# data[].attributes.body
- States and municipalities that comprise the SUS can manage, maintain, and provide health services directly or indirectly, including through complementary participation by the private sector

- The public sector delegates or transfers the execution of services under the SUS to indirect administration, including  foundations, government-owned companies, and semi-public Corporation

- It is noticed that there is a dissemination of alternative management models for public healthcare services. The first explanation, is situated in the scenario of privatizations and transfer of the government’s responsibilities to the private sector, with a gradual retreat from public policies. The second explanation, was a response to the difficulties encountered by direct government administration due to its low operational capacity, lack of budget financial, and administrative autonomy, and excessive bureaucracy.

# data[].attributes.body
Preventive  medicine  undergraduate  professional  training  program  is  the  major  approach  to  training  public  health  practitioners

- the goal is to train practitioners, who have a deep understanding of the knowledge and skills in public health/preventive medicine and who have the capacity to fulfill the required tasks in such public health institutions

-courses are centered on “five major public health components” (environmental health, workplace hygiene, nutrition and food hygiene, child health, radiological), epidemiology, and biostatistics

-theory-based phase: basic public health courses, basic medical courses, clinical courses, public health/preventive medicine foundations, and professional courses

- practical content focuses on : clinical skills, public health vocational skills, and scientific research training

- The reform was based on the “Public Health Education Basic Requirements”, which is composed of 6 competencies: professionalism, medical foundation, population health, health management and social mobilization, information management, and scientific research

# data[].attributes.body
- Universal coverage as part of its national health insurance law, which says: "Health insurance…shall be based on principles of justice, equality, and mutual assistance"

- The insurance includes hospital, primary, specialty, mental health maternity care, prescription drugs. It is funded through a national income tax and an income-related health tax.

-Members of all plans can choose their general practitioners from among those on the plan’s list and can switch freely

- Long-term care is not covered by NHI, but is covered separately. The government publicly funds long-term care services through general taxes.

- Some innovations: environment to encourage healthy diets, the bigger role of nurses in the Community, major dental care coverage, and the scope, breadth, and depth of services for older people

- role of government: works through the Ministry of Health, is responsible for maternal and child health centers, half of the nation’s acute care bed capacity, and about 80 percent of its psychiatric bed capacity, the funding of prenatal and preventive care, infant developmental tests

- role of private health insurance: complementary role, covering benefits excluded from the NHI scheme (dental care for adults, certain medications, alternative medicines)

# data[].attributes.attachment_link.readable_text
Demographics and Health Risk Factors

Total Population (Millions of People), 2017

Health System Statistics

Health Care Spending per Capita, 2017

How does universal health coverage work?

How is the delivery system organized and how are providers paid?

Physician education and workforce: Israel has six medical schools, which are all part of public, nonprofit universities. The number of medical schools and students is regulated by the higher education council. As of 2015, more than half (58%) of Israeli physicians under age 65 had completed their medical studies abroad. Annual tuition, heavily subsidized by the government, is approximately NIS 11,100 (USD 3,000) for the first three years and NIS 14,800 (USD 4,000) for the next three years.

To address physician shortages in the entire country and in remote areas in particular, the government introduced two measures in 2011: it increased the number of physician positions in all hospitals throughout the country and introduced financial incentives (onetime bonuses and salary differentials) to encourage physician graduates to pursue their residencies in remote regions. The combination of these two programs has increased the number of residencies completed, especially in remote settings. Similar financial incentives encourage physicians to choose in-demand specialties, such as anesthesiology, geriatrics, and pediatric neurology.

Primary care: In 2018, 5,052 of the 38,523 licensed physicians (13%) were employed as general practitioners (GPs). The average number of GPs per capita in Israel is 0.6 GPs per 1,000 people (or 1 GP per 1,653 insured). However, this rate varies across regions and health plans (ranging from 0. 57 to 0.73). ⁹

Most GPs contract with one of the four competing nonprofit NHI health plans. Only 5 percent have contracts with more than one health plan. ¹⁰

The four NHI health plans (Clalit, Maccabi, Meuhedet, and Leumit) have different approaches to organizing care. Clalit, the largest health plan, provides most primary care in clinics that it owns and operates, and GPs are salaried employees. The typical clinic is multidisciplinary, with three-to-six GPs and several nurses, pharmacists, and other professionals. Clalit also contracts with independent physicians who tend to work in solo practices, with some access to administrative and nonphysician services at Clalit district clinics.

The other three health plans also use a mix of multidisciplinary clinics and independent primary care practices. In Maccabi (the second-largest plan) and Meuhedet, almost all of the primary care is provided by independent physicians, while in Leumit the clinic model predominates.

Members of all plans can generally choose their GP from among those on the plan's list and can switch freely. In practice, nearly all patients remain with the same GP for extended periods.

In Clalit, each patient is registered with a GP who has responsibility for coordinating care. Clalit is also the only plan that requires gatekeeping; referrals are required for secondary care, except for five common specialties (dermatology, otorhinolaryngology, ophthalmology, orthopedics, and gynecology). In Leumit, patients are registered with a clinic rather than with a GP, and in the other two plans there is no registration.

Approximately one-third of Israel's nurses work in community settings, primarily as salaried employees of the four NHI health plans. Their roles have been expanding beyond traditional routine nursing care (see " What innovations and reforms have recently been introduced?"). In a 2015-2016 national survey, 38 percent of frontline nurses employed by health plans identified "caring for chronically ill patients" as their main area of activity in addition to routine care, and 30 percent noted "health promotion." ¹¹

Doctors are paid entirely by the health plans; they cannot collect additional fees from their patients.

Salaries of Clalit clinic-based physicians are set via a collective bargaining agreement with the Israel Medical Association. Capitation rates for independent physicians in all health plans are set by the plans in consultation with physicians' associations.

Clalit and Leumit use predominantly "passive capitation," a quarterly, per-member payment made irrespective of whether the member visited the GP in the relevant quarter. Maccabi and Meuhedet use "active capitation," whereby payment is made only for members who visited their GP at least once during the quarter. Independent physicians also receive limited fee-for-service payments for certain procedures. Quality-related financial incentives are generally not used.

Outpatient specialty care: Outpatient specialty care is provided predominantly in community settings, either in health plan clinics or in physicians' offices. The former tend to be integrated multispecialty clinics, while the latter tend to be single-specialty.

Patients can choose freely among community-based specialists who are contracted with their health plan. Services provided by out-of-network specialists are paid for out-of-pocket or covered by voluntary health insurance.

Most outpatient specialists are paid on an active capitation basis, plus fee-for-service for certain procedures, up to a quarterly ceiling. Rates are set by the health plans. Specialists may not "balance bill" for NHI-covered services. Nevertheless, specialists can receive patients from NHI health plans along with patients who have private voluntary health insurance, but not the same patient in both settings. For privately insured patients, specialists can set their payment rates at their discretion.

Administrative mechanisms for direct patient payments to providers: When copayments and coinsurance are owed, such as for specialist visits and pharmaceuticals, patients never pay providers directly. Instead they use their health plan membership cards to make copayments. The provider then receives the full fee from the health plans, which collect copayments electronically from enrollees' bank accounts each month.

After-hours care: After-hours care is available via hospital emergency departments (EDs), freestanding walk-in urgent care centers (both nonprofit and for-profit), and physician home visits provided by for-profit companies. The Ministry of Health has overall responsibility for after-hours care, and it has promoted the establishment of urgent care in several localities that are far from hospital EDs.

Primary care physicians are not required to provide after-hours care. They receive reports on their patients from the after-hours providers and, increasingly, this information is conveyed electronically.

All health plans operate national telephone advice lines for their members, staffed by nurses with physician backup. All of Israel's hospital EDs are connected to the national health information exchange; efforts are underway to link them with community-based urgent care centers as well.

Hospitals: Of the 45 acute care hospitals, 18 are government-owned, either by the Ministry of Health or by municipalities. These account for 57 percent of the national capacity. Another 40 percent of acute care beds are operated by 16 private nonprofit hospitals that are owned by health plans or nonprofit organizations. Eleven for-profit hospitals account for the remaining 3 percent of bed capacity. These tend to be smaller hospitals that specialize in elective procedures. ¹²

Reimbursement of hospital care varies:

Hospital emergency care is reimbursed on a fee-for-service basis.

Inpatient medical care is reimbursed on a per-diem basis.

Inpatient procedures are paid either per diem or through activity-based, procedure-related group (PRG) arrangements.¹³

Outpatient care is reimbursed on either a fee-for-service or a procedure-related group basis.

Maximum payment rates are set by the government, but health plans negotiate discounts. The government also sets revenue parameters (minimum and maximum), which limit the extent to which each hospital's total revenues can decrease or grow from year to year. Hospital payments cover all costs, including the cost of the physicians. Procedure-related group payments include all costs of a hospitalization episode, excluding rehabilitation. There are no extra payments for severity, outliers, expensive treatments, or the adoption of new technologies.

Government and nonprofit hospitals follow a national hospital fee schedule, but for-profit hospitals' prices are unregulated. Fee-for-service is the predominant payment mode for private for-profit hospitals.

In government and nonprofit hospitals, physicians are predominantly salaried employees, with limited arrangements for supplemental fee-for-service payments for procedures performed outside regular hospital hours.

Until 2018, there was largely no choice of specialist in nonprofit hospitals. Patients wishing to choose a specialist or surgeon had to go to a for-profit hospital and pay out of pocket or use voluntary health insurance. Since 2018, some large public hospitals have started offering free choice of surgeon.

Mental health care: In 2015, responsibility for the provision of mental health care was transferred from the Ministry of Health to the NHI health plans, which provide care through a mix of salaried professionals, contracted independent professionals, and purchased services. The Ministry of Health continues to own and operate community-based mental health clinics, which are now under contract with the health plans.

NHI-mandated mental health coverage is broad and includes psychotherapy, medications, and inpatient and outpatient care. Integration of mental health and medical services is currently limited but is expected to improve because of the transfer of responsibility to the health plans. Psychologists are the main source of professional mental health care for half of patients, and psychiatrists and primary care physicians serve a quarter of patients. ¹⁴

Since the health plans took over mental health care, the availability of community-based services has increased substantially. However, there are still significant waiting times, particularly for psychotherapy and child psychiatry. These delays are due in part to shortages of some types of mental health professionals and to the health plans' difficulties in attracting and contracting with professionals, who can earn much more in the private sector.

Long-term care and social supports: Long-term care is not covered by NHI, but is covered separately. The government publicly funds long-term care services through general taxes.

In 2014, 86 percent of adults age 65 and older with disabilities received community-based long-term care, while the remaining 14 percent received institutional long-term care. ¹⁵ Community-based services account for 52 percent of total long-term care expenditures, of which 67 percent was publicly funded. ¹⁶

Approximately half of the adult population purchases private long-term care insurance. ¹⁷

Institutional long-term care financing is subsidized by the Ministry of Health and is awarded based on needs and means tests. These subsidies are generally paid directly to providers, although families can receive cash subsidies to pay providers.

Community-based long-term care is funded by the National Insurance Institute, and eligibility is based on needs and means tests. It includes personal care and housekeeping services for community-dwelling seniors with disabilities. ¹⁸ In addition, the National Insurance Institute covers an extensive network of daycare centers and a growing network of supportive neighborhoods. An emergency call service, physician home visits, and social activities are also covered. Additionally, in every community, a facilitator coordinates social supports and apartment repairs.

Until 2018, there was no financial support for informal or family caregivers; there are means-tested government subsidies for home aids.

NHI health plans are responsible for providing medical care, such as home nursing care, for the disabled elderly living in the community. In recent years, they have increased access to clinicians (particularly for the homebound elderly) via home care teams and telemedicine.

About two-thirds of nursing home care and nearly all home aids are provided by private, for-profit companies, with the remainder being public.

Hospice care is a mandated NHI benefit. In practice, however, while some hospice care is available, particularly home hospice, there is considerable unmet need.

What are the major strategies to ensure quality of care?

What is being done to reduce disparities?

What is being done to promote delivery system integration and care coordination?

What is the status of electronic health records?

How are costs contained?

What major innovations and reforms have recently been introduced?

¹This profile draws on B. Rosen, R. Waitzberg, and S. Merkur, "Israel: Health System Review," Health Systems in Transition 17, no. 6 (European Observatory on Health Systems and Policies, 2015): 1-112; and"Israel," The Health Systems and Policy Monitor (European Observatory on Health Systems and Policies), http://www.hspm.org/countries/israel25062012/countrypage.aspx.

² Rosen et al., "Israel: Health System Review.

³ Rosen et al., "Israel: Health System Review."

⁵ S. Brammli-Greenberg, R. Waitzberg, and R. Gross, "Integrating Private Insurance into the Israeli Health System: An Attempt to Reconcile Conflicting Values," in S. Thomson, A. Sagan, and E. Mossialos (eds.), International Experience with Private Health Insurance: History, Politics, Performance (Cambridge University Press, 2019).

⁶ N. Bentur, L. L. Emanuel, and N. Cherney, "Progress in Palliative Care in Israel: Comparative Mapping and Next Steps," Israel Journal of Health Policy Research 1, no. 1 (Feb. 20, 2012): 9.

⁷ Central Bureau of Statistics Statistical Abstract of Israel, 2017.

⁸ Conversion rate: 1 USD = NIS 3.7.

¹⁰ Ministry of Health, "Practitioners and Specialists in Family Medicine - 2018."

¹¹ R. Nissanholtz-Gannot, B. Rosen, and M. Hirschfeld, "The Changing Roles of Community Nurses: The Case of Health Plan Nurses in Israel," Israel Journal of Health Policy Research 6, no. 1 (Dec. 23, 2017): 69.

¹² R. Waitzberg and S. Merkur, "Policy Efforts to Strengthen Public Hospitals in Israel," EuroHealt h 23, no. 4 (2017): 34-38.

¹³ S. Brammli-Greenberg et al., "Why and How Did Israel Adopt Activity-Based Hospital Payment? The Procedure-Related Group Incremental Reform," Health Policy 120, no. 10 (Oct. 2016): 1171-76.

¹⁷ Brammli-Greenberg et al., "Integrating Private Insurance into the Israeli Health System."

¹⁸ S. Asiskovitch, "The Long-Term Care Insurance Program in Israel: Solidarity with the Elderly in a Changing Society," Israel Journal of Health Policy Research 2, no. 1 (Jan. 23, 2013): 3.

¹⁹ D. H. Jaffe et al., "Community Healthcare in Israel: Quality Indicators 2007-2009," Israel Journal of Health Policy Research 1, no. 1 (Jan. 30, 2012): 3.

²⁰ B. Rosen et al., "What the United States Could Learn from Israel About Improving the Quality of Health Care," Health Affairs 30, no. 4 (April 2011): 764-72; R. D. Balicer et al., "Sustained Reduction in Health Disparities Achieved Through Targeted Quality Improvement: One?Year Follow?Up on a Three?Year Intervention," Health Services Research 50, no. 6 (Dec. 2015): 1891-909.

²¹ B. Rosen et al., "What the United States Could Learn from Israel About Improving the Quality of Health Care."

²² T. Horev and H. Avni, "Strengthening the Capacities of a National Health Authority in the Effort to Mitigate Health Inequity - The Israeli Model," Israel Journal of Health Policy Research 5 (Aug. 15, 2016): 19.

²³ B. Rosen, "Inclusion of Dental Care for Children in NHI," Health Systems and Policies Platform.ha (2016).

²⁴ Intel Health and Life Sciences, Improving Health Outcomes and Reducing Costs with Video Conferencing Technology (case study), 2015.

²⁵ J. Zwanziger and S. Brammli-Greenberg, "Strong Government Influence over the Israeli Health Care System Has Led to Low Rates of Spending Growth," Health Affairs 30, no. 9 (Sept. 2011): 1779-85, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2010.0936).

²⁶ Ministry of Health, "Healthy Diet Committee," https://www.health.gov.il/Services/Committee/HealthyDietCommittee/Pages/default.aspx; accessed Sept. 26, 2017.

²⁷ Ministry of Health, Specialist Nurses in the Community, circular, 136/17 (in Hebrew) https://www.health.gov.il/hozer/ND136_2017.pdf; accessed Feb. 1, 2018.

²⁸ R. Waitzberg, " Community-Based Emergency Medical Facilities Work Towards Improving Continuity of Care," reform log, Nov. 9, 2017, https://www.hspm.org/countries/israel25062012/countrypage.aspx.

²⁹ Ministry of Health, "Many Reforms to the Health System in the State Budget Approved Tonight," (in Hebrew), https://www.health.gov.il/NewsAndEvents/SpokemanMesseges/Pages/15032018_1.aspx; accessed April 9, 2018.

Demographics and Health Risk Factors

Total Population (Millions of People), 2017

Health System Statistics

Health Care Spending per Capita, 2017

How does universal health coverage work?

How is the delivery system organized and how are providers paid?

Physician education and workforce: Israel has six medical schools, which are all part of public, nonprofit universities. The number of medical schools and students is regulated by the higher education council. As of 2015, more than half (58%) of Israeli physicians under age 65 had completed their medical studies abroad. Annual tuition, heavily subsidized by the government, is approximately NIS 11,100 (USD 3,000) for the first three years and NIS 14,800 (USD 4,000) for the next three years.

To address physician shortages in the entire country and in remote areas in particular, the government introduced two measures in 2011: it increased the number of physician positions in all hospitals throughout the country and introduced financial incentives (onetime bonuses and salary differentials) to encourage physician graduates to pursue their residencies in remote regions. The combination of these two programs has increased the number of residencies completed, especially in remote settings. Similar financial incentives encourage physicians to choose in-demand specialties, such as anesthesiology, geriatrics, and pediatric neurology.

Primary care: In 2018, 5,052 of the 38,523 licensed physicians (13%) were employed as general practitioners (GPs). The average number of GPs per capita in Israel is 0.6 GPs per 1,000 people (or 1 GP per 1,653 insured). However, this rate varies across regions and health plans (ranging from 0. 57 to 0.73). ⁹

Most GPs contract with one of the four competing nonprofit NHI health plans. Only 5 percent have contracts with more than one health plan. ¹⁰

The four NHI health plans (Clalit, Maccabi, Meuhedet, and Leumit) have different approaches to organizing care. Clalit, the largest health plan, provides most primary care in clinics that it owns and operates, and GPs are salaried employees. The typical clinic is multidisciplinary, with three-to-six GPs and several nurses, pharmacists, and other professionals. Clalit also contracts with independent physicians who tend to work in solo practices, with some access to administrative and nonphysician services at Clalit district clinics.

The other three health plans also use a mix of multidisciplinary clinics and independent primary care practices. In Maccabi (the second-largest plan) and Meuhedet, almost all of the primary care is provided by independent physicians, while in Leumit the clinic model predominates.

Members of all plans can generally choose their GP from among those on the plan's list and can switch freely. In practice, nearly all patients remain with the same GP for extended periods.

In Clalit, each patient is registered with a GP who has responsibility for coordinating care. Clalit is also the only plan that requires gatekeeping; referrals are required for secondary care, except for five common specialties (dermatology, otorhinolaryngology, ophthalmology, orthopedics, and gynecology). In Leumit, patients are registered with a clinic rather than with a GP, and in the other two plans there is no registration.

Approximately one-third of Israel's nurses work in community settings, primarily as salaried employees of the four NHI health plans. Their roles have been expanding beyond traditional routine nursing care (see " What innovations and reforms have recently been introduced?"). In a 2015-2016 national survey, 38 percent of frontline nurses employed by health plans identified "caring for chronically ill patients" as their main area of activity in addition to routine care, and 30 percent noted "health promotion." ¹¹

Doctors are paid entirely by the health plans; they cannot collect additional fees from their patients.

Salaries of Clalit clinic-based physicians are set via a collective bargaining agreement with the Israel Medical Association. Capitation rates for independent physicians in all health plans are set by the plans in consultation with physicians' associations.

Clalit and Leumit use predominantly "passive capitation," a quarterly, per-member payment made irrespective of whether the member visited the GP in the relevant quarter. Maccabi and Meuhedet use "active capitation," whereby payment is made only for members who visited their GP at least once during the quarter. Independent physicians also receive limited fee-for-service payments for certain procedures. Quality-related financial incentives are generally not used.

Outpatient specialty care: Outpatient specialty care is provided predominantly in community settings, either in health plan clinics or in physicians' offices. The former tend to be integrated multispecialty clinics, while the latter tend to be single-specialty.

Patients can choose freely among community-based specialists who are contracted with their health plan. Services provided by out-of-network specialists are paid for out-of-pocket or covered by voluntary health insurance.

Most outpatient specialists are paid on an active capitation basis, plus fee-for-service for certain procedures, up to a quarterly ceiling. Rates are set by the health plans. Specialists may not "balance bill" for NHI-covered services. Nevertheless, specialists can receive patients from NHI health plans along with patients who have private voluntary health insurance, but not the same patient in both settings. For privately insured patients, specialists can set their payment rates at their discretion.

Administrative mechanisms for direct patient payments to providers: When copayments and coinsurance are owed, such as for specialist visits and pharmaceuticals, patients never pay providers directly. Instead they use their health plan membership cards to make copayments. The provider then receives the full fee from the health plans, which collect copayments electronically from enrollees' bank accounts each month.

After-hours care: After-hours care is available via hospital emergency departments (EDs), freestanding walk-in urgent care centers (both nonprofit and for-profit), and physician home visits provided by for-profit companies. The Ministry of Health has overall responsibility for after-hours care, and it has promoted the establishment of urgent care in several localities that are far from hospital EDs.

Primary care physicians are not required to provide after-hours care. They receive reports on their patients from the after-hours providers and, increasingly, this information is conveyed electronically.

All health plans operate national telephone advice lines for their members, staffed by nurses with physician backup. All of Israel's hospital EDs are connected to the national health information exchange; efforts are underway to link them with community-based urgent care centers as well.

Hospitals: Of the 45 acute care hospitals, 18 are government-owned, either by the Ministry of Health or by municipalities. These account for 57 percent of the national capacity. Another 40 percent of acute care beds are operated by 16 private nonprofit hospitals that are owned by health plans or nonprofit organizations. Eleven for-profit hospitals account for the remaining 3 percent of bed capacity. These tend to be smaller hospitals that specialize in elective procedures. ¹²

Reimbursement of hospital care varies:

Hospital emergency care is reimbursed on a fee-for-service basis.

Inpatient medical care is reimbursed on a per-diem basis.

Inpatient procedures are paid either per diem or through activity-based, procedure-related group (PRG) arrangements.¹³

Outpatient care is reimbursed on either a fee-for-service or a procedure-related group basis.

Maximum payment rates are set by the government, but health plans negotiate discounts. The government also sets revenue parameters (minimum and maximum), which limit the extent to which each hospital's total revenues can decrease or grow from year to year. Hospital payments cover all costs, including the cost of the physicians. Procedure-related group payments include all costs of a hospitalization episode, excluding rehabilitation. There are no extra payments for severity, outliers, expensive treatments, or the adoption of new technologies.

Government and nonprofit hospitals follow a national hospital fee schedule, but for-profit hospitals' prices are unregulated. Fee-for-service is the predominant payment mode for private for-profit hospitals.

In government and nonprofit hospitals, physicians are predominantly salaried employees, with limited arrangements for supplemental fee-for-service payments for procedures performed outside regular hospital hours.

Until 2018, there was largely no choice of specialist in nonprofit hospitals. Patients wishing to choose a specialist or surgeon had to go to a for-profit hospital and pay out of pocket or use voluntary health insurance. Since 2018, some large public hospitals have started offering free choice of surgeon.

Mental health care: In 2015, responsibility for the provision of mental health care was transferred from the Ministry of Health to the NHI health plans, which provide care through a mix of salaried professionals, contracted independent professionals, and purchased services. The Ministry of Health continues to own and operate community-based mental health clinics, which are now under contract with the health plans.

NHI-mandated mental health coverage is broad and includes psychotherapy, medications, and inpatient and outpatient care. Integration of mental health and medical services is currently limited but is expected to improve because of the transfer of responsibility to the health plans. Psychologists are the main source of professional mental health care for half of patients, and psychiatrists and primary care physicians serve a quarter of patients. ¹⁴

Since the health plans took over mental health care, the availability of community-based services has increased substantially. However, there are still significant waiting times, particularly for psychotherapy and child psychiatry. These delays are due in part to shortages of some types of mental health professionals and to the health plans' difficulties in attracting and contracting with professionals, who can earn much more in the private sector.

Long-term care and social supports: Long-term care is not covered by NHI, but is covered separately. The government publicly funds long-term care services through general taxes.

In 2014, 86 percent of adults age 65 and older with disabilities received community-based long-term care, while the remaining 14 percent received institutional long-term care. ¹⁵ Community-based services account for 52 percent of total long-term care expenditures, of which 67 percent was publicly funded. ¹⁶

Approximately half of the adult population purchases private long-term care insurance. ¹⁷

Institutional long-term care financing is subsidized by the Ministry of Health and is awarded based on needs and means tests. These subsidies are generally paid directly to providers, although families can receive cash subsidies to pay providers.

Community-based long-term care is funded by the National Insurance Institute, and eligibility is based on needs and means tests. It includes personal care and housekeeping services for community-dwelling seniors with disabilities. ¹⁸ In addition, the National Insurance Institute covers an extensive network of daycare centers and a growing network of supportive neighborhoods. An emergency call service, physician home visits, and social activities are also covered. Additionally, in every community, a facilitator coordinates social supports and apartment repairs.

Until 2018, there was no financial support for informal or family caregivers; there are means-tested government subsidies for home aids.

NHI health plans are responsible for providing medical care, such as home nursing care, for the disabled elderly living in the community. In recent years, they have increased access to clinicians (particularly for the homebound elderly) via home care teams and telemedicine.

About two-thirds of nursing home care and nearly all home aids are provided by private, for-profit companies, with the remainder being public.

Hospice care is a mandated NHI benefit. In practice, however, while some hospice care is available, particularly home hospice, there is considerable unmet need.

What are the major strategies to ensure quality of care?

What is being done to reduce disparities?

What is being done to promote delivery system integration and care coordination?

What is the status of electronic health records?

How are costs contained?

What major innovations and reforms have recently been introduced?

¹This profile draws on B. Rosen, R. Waitzberg, and S. Merkur, "Israel: Health System Review," Health Systems in Transition 17, no. 6 (European Observatory on Health Systems and Policies, 2015): 1-112; and"Israel," The Health Systems and Policy Monitor (European Observatory on Health Systems and Policies), http://www.hspm.org/countries/israel25062012/countrypage.aspx.

² Rosen et al., "Israel: Health System Review.

³ Rosen et al., "Israel: Health System Review."

⁵ S. Brammli-Greenberg, R. Waitzberg, and R. Gross, "Integrating Private Insurance into the Israeli Health System: An Attempt to Reconcile Conflicting Values," in S. Thomson, A. Sagan, and E. Mossialos (eds.), International Experience with Private Health Insurance: History, Politics, Performance (Cambridge University Press, 2019).

⁶ N. Bentur, L. L. Emanuel, and N. Cherney, "Progress in Palliative Care in Israel: Comparative Mapping and Next Steps," Israel Journal of Health Policy Research 1, no. 1 (Feb. 20, 2012): 9.

⁷ Central Bureau of Statistics Statistical Abstract of Israel, 2017.

⁸ Conversion rate: 1 USD = NIS 3.7.

¹⁰ Ministry of Health, "Practitioners and Specialists in Family Medicine - 2018."

¹¹ R. Nissanholtz-Gannot, B. Rosen, and M. Hirschfeld, "The Changing Roles of Community Nurses: The Case of Health Plan Nurses in Israel," Israel Journal of Health Policy Research 6, no. 1 (Dec. 23, 2017): 69.

¹² R. Waitzberg and S. Merkur, "Policy Efforts to Strengthen Public Hospitals in Israel," EuroHealt h 23, no. 4 (2017): 34-38.

¹³ S. Brammli-Greenberg et al., "Why and How Did Israel Adopt Activity-Based Hospital Payment? The Procedure-Related Group Incremental Reform," Health Policy 120, no. 10 (Oct. 2016): 1171-76.

¹⁷ Brammli-Greenberg et al., "Integrating Private Insurance into the Israeli Health System."

¹⁸ S. Asiskovitch, "The Long-Term Care Insurance Program in Israel: Solidarity with the Elderly in a Changing Society," Israel Journal of Health Policy Research 2, no. 1 (Jan. 23, 2013): 3.

¹⁹ D. H. Jaffe et al., "Community Healthcare in Israel: Quality Indicators 2007-2009," Israel Journal of Health Policy Research 1, no. 1 (Jan. 30, 2012): 3.

²⁰ B. Rosen et al., "What the United States Could Learn from Israel About Improving the Quality of Health Care," Health Affairs 30, no. 4 (April 2011): 764-72; R. D. Balicer et al., "Sustained Reduction in Health Disparities Achieved Through Targeted Quality Improvement: One?Year Follow?Up on a Three?Year Intervention," Health Services Research 50, no. 6 (Dec. 2015): 1891-909.

²¹ B. Rosen et al., "What the United States Could Learn from Israel About Improving the Quality of Health Care."

²² T. Horev and H. Avni, "Strengthening the Capacities of a National Health Authority in the Effort to Mitigate Health Inequity - The Israeli Model," Israel Journal of Health Policy Research 5 (Aug. 15, 2016): 19.

²³ B. Rosen, "Inclusion of Dental Care for Children in NHI," Health Systems and Policies Platform.ha (2016).

²⁴ Intel Health and Life Sciences, Improving Health Outcomes and Reducing Costs with Video Conferencing Technology (case study), 2015.

²⁵ J. Zwanziger and S. Brammli-Greenberg, "Strong Government Influence over the Israeli Health Care System Has Led to Low Rates of Spending Growth," Health Affairs 30, no. 9 (Sept. 2011): 1779-85, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2010.0936).

²⁶ Ministry of Health, "Healthy Diet Committee," https://www.health.gov.il/Services/Committee/HealthyDietCommittee/Pages/default.aspx; accessed Sept. 26, 2017.

²⁷ Ministry of Health, Specialist Nurses in the Community, circular, 136/17 (in Hebrew) https://www.health.gov.il/hozer/ND136_2017.pdf; accessed Feb. 1, 2018.

²⁸ R. Waitzberg, " Community-Based Emergency Medical Facilities Work Towards Improving Continuity of Care," reform log, Nov. 9, 2017, https://www.hspm.org/countries/israel25062012/countrypage.aspx.

²⁹ Ministry of Health, "Many Reforms to the Health System in the State Budget Approved Tonight," (in Hebrew), https://www.health.gov.il/NewsAndEvents/SpokemanMesseges/Pages/15032018_1.aspx; accessed April 9, 2018.

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By Ruth Waitzberg and Bruce Rosen, Myers-JDC-Brookdale Institute Israel provides universal coverage to citizens and permanent residents as part of its national health insurance law. Residents choose from four competing nonprofit health plans that provide a mandated benefit package, including hospital, primary, specialty, mental health, and maternity care, as well as prescription drugs and other services.

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Lethal pneumonia of unknown cause in Kazakhstan

- Kazakhstan is not performing tests for covid but many people are hospitalized due to pneumonia of unknown cause

- Distancing protocols between patients and professionals are not adopted, as they are not considered as suspected of covid

- China is questioning the lack of care and is alerting the Chinese people

- It seems to be more lethal as it is only being analyzed among cases of pneumonia

- OMS recognizes as non-diagnostic covid cases