Background
Ever since the passing of the National Health Insurance Law in 1995, the Myers-JDC-Brookdale Institute has been monitoring the Israeli health system’s performance through research based on biannual public surveys on the system’s service level and general functioning. The research examines the viewpoint of the public, seeking to give voice to their positions in the policymaking process. The research population includes all inhabitants of Israel aged 22 and above who are entitled to services by virtue of the National Health Insurance Law, and the sample represents that population well. Among other things, the surveys address the following issues: trust in the health system, satisfaction with the system and with the health plans, seeking services outside the public system (private medicine and insurances), access to services, the availability of services and barriers to receiving them, and the patient’s experience of primary and secondary care.[1]
This study reports on a secondary analysis of the data of “The Public Opinion on the Service Level and Performance of the Health System, 2018” [Hebrew], with regard to three population groups: Jews born in Israel along with veteran immigrants (immigrants who came to Israel before 1990); Arabs; and post-1990 immigrants (Jews who have immigrated here from all countries after 1990).
Objectives
Identify differences between Jews born in Israel along with veteran immigrants, Arabs and post-1990 immigrants in various aspects related to the health system: patterns of using health services; foregoing health services; having voluntary insurances and seeking services outside the public system; satisfaction with the health plans and health system; and trust in the health system.
Method
Secondary analysis of public survey data on service level and the performance of the health system in 2018. The differences between the three population groups (Jews born in Israel along with veteran immigrants; Arabs; and post-1990 immigrants) were estimated using crosstabs as well as a multivariate logistic regression. The controlled variables were gender, age, chronic health condition, income, area of residence and health plan membership.
Research population: All inhabitants of the State of Israel age 22 and above entitled to services by virtue of the National Health Insurance Law.
Sample: 3,508 interviewees aged 22 and above. The characteristics of the sample are close to the characteristics of the population according to the data of the Central Bureau of Statistics (CBS), the Ministry of Health and the National Insurance Institute. Weighting was done according to gender, age, population group (Jews and others, Arabs) and district of residence in order to achieve an accurate representation of the various population groups. In the present study, nine out of all 3,517 participants in the original study were excluded from the analysis because they had not answered the question about whether they were born in Israel. The distribution of the sample was: 66% Jews born in Israel along with veteran immigrants, 19% Arabs, and 15% post-1990 immigrants (76% of whom from the former Soviet Union).
Main Findings
All differences presented in this section between Arabs or Post 1990 immigrants, and between Jews born in Israel along with veteran immigrants are significant at the level of 0.05 at least. No statistical tests were conducted to determine significant differences between Arabs and Post 1990 immigrants.
Post 1990 Immigrants Compared to Jews born in Israel along with veteran immigrants
- Health plan membership. The rate of Post 1990 immigrants insured in Maccabi Health Services (41%) and Leumit Health Services (10%) is higher than the rate of Jews born in Israel along with veteran immigrants insured in those plans (29% and 5% respectively). The rate of Post 1990 immigrants insured in Clalit Health Services (34%) is lower than the rate of Jews born in Israel along with veteran immigrants insured in that plan (55%).
- Voluntary insurances. Complementary insurance coverage among Post 1990 immigrants is lower (odds ratio[2] is 0.30) than among Jews born in Israel along with veteran immigrants, whereas coverage by private insurance plans is similar in both groups.
- Health service usage patterns. Post 1990 Immigrants contact family physicians and specialists through the health plans in rates similar to those of Jews born in Israel along with veteran immigrants; post 1990 Immigrants turn to family physicians more (odds ratio is 1.41) for the purpose of only filling out forms (without the need for an examination); fewer Post 1990 immigrants contact private physicians (odds ratio is 0.57).
- Foregoing health services. Compared to Jews born in Israel along with veteran immigrants, Post 1990 immigrants forego medical services less (odds ratio is 0.75) due to long waiting times.
- Satisfaction and trust. Post 1990 Immigrants’ satisfaction with their health plan and most of the services it provides are lower than that of Jews born in Israel along with veteran immigrants, whereas their satisfaction with the health system is higher (odds ratio is 1.70), and their trust level is similar.
Arabs Compared to Jews born in Israel along with veteran immigrants
- Health plan membership. The rate of Arabs insured in Clalit Health Services (63%) and Leumit Health Services (9%) is higher than the rate of Jews born in Israel along with veteran immigrants insured in those plans (55% and 5% respectively). The rate of Arabs insured in Maccabi Health Services (15%) is lower than the rate of Jews born in Israel along with veteran immigrants insured in that plan (29%).
- Voluntary insurances. Complementary and private insurance coverage among Arabs is lower (odds ratio is 0.69 for private coverage and 0.11 for complementary coverage) than among Jews born in Israel along with veteran immigrants.
- Health service usage patterns. Arabs contact family physicians more than do Jews born in Israel along with veteran immigrants (odds ratio is 1.81); they contact specialists through the health plan or private physicians less than do Jews born in Israel along with veteran immigrants (odds ratio is 0.77 for contacting specialists through the health plan and 0.54 for contacting private physicians).
- Foregoing health services. Compared to Jews born in Israel along with veteran immigrants, Arabs forego medical services less due to distance (odds ratio is 0.54) and long waiting times (odds ratio is 0.49) than do Jews born in Israel and veteran
- Satisfaction and trust. Arabs’ satisfaction with most health plan services is lower than that of Jews born in Israel along with veteran immigrants, whereas their satisfaction with and trust in the health system are considerably higher (odds ratio is 2.4 for the level of trust and 5.09 for satisfaction with the health system).
In summary, in this study we found significant differences between Jews born in Israel along with veteran immigrants, Arabs and post-1990 immigrants in various aspects related to the health system: including patterns of using health services; the foregoing of health services; having voluntary insurances and seeking services outside the public system; satisfaction with the health plans and the health system; and trust in the health system.
These differences require consideration and treatment by health policy makers for the purpose of improving services, reducing barriers and promoting health equity.
[1] For further information, see “Public Opinion on the Service Level and Performance of the Health system in 2018 and Comparison with Previous Years: Methodological Appendix” [Hebrew].
[2] The odds ratios show the correlation between the presence or absence of trait A and the presence or absence of trait B (for example, the correlation between the insured being in the age range of 22-44 and the likelihood that he will see a family doctor). When the odds ratio is not significantly different than 1, there is no significant correlation between the presence of trait A and the presence of trait B. A result that is significantly different than 1 shows that those who have trait A have a different probability (higher or lower) that they will also have trait B, compared to those who do not have trait A. A significant result does not indicate causality.
Citing suggestion: Fialco, S., & Brammli-Greenberg, S. (2022). Attitudes and Perceptions of Selected Population Groups Regarding the Health System and the Use of Its Services: Secondary Analysis of the Population Survey on the Level of Service and Healthcare System Performance in 2018. S-209-22. Myers-JDC-Brookdale Institute. (Hebrew)