Israel’s health system has been recognized internationally as one of the most effective models of health care, both in terms of its emphasis on health in the community and its relatively low cost.
There has been growing concern, however, that recent changes are threatening some of its most important achievements and are eroding the general public's confidence in the system.
These include the decline in resources available to the publicly financed system, increasing use of private health insurance and private health care to supplement public care, and the movement of senior physicians and resources from the public to the private system.
These trends have contributed to greater gaps in access to health care between those who can and cannot afford private care.
In response to these concerns, Minister of Health Yael German established the German Committee to Strengthen the Public Health System, as reported in our Summer/Fall 2013 Newsletter.
This past June, the Committee issued its report, which represents the most significant proposed reform to Israel's health care system since the 1995 introduction of national health insurance.
The committee's 100+ recommendations have been designed to significantly strengthen the public system and prevent further growth of the private health care system. The government has already begun to implement some of the recommendations, including:
· An immediate increase in the health system's base funding by about 2%. Health budgets will also be tied to a demographic index and will grow as the population grows and ages. This will prevent the erosion of health care resources that characterized the first two decades of national health insurance.
· An initiative to modernize the hospital pricing system, to better reflect true costs, provide incentives for greater efficiency, and reduce incentives for cream-skimming.
· An effort to reduce waiting times for surgical operations in public hospitals, by providing incentives for hospitals to staff additional shifts in operating rooms, to expand staffing slots for operating room nurses, and to create a new profession of anesthesiology assistants. The government is also planning to publish hospital-specific data on waiting times to push hospitals to reduce wait-times and to guide hospital choice for patients and health plans.
· The limitation of private medical services (known in Hebrew as sharap) to Jerusalem medical centers where they currently exist, with no expansion to hospitals elsewhere in the country.
· Encouraging selected senior physicians in hospitals to become full-time hospital employees. This would reduce the practice in which doctors leave the public hospitals to work in private clinics in the afternoons, and would thus expand their availability to treat patients and perform surgery in public hospitals.
· Israelis wishing to purchase additional health insurance beyond the universal basket of services will be able to choose from a simplified array of options, with greater competition among providers. The goal is to reduce costly duplicate insurance coverage and improve efficiency.
· The rapidly growing medical tourism field, whereby foreigners come to Israel to obtain medical care, will be more closely regulated so as to avoid negatively impacting the care of Israeli citizens.
Minister German personally chaired the committee, which included top-level representation from government, the health care system, and external experts.
MJB played multiple and significant roles in the German Committee’s work. MJB's Dr. Shuli Brammli-Greenberg, a senior researcher at the Smokler Center for Health Policy Research and Israel's leading expert on the private health insurance market, served on the 14-person committee. She also served on the subcommittee on private insurance and was part of the team that developed the new system’s delivery model.
Smokler Center Director Dr. Bruce Rosen and Center staff prepared a set of key background papers for the Committee, including a review of international experience, and contributed important testimony.
In September, the Director General of the Ministry of Health, together with senior budget staff from the ministries of Health and Finance, met with MJB's international Health Advisory Committee to solicit their input and advice on the reform.
The Institute’s multiple contributions are based on its longstanding involvement in the most important issues facing the health system, and on its reputation for independence and objectivity.
This is a defining moment for Israel’s health care system, and its future will be deeply influenced by the extent to which these recommendations will be implemented. As the government implements the reform, MJB will assist in its planning and in the evaluation of key elements. Prof. Gary Freed, chair of the Smokler Center's Health Advisory Committee and professor in the University of Michigan School of Medicine, described the German Committee’s report as “an example of outstanding public responsibility. The Institute's contributions demonstrate the fundamental role that MJB's professionals play in national policy deliberations.”