israel health care system 2014
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israel health systemTRANSCRIPT
Israel Health Care System:Development and Challanges
Nadav Davidovitch, MD, MPH, PhDDepartment 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 financing 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 Health’s dual role as service
provider and regulator• vague financing 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
YearGovernmentHouseholds19957525199674.525.5199970.529.2200165.5 30.8200265.7 31.5200359.429.8200457.830.8200555.932.4200654.533.5200754.333.4200854.332.1
Co-payment as percentage of sick funds' income
YearCo-payment percentage of sick funds' income
19955.719965.319975.619986.219997.620008.120018.820029.6
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National Health Insurance National Health Insurance Law 1994Law 1994
“National Health Insurance according to this Law is based on the principles of justice, equality and solidarity …”
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Age adjusted Odds Ratio of Death Age adjusted Odds Ratio of Death of Women by Education & Time Period In of Women by Education & Time Period In
IsraelIsrael
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+
Year
s of
edu
catio
n
IMR
Data: Israeli Ministry of Health, 2005
Mortality rate per 1000 live births
Yrs
educ
atio
n
X 3.5
Infant Mortality by Maternal Education1996-1993
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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
SouthNational
1.42.0Hospital beds (general)
0.300.47Hospital beds (mental health)
2.02.8Geriatric beds (rates for age 75+)
0.040.1Rehabilitation beds
0.050.09Dialysis
0.090.15Emergency room
Gaps in health services – Southern District) rates per 1000 population(
South/national rate
70%
64%
71%
40%
56%
60%
South National
11.215.0Total
0.40.8Dentists
4.25.2Nurses
2.53.2Doctors
Gaps in health care personnel – Southern District) rates per 1000 population(
South/national rate
75%
50%
81%
78%