeli Health Care System Manfred S Green MD,PhD School of Public Health, University of Haifa 19-8-15
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Transcript of Manfred 19 8-15 - israeli healthcare system - ukraine
The Israeli Health Care System
Manfred S Green MD,PhD
School of Public Health,University of Haifa
19-8-15
Population: ~ 8,000,000 Jews: 75%, Arabs 20%, Others
5% Age: Over 65 – 10%, Under 15 –
28% Area – About 3% of Ukraine GDP: $35,800 per cap. (PPP) Government: Parliamentary
democracy
Israel
Life Expectancy at Birth - Selected Countries
1975 1980 1985 1990 1995 2000 2005 20107072747678808284
73.975.7
7778.4
79.580.5
82.3 82.8
70.372.1
73.574.9 75.5
76.578.3 78.5
Women Men
Age
Ranked 16th in the world (CIA Factbook 2010)
Life Expectancy in Israel
Infant Mortality Rates
Health Expenditure as a Percent of GDP
Health Expenditure Per Capita (USD)
Practicing Physicians per 1,000 Population
Hospital Beds per 1,000 Population
MRI Units and CT Scanners
2012
US = 33
Health care is considered as a fundamental Human Right and is taken care of by the government
National Health Insurance Law - 1995: All Israeli residents entitled to basic health
care Based on equity and solidarity The law determines the medical services
which each of the four health funds is required to provide for its members.
Health Care
Principles Health as a national priority Universal access Strong tradition of primary care and
prevention Increasing attention health promotion Adoption of leading world standards Research, teaching and service
Dealing with Changing Health Needs
PrioritiesHealth targetsCost effectiveness analysisReform in structure and
contentPopulation-based health
approachPerformance indicators Health promotion
Principal Components of the Health System
Primary health service delivery system
Health workforce Leadership and governance Health systems financing Supply of medical products and
technologies Health information systems Households
The Israeli Health System
Ministry of Health
Health Funds
Klalit 54%
Maccabi 24%
Meuhedet 12%
Leumit 10%
Hospitals
Acute Care 46
Beds: 14,582
Psychiatric 14
Beds: 4,240
Geriatric 310
Beds: 22,283
Ministry of Finance
Resources and Regulation – the State
Responsibility for Personal Health - Health Funds
Suppliers of Services – Health Funds and Others Primary care – Mainly HF Hospitals – HF, Governmental, Other
public Workforce – mainly salaried
Structure of the Health Care
System
National Health Insurance Law 1995
Universal, compulsory, health insurance Financed by earmarked and general
taxation Citizens pay a healthcare tax – 4.8% of
income “Cost of the Basket of Services” :
Based on previous expenditures of the health funds
Updated yearly based on a health index
If the taxes not sufficient, the government must add to guarantee the basket of services
Special Fund for New Technologies
Special allocation of funds each year for new technologies
Recommended by national professional councils and the drug industry
Evaluated by an MOH committee headed by a senior medical professional with representatives from the public
Providers of Health Care
MOH Mother and Child Clinics (Tipot Halav)
Initiated in 1912 and run by MOH Immunization, growth and
development Vits A, D, routine iron supplements Pregnancy care Parallel to clinics of Sick Funds Some subcontracted to health funds Located in every neighborhood Nursing staff and visiting MDs
Every citizen is a member of an HMO (Health Fund)
Health funds provide a uniform, legally defined basket of services for every citizen
Citizens are free to choose and move There are public and private
providers of services
The Health Funds (HMOs)
Supplies services - own facilities and outside providers
Selectively contracts with providersFree patient choice of physician Methods of payment to providers:
Physicians: Quarterly visits within global budgetHospitals: Negotiated Caps Other providers: Fee-for-service
Functions of the HMO
Co-payments for medications, visits to physicians and specialist clinics
Services not currently covered by the health funds include much of mental health, long term nursing care, and dental care for adults
Health funds offer supplementary health insurance for additional services
Extra Charges to Patients
Acute Care Hospital System
11 Ministry of Health Hospitals 46.5% of beds 8 Klallit Health Fund Hospitals 30.4% of beds 7 Non-profit Hospitals 10% of beds 2 Hadassah Hospitals 6.0% of beds 6 Mission Hospitals 3.6% of beds 11 Private for-profit Hospitals 3.4% of beds 1 Meuhedet Hospital 0.1% of beds
Number of Beds = 14, 582 – 2.05 beds/1000
Characteristics of the Acute Care Hospital System
All hospitals have outpatient ambulatory services
All public hospitals have Emergency Rooms Staffing linked to the number of beds in
each department Physicians are salaried employees of the
hospital Hospital physicians may have private
practices and may contract with health funds as independent doctors
Funding the Israeli Health Care System
● Public and Private Financing
● Public and Private Healthcare Services
Budgeted by the state through a “Capitation Mechanism” - Prospective budget = # of enrolled capita weighted by age and residence location.
Supply of healthcare services Primary care – supplied by the health funds’
personnel Secondary (Specialists’) care – supplied by
health funds’ personnel or purchased Tertiary (hospital) care – Owned or purchased
Budget and Function of the HMO’s (“Health Funds”)
1st level – Public + copayments
2nd level – Semi private 3rd level - Private
Financing Health Care
Paid through taxation – about 5% of salary Discount to low income families. Minimum payment for unemployed
Free Basic Package of services Defined by law and updated annually Co-payment for drugs ($4) and ambulatory
services (~$6). No co-payment for hospitals. Very wide coverage (incl. fertility, cancer,
transplantation etc.) Limited choice of suppliers
The 1ST level
Cosmetic Plastic Surgery Dentistry for adults Non-conventional medicine
Services Not Supplied
Semi-Private insurance Low cost, Based on age only (~20$ per month)
No denial for any reason (by law) Managed by the health funds but
financially separated from basic insurance Coverage – 80% of the population
The 2nd level
Private insurance Administered by private insurers Expensive ($100+/month) premium Very limited addition of services as compared to 1st
and 2nd levels Underwriting (Cost of premium related to the
insured health status) Owned by 42% of the population
The 3rd level
I pay 10%-48% income tax (14%) per month.
In addition I pay 5%-15% of my salary for social security and the health tax
I pay for supplementary insurance to the health fund - ~20$ per month
I can also add a private insurance or to get it from my work place
Let’s try to summarize how it works
1st level
2nd level
3rd level
Computerization of the Healthcare System
Electronic Medical Record Every transaction computerized The Central Medical Record Electronic laboratory results,
prescriptions and consultations Telemedicine Alerts and Reminders Patient Website
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
1. Eliminate ineffective and inappropriate services2. Improve rational use of medicines
3. Allocate more to public health, primary and outpatient specialist care at the expense of hospital care
4. Invest in infrastructure that is less costly to run – “invest to save”5. Cut the volume of least cost-effective services
Focus on Health Systems’ Performance -
WHO
Manfred S Green
Questions?
Acknowledgements I wish to acknowledge the various people
who have made their presentations freely available on the internet.
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SDR, chronic liver disease andcirrhosis, all ages per 100000
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% of regular daily smokersin the population, age 15+
