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Friday, May 21, 2010

Israel's socialized medicine

As many of you know already, we have socialized medicine in Israel. The government instituted universal health coverage in 1995. Prior to that time, there was one health fund that was operated by the country's monolithic labor union (best described as a combination of the AFL-CIO, the Mafia and the Teamsters), and there were three private health funds that were in considerably better financial shape. Now, all four funds are shaky financially but they are managing.

Marty Peretz points us to this article in the Jerusalem Post.
From the perspective of the bottom line, the figures are impressive: Israel’s per capita health costs are half those of the United States, and the country expends a much smaller proportion of its GDP on health care, yet it provides universal health coverage, and top-notch, technologically up-to-date care. Its outcomes in many areas are superior.

Compared to the US, Israel has more physicians per capita, a lower infant mortality rate, higher life expectancy, and lower rates of cardiovascular disease. The country has the highest number of IVF units in the world per population, and is near the top of the lists of transplant units per population and overall physicians per population.

Although not without its flaws, and always with room for improvement, surveys indicate remarkable general satisfaction with the health care system; a survey conducted every two years by the Myers-JDC-Brookdale Institute consistently shows 88 percent of Israelis report a high level of satisfaction with their health plans.

Notably, that figure is even higher among minorities: The percentage of respondents who were satisfied or very satisfied was highest among Arabic speakers, at 94 percent. “The health system in this country is in good shape, by any measured parameter, in both accomplishments and containing expenses,” says Kobi Glazer, a professor in the Tel Aviv University School of Management, specializing in Health Economics.

In fact, a study that the Pittsburgh Regional Health Initiative (PRHI), a consortium of medical, business and civic leaders in Pennsylvania, commissioned in the autumn of 2009, concluded that the US and other countries might do well to learn from the Israeli health system. “Israel’s healthcare system has significant relevance and important lessons to lend to healthcare reform efforts in the United States,” says Bruce Rosen, director of the Smokler Center for Health Policy Research at the Myers-JDC-Brookdale Institute, who participated in the PRHI study.

“US health reform debates have been about the best ways to move toward a more integrated model, through which payment is aligned with care delivery and that targets safety, efficiency, access, and quality. Therefore, as the US moves to strengthen primary care, contain costs, and require multi-provider accountability for coordinated high-quality care, there is much to learn from Israel, where these concepts are already at work.”

Despite widespread misconceptions, the country’s health care system is not a socialized, single-payer system. Israelis generally accept as almost axiomatic that there should be universal health coverage, with a significant acceptance of government involvement in regulating health care for the sake of redistribution, accountability, and preventing competition from leading to uncontrollable cost overruns. At the same time, there is also recognition of the benefits of keeping a strong measure of competition in the system. This has led to what Glazer describes as “regulated competition”: universal state-financed insurance coverage is provided through four competing health-maintenance organizations.
A few points. One of the reasons we spend less on health care is that we are far less litigious than in the United States, and the costs of malpractice insurance are therefore far less.

What they say about IVF is true. This may be the only country in the world where you have the right to have a family by IVF and not just a child. The health funds pay for up to three children by IVF. Transplants, on the other hand, are a problem because we have a perpetual shortage of organs available for donation. This is because of rabbinic disputes over the moment of death (one of the viewpoints makes transplants extremely rare) and - although most people would not admit it - I suspect there's reluctance among much of the Jewish population to have organs transplanted into Arabs and vice versa.

People are happy with the healthcare system on the whole, but those who can maintain additional layers of insurance beyond the minimum. Among the things covered by that insurance are surgeries abroad (when the success rates abroad are higher), transplants (see above), drugs that are not part of the 'medicine basket,' and the right to choose your own physician rather than having to take whomever the fund or hospital gives you. Each of the healthcare funds offers two or three levels of additional insurance (you can choose one of them) and then there is private insurance available on top of that additional insurance.

All in all, it's not cheap, but it does cost much less than what it costs in the US, and it's far better than what's available in England or Canada. You'd still want to go abroad for some catastrophic illnesses (God forbid) but for the routine stuff, the quality you get at the price you pay cannot be beat.


At 9:53 PM, Anonymous Anonymous said...

A few points. One of the reasons we spend less on health care is that we are far less litigious than in the United States, and the costs of malpractice insurance are therefore far less.

Another factor: watch how many ads for a million and one medications there are on US TV and magazines. It is astounding! There is a medicine for every nuance of a single symptom and everyone seems to need to have something.

Here in Israel, for the most part, we pop a few Acamols (paracetamol) too many. But that's about it. Our medicine box (we have no need for a "chest") contains only 2 or 3 essentials and prescription leftovers. That's it.

BTW, unnecessary medication and prescriptions is a big contributor to the US system's cost, especially since so many of the meds have life threatening side effects, piling up more costs at the doctor's office, the hospital and the insurers.

Big pharma need to get their invested money back somehow and the only cure is more oversubscribing.


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