Background
Since Israel’s National Health Insurance Law went into force in 1995, the Myers-JDC-Brookdale Institute has been surveying public perceptions of the quality of the services and performance of the health care system through a series of biennial surveys. The surveys are funded with the assistance of the Ministry of Health and conducted with the support and guidance of a steering committee that includes representatives from the Ministry of Health, the Ministry of Finance, the National Insurance Institute (NII), the health plans, patients’ organizations, and the academe.
Goal
The multi-year goal of the series of biennial surveys is to examine various aspects of the health care system performance: patients’ perspectives regarding their care experience and satisfaction with the level of service; the quality of the primary and secondary care services; public trust in the health care system; service accessibility and availability; and the use of telehealth services. Other issues were also examined in the 2021-2022 survey: the use of telehealth services, examined from a broader perspective; preventive medicine; home hospitalization as an alternative to inpatient hospital care; satisfaction with the health plans during the COVID-19 pandemic; and language accessibility.
Method
The data were collected through a telephone survey from October 2021 to March 2022. The survey sample is representative of the adult population in Israel (the 22+ age group). A random sample was taken from the NII database of health plan members. 2,536 individuals were interviewed in three languages (Hebrew, Arabic, and Russian), and the response rate was 52%. Following data collection, the sample was weighted according to population age group, gender, and health plan membership to ensure an accurate representation of the population (see the Methodology Annex on the Myers-JDC-Brookdale Institute website).
Key Findings
An increase of 10 percentage points was found in the present survey in the satisfaction with the health care system: 68% of the interviewees reported being satisfied or very satisfied with the health care system, compared with 58% in the previous survey, conducted in 2018. 62% of the interviewees expressed some level of confidence that the health care system would provide them with the best and most effective care in the case of a significant deterioration in their health; 42% expressed some level of confidence that the health care system would cover the costs of care in that case; and 75% reportedly believed that they would have to pull some strings to get faster and better care.
88% of the interviewees reported satisfaction with their health plan, in general. Different levels of satisfaction were found with the diverse health plan services examined in the survey: the rate of satisfaction with the availability of the call centers was the lowest (62%). The highest satisfaction rates were reported with regard to the laboratory services (95%); the facilities (94%); the nurses (94%); and the attitude of the family doctors (93%). 36% of the interviewees reported that the health plan provided them with information on maintaining their health, and 73% believed that the health plan did its best to meet the health needs of its members during the COVID-19 pandemic.
83% of the interviewees visited a family doctor in the year preceding the survey. About half of them visited the family doctor solely for the purpose of filling out forms. 60% reported that the family doctor coordinated the care services they needed; and 53% reported that the family doctor discussed with them the issue of a healthy lifestyle on his own initiative. The percentage of interviewees who reported experiencing mental distress increased, compared with the previous survey (24% compared with 20%, respectively). 75% of those who reported experiencing mental distress said that they were not asked about it by their family doctor.
In the year preceding the survey, 65% of the interviewees sought an appointment with a specialty care physician, and 32% reported waiting one month or more for an appointment. No differences were found between the health plans in the percentage of patients who waited for an appointment with a specialty care physician. A high percentage of patients waited for an appointment with an expert gastroenterology physician (51%), a surgeon (43%), or a dermatologist (42%). A lower percentage of interviewees reported a positive care experience in a visit to a specialty care physician (75%), compared with the percentage of interviewees who reportedly had a positive care experience when visiting the family doctor (86%). No differences were found in the reported care experience between the health plans or the types of visits (an in-person clinic visit or a virtual visit).
Telehealth services are in common use: 55% of the interviewees used the health plan website or application to contact a health care provider, and 91% of them thus had no need to visit a clinic to receive the required service; 44% of the interviewees contacted the health care provider by phone or video chat, and 90% of them thus had no need to visit a clinic to receive the required service.
35% of the interviewees chose to forego medical care due to the long waiting times – an increase of 6 percentage points compared with the previous survey; 19% chose to forego medical care because the clinic was too far away – an increase of 8 percentage points compared with the previous survey; and 12% reportedly had to forego specialty care services, medical care, or medications because they could not afford the cost; 42% of those who chose to forego medical care because the clinic was too far away and 51% of those who chose to forego medical care due to the long waiting times sought private medical services.
81% of the interviewees are covered by supplemental health insurance through the health plans, and 49% are covered by private health insurance through private insurance companies; 44% are covered by both supplemental health insurance through the health plans and private health insurance; and 14% are not covered by any voluntary health insurance (either supplemental health insurance or private health insurance). The highest percentages of health plan members who are not covered by any voluntary health insurance were found in the Arab population (46%) and in the lowest income quintile (33%).
Summary
The service and performance quality of any health care system is evaluated, among other things, by its responsiveness to the needs of the insured. The four main aspects of system responsiveness are: respect for the patient, a patient-centered approach, service accessibility and availability, and the quality of care. One of the ways to evaluate system responsiveness is through population surveys. The present survey, the 13th in the series of surveys conducted by the Myers-JDC-Brookdale Institute, examined system responsiveness to the needs of the insured at a time when the health care system faced a global health crisis – the COVID 19 pandemic.
The findings show that a high level of satisfaction with the health plans and the diverse health services they provide has been maintained, and that satisfaction with the responsiveness of the health plans during the COVID-19 pandemic was also high. An increase of 10 percentage points was found in the satisfaction with the health care system, in general, and confidence was expressed that the health care system would provide the best and most effective care in the case of a significant deterioration in the health status of the insured. At the same time, a rather low level of confidence was found with regard to the coverage of medical care costs by the health care system in that case. It was also found that many of the insured believed that they would have to pull some strings to get faster and better care.
The survey further showed that there was an increase in the percentage of those who reportedly experienced mental distress and that in most cases, the family doctor did not raise the issue on his own initiative. It was also found that about a third of those who sought specialty care services had to wait a month or even more for an appointment and that there was an increase in the percentage of those who chose to forego medical care due to long waiting times or because the clinic was too far away. Finally, the survey showed that there were significant gaps between population groups in terms of health status, use of health care services or foregone services, and voluntary insurance coverage.
The policy makers are informed of the findings to help them identify the strengths and weaknesses of the health care system from the perspective of the insured and thereby formulate policy and take action to reduce gaps and enhance the responsiveness of the Israeli health care system to the needs of the insured.
Citing suggestion: Laron, M., Maoz Breuer, R., & Fialco, S. (2022). Population Survey on the Level of Service and Health Care System Performance in 2021-2022. S-215-22. Myers-JDC-Brookdale Institute. (Hebrew)