Summary of 2016 Healthcare Survey

Summary of the Findings from the Eleventh Survey of Public Opinion on the Level of Service and Performance of the Healthcare System in Israel: 2016

Shuli Brammli-Greenberg, Tamar Medina-Artom and Alexey Belinsky

Summary

Since 1995, Myers-JDC-Brookdale Institute has been monitoring the performance of the healthcare system from the perspective of the insured. The following is a summary of the findings from the survey conducted from August to December 2016. [1] [2]

In general, the survey presents a complex picture of the public experience as expressed in two measures: satisfaction and confidence of receiving assistance in the event of serious illness. While the levels of satisfaction with the health plans and the system are high, there is little sense of confidence that assistance will be given in the event of serious illness.

Most of the respondents (90%) had seen their family physician in the previous year: 35% reported that the most recent visit was for the sole purpose of filling out forms and receiving documentation.
About half of the respondents (45%) reported that they had seen a specialist through their health plan in the previous three months and 19% had seen a specialist privately (a decline from 26% in 2014).
One in four patients who visited a specialist through the health plan reported waiting more than a month for the appointment. Twenty-seven percent of the respondents reported going without a medical treatment due to the long waiting time (approximately 70% of those patients went without seeing a specialist and 30% went without some other medical service).
There was a slight decline in the percentage of respondents reporting that in the previous year they went without a medical treatment or medication due to the cost (9% in 2016, vs. 11% in 2014). There was no change in the percentage of those reporting that they went without a service because it was far away (10%).
There was a considerable decline in the percentage reporting that they or another family member went without dental treatment because of the cost to them (from 25% in 2014 to 18% in 2016).
The rate of respondents with voluntary insurance (supplemental or commercial) remained high: 84% had supplemental insurance and 57% owned commercial health insurance (a slight increase over 53% in 2014).
In 2016, we asked the respondents whether they had felt the need to pay a discreet, informal payment in order to receive preferential health services in the previous 5 years. 6% answered “yes” and 1% refused to answer the question.

Selected Findings

In general, the survey presents a complex picture of the public experience as expressed in two measures: satisfaction and confidence of receiving assistance in the event of serious illness.

On the one hand, the general level of satisfaction with the health plans and the health system remains high: 89% of the respondents were satisfied or very satisfied with their health plan services and 63% were satisfied or very satisfied with the healthcare system.
On the other hand, the level of confidence that they would receive assistance in the event of a serious illness was low: 44% were confident or very confident that they would get the best and most effective treatment in the event of a serious illness and 31% were confident or very confident that they would be able to afford the treatment they needed.
With regard to assistance from the service providers in the event of a serious illness, 44% responded that they were confident or very confident that they would get the assistance from the health plans; 46% noted this about public hospitals, and 41% about the insurance companies.

Figure 1: Satisfaction vs. Confidence in the System in the Event of Serious Illness

Each column presents the percentage of respondents who noted the top two categories (satisfied and very satisfied/confident and very confident)

The complex picture of both measures is also expressed in the differences among the health plans:[3] [1]

[3] All the differences among the health plans emphasized in this document are statistically significant in chi square tests and constant in multivariate analyses after controlling for background variables: age, sex, income, ethnic background, domicile, and chronic illness. For further detail, see Appendix 1.

Among members of Maccabi Healthcare Services, a relatively high percentage reported satisfaction with the health plan in general: 93% of them reported that they were satisfied or very satisfied with the health plan’s services, compared with an average of 88% of members of the other health plans.
Among members of Clalit, a relatively high percentage reported that they were confident or very confident that in the event of a serious illness that would receive assistance from the health plan (48%, compared with an average of 41% of members of the other health plans) and from public hospitals (50% vs. 43% of members of other health plans).
Among respondents aged 65+ the percentage of those who were satisfied or very satisfied was relatively high among members of Maccabi (92%) and the Meuhedet (91%). The percentage of respondents aged 65+ reporting that they were confident they would receive assistance from the health plan in the event of serious illness was relatively high among members of Leumit (55%) and Clalit (53%).

The percentage of respondents who were very satisfied with aspects of the health plans’ services remained high (7 aspects were measured):

The aspects of service that received the highest percentage of reports of very satisfied were the attitude of the family physician (55%) and the professionalism of the family physician (47%). 48% were very satisfied with the attitude of the nurses, 43% with the lab services, 42% with the ease of obtaining medication, 38% with the ease of obtaining referrals and medication, and 34% with the professionalism of specialist physicians. Altogether, 37% were very satisfied with the health plan in general.

In 2016, for the first time, we examined satisfaction with the health plans’ telemedicine options:

Altogether, 42% reported that they had read personal medical information on their health plan’s website: 59% among Maccabi members, 38% among Clalit members, 33% among Leumit members and 32% among Meuhedet members.
A fifth (20%) reported that they had contacted their family physician via the health plan website or online services: 37% among Maccabi members, 16% among Clalit members, 13% among Leumit members and 5% among Meuhedet members.
36% reported that they were very satisfied with these options: 45% among Maccabi members, 34% among Clalit members and 26% among Meuhedet and Leumit members.

Transferring among the health plans

7% of the respondents reported that they had changed health plan in the previous five years. The main reasons given were: the deployment of services and possibilities of choice of service provider, the quality of care, the family physician, and the wish to be a member of the same health plan as the rest of the family.
14% reported that they had thought about changing health plan in the previous five years, but decided not to. The main reasons for not changing were: the bureaucracy, the wish to stay with the family physician or with the rest of the family, and the fear that it would be detrimental to their eligibility for services, or that health plan they wanted to transfer to would not accept them.

Most of the respondents (90%) had contacted the family physician in the previous year; 35% of them reported that the most recent visit had for the sole purpose of filling out forms and receiving documentation (with no need for a medical examination)

There are differences among the ages: About half (48%) of those aged 65+ reported that the visit had been solely to complete forms and receive documentation.

Referral to specialist in previous three months

About half (45%) the respondents reported that they had seen a specialist through the health plan in the previous three months. While the percentage of those referring to a specialist through their health plan remains similar to 2014, the percentage of those referring to a private specialist declined from 26% to 19%. About half of those who sought a private specialist also saw a specialist through the health plan.

One in four patients who saw a specialist through the health plan reported waiting over a month for the appointment.

There are differences among the ages: 34% of patients aged 65+ reported that they waited more than a month, compared with 26% aged 45-64 and 21% aged 22-44.

Figure 2: Waiting Time for an Appointment for a Specialist through the Health Plan (among those who visited a specialist, waiting time for most recent visit)

The lowest national average waiting time was among members of Meuhedet: it had the highest percentage of patients who waited up to two weeks (66% vs. an average of 52% in the other health plans). At the same time, the percentage of patients waiting more than a month was lowest in Meuhedet (21% vs. an average of 26% in the other health plans).

Percentage of patients who went without medical treatment due to the long waiting times:

27% reported going without treatment due to the waiting time for an appointment. Around 70% of these reported that they went without seeing a specialist and 28% of them saw a private physician (vs. 15% of the others).

Going without medical treatment or medication because of the cost:

7% reported that they went without medical treatment because of the cost and 5% went without prescription medication because of the cost. Altogether 9% went without medical care or prescription medication because of the cost (a slight decline compared with 11% in 2014).

Association between going without medical treatment and lack of confidence in the system in the event of serious illness:

Among those who reported that they went without treatment due to the waiting time for an appointment, 70% noted that they were not so confident or not at all confident that they would receive the best treatment and 77% of them noted that they were not so confident or not at all confident that they could afford the treatment.
Among those who reported that they went without medical treatment or prescription medication because of the cost, 77% noted that they were not so confident or not at all confident that they would receive the best treatment and 92% of them noted that they were not so confident or not at all confident that they could afford the treatment.

Considerable decline in the percentage of respondents reporting that they went without dental treatment because of the cost:

There was a considerable decline in the percentage of respondents reporting that they or a family member had gone without dental treatment because of the cost to them (from 25% in 2014 to 18% in 2016). The greatest decline was in the Jerusalem district (from 41% in 2014 to 27% in 2016), although the percentage in that district remains high.
The types of dental treatment most respondents went without were root canals and crowns (27% of those who reported going without dental treatment), implants (22%), and general check-ups or visits to the hygienist (20%).

Association between going without medical treatment, income, and chronic illness:

There was a higher rate of patients going without treatment or mediation due to the cost among respondents in the lowest income quintile than among those with higher incomes (14% vs. 8%, respectively). A higher percentage of them also reported going without dental care (31% vs. 16%, respectively).
In contrast, the rate of patients going without treatment due to waiting times for an appointment was lower in the lowest income quintile than among respondents with higher incomes (20% vs. 29%, respectively). This might have something to do with the ability to go to a private physician.
No difference by income was found with regard to going without treatment due to geographical distance.

Figure 3: Going Without Medical Treatment or Medication, by Income Group

The percentage of patients with chronic illnesses reporting that they went without treatment or
medication because of cost was higher than among healthy individuals (12% vs. 8%), and the percentage of patients with chronic illnesses reporting that they went without dental treatment because of cost was higher than among healthy individuals (22% vs. 17%). No difference was found between patients with chronic illness and healthy individuals with regard to geographical distance and waiting times.
From 2014 to 2016, there was a decline in the rate of chronically ill patients who went without treatment or medication because of the cost (12% vs. 15%), and the rate of chronically ill patients who went without dental treatment because of the cost (22% vs. 26%).

Emergency medicine: This year we asked, for the first time, about visits to hospital emergency rooms and emergency services in the community:

Altogether, 21% of the respondents reported that they had gone to an emergency medicine service in the community in the previous year (either of the health plan or other, such as Terem), 27% had been to a hospital emergency room (8% had been to both a service in the community and in hospital).
78% of those who had used emergency services reported that they were satisfied or very satisfied with the care in the community service: 85% of members of Leumit, 77% of members of Clalit and Maccabi, and 74% of members of Meuhedet.
Satisfaction with hospital emergency rooms was lower: 62% of those who went to emergency rooms reported that they were satisfied or very satisfied with the treatment in the emergency room. No differences were found among the health plans.

The rate of voluntary health insurance ownership (commercial or supplemental)[1] remained high.

84% reported that they owned some form of supplemental insurance and 57% reported ownership of some form of commercial insurance policy (a slight increase over 54% in 2014). Altogether, 52% reported they had both supplemental and commercial; 32% had only supplemental, 5% had only commercial, and 11% had no voluntary insurance at all.
The percentage of patients who went to private physicians was higher among those with voluntary insurance: 67% had both supplemental and commercial, 25% had supplemental only, 3% had commercial only, and 5% of the respondents who saw a private physician had no voluntary insurance at all.
Of those with commercial insurance, 53% reported that they had a collective policy, 40% had an individual policy, and 7% had both individual and collective policies. Among those with individual policies, 30% reported that they had more than one policy.
Altogether, in terms of the whole population, one out of two people have both supplemental and commercial policies and one in nine have more than one commercial insurance policy.

Discreet informal payment in order to obtain preferential treatment.

This year we asked the respondents if, in the previous five years, they had felt the need to make a discreet and informal payment in order to receive preferential treatment: 6% responded affirmatively and 1% refused to answer.
The question was put to the entire population, and not only those who had had a significant encounter with the healthcare system, so it can be assumed that the estimate is higher among those who encountered the healthcare system. In a multivariate analysis, after controlling for background variables, the chances that those who had had surgery were 2.2[1] times greater than other respondents that they would report they had felt such a need.
A statistically significant difference was found by geographic area: Among those living in the Jerusalem area, 9% reported the need, vs. 6% in Haifa and the north, 4.5% in Tel Aviv and the center, and 4% in Beersheva and the south.

About the Survey

Since 1995, the Myers-JDC-Brookdale Institute has been monitoring the health care system from the perspective of the consumers. The latest survey was conducted from August to December 2016 under the direction of Dr. Shuli Brammli-Greenberg, Tamar Medina-Artom and Alexey Belinsky, with the support of a steering committee comprising representatives of all the health plans, the Ministry of Health, the Ministry of Finance, the National Insurance Institute (NII) and consumer organizations.

The data are collected under the supervision of the research team at MJB by the Institute’s Data Collection Unit headed by Chen Tzuk-Tamir and coordinated by Lev Zhivaev. The sample is a representative sample of the adult population (age 22+) in Israel. This year it also included respondents who owned cellphones only (i.e., no landline). Altogether, 2,513 individuals were interviewed in three languages (Hebrew, Arabic, and Russian) and there was a 68% response rate. The characteristics of the sample are close to those of the population according to data from the Central Bureau of Statistics, the Ministry of Health and the NII. The data were weighted by age for accurate representation of the various age cohorts. For further information, see the methodology appendix on our website.

The survey examined the following additional topics: primary-care medicine; medication; hospitalization and surgery and the financing organization; assessment of the functioning of the healthcare system; accessibility and barriers; importance of choice of hospital and surgeon; and mental health services.

For citations:

Brammli-Greenberg, S.; Medina-Artom, T. and Belinsky, A. 2017. Summary of Findings from the Eleventh Survey of Public Opinion on the Level of Service and Performance of the Healthcare System. Myers-JDC-Brookdale Institute: Jerusalem (Hebrew).

Appendix 1: Satisfaction, Confidence in the Health Plans in the Event of Serious Illness and Waiting Times, by Health Plan

This table sets out the findings by health plan regarding the main variables presented in this document. A rate that is highlighted and marked with an asterisk (*) indicates a significant difference in the specific variable between a particular health plan and all the other funds as a group. The difference is constant in the multivariate analysis after controlling for background variables: Age, sex, income, ethnic background, area of domicile, and chronic illness. The analysis is important in order to control for differences in the composition of the population in each of the health plans.

It is important to remember that differences of a few percent are of no practical importance.

[1] Details about the survey appear at “About the Survey”.

[2] All the differences presented in this document are statistically significant unless stated otherwise.

[1] All the differences among the health plans emphasized in this document are statistically significant in chi square tests and constant in multivariate analyses after controlling for background variables: age, sex, income, ethnic background, domicile, and chronic illness. For further detail, see Appendix 1.

[4] Note that the estimates are among the adult population aged 22+.

[5] Odds ratio in a logistic regression multivariate analysis.