Download The Israeli Public Health Care System

Basic Demographic & Health Data*
Israel
Total Population – millions (2008)
Serbia
7.1
9.8
Annual Growth Rate: 1998-2008
1.9%
-0.4%
60+ as % of total (2008)
14%
19%
Life Expectancy at birth – (2008(
81
74
Probability of dying under age 5 years per 1000 live births - both
sexes -)2008)
5.0
8.0
Physicians per 1,000 population : (2006(
3.7
2.0
Health Expenditures as % of GDP (2007)
8.0%
9.9%
Per Capita Health Expenditures at International $ rate )2007)
1,672
769
Private as a % of total Health Expenditures (2007)
44.1%
38.2%
Government health expenditures as % of total gov’t expenditure
*WHO
10.1%
13.8%
The Israeli Health System
Ministry of
Health
Ministry of
Finance
Health Funds
Klalit
54%
Maccabi
24%
Meuhedet
12%
Leumit
10%
Hospitals
Acute Care 46
Beds: 14,582
Psychiatric 14
Beds: 4,240
Geriatric 310
Beds: 22,283
Israeli Healthcare System
Public and Private Financing
Public and Private Healthcare Services
National Health Insurance Law of 1995
 Universal compulsory statutory health insurance
 Financed by earmarked and general taxation
 Citizens pay a healthcare tax – 4.8% of income
 “Cost of the Basket of Services” :

Based on expenditures of the health funds in previous years.

Updated yearly based on a health index
 If the earmarked taxes not sufficient, the government must add
funding to guarantee that the updated “cost of the basket of
services” is maintained.
National Health Insurance Law of 1995
 Coverage for health care services is provided by 4 competing
nationwide health funds (HMOs) under the National Health
Insurance Law of 1995
 Some are quasi public (owned by labor unions), some are private,
not for profit mutual companies
 Health funds are financed primarily by government via age-related
capitation payments (90% of total), patient charges and other
income (10%)
The Israeli Public Health Care System
 Every citizen is a member of one of these four health funds
 Citizens are free to choose and move between health funds
 Health funds must accept all applicants for membership
 Health Funds provide a uniform legally defined basket of services
to which every citizen is entitled ( which amounts to about 60% of
total health expenditures).
 There are public and private providers of services including
physicians, hospitals, pharmacies and other health care
professionals.
The Israeli Public Health Care System
 Health funds purchase services from outside suppliers or
supply services in- house.
 Services in the basic basket not currently covered by the
health funds include much of mental health, long term
nursing care, maternity (hospital) care, dental care for
adults
 Health funds can provide -for a premium which they collect
directly- additional services not in the basic basket
(supplementary health insurance)
The Israeli Public Health Care System
 Supplementary services include choice of doctor in private
hospital, second opinion from senior consultants, dental
services, alternative medicine, medications not in in the
public basket, medical accessories, medical care abroad,
etc.
 Health funds have purchased collective policies for long
term care insurance from private insurance companies
 Health Funds also offer their members travel insurance
through a contract with a private insurance company
Composition of Israeli Acute Care Hospital System
Number of Beds = 14, 582 – 2.05 beds/1000 population

11 Ministry of Health Hospitals
46.5% of beds

8 Klallit Health Fund Hospitals 30.4% of beds

7 Non-profit Hospitals
10% of beds

2 Hadassah Hospitals
6.0% of beds

6 Mission Hospitals
3.6% of beds

11 Private for-profit Hospitals
3.4% of beds

1 Meuhedet Hospital
0.1% of beds
Characteristics of Israeli Acute Care Hospital System
 All hospitals have outpatient ambulatory services
 All public hospitals have Emergency Rooms
 In public hospitals, staffing is linked with the number of beds in each
department
 All medical residency programs are predominantly hospital based
 Physicians are salaried employees of the hospital
 Hospital physicians may have private practices outside of the public
hospital and may contract with health funds as independent doctors
 Public hospital outpatient departments are manned largely by senior
residents backed up by department doctors
Maccabi Healthcare Services
 Second largest and fastest growing Health Fund in
Israel
 Non-profit mutual.
 Recognized health fund - Israeli National Health
Insurance Law
 Provides public basket of services
 Supplies services via own facilities and outside
providers (both public and private)
Maccabi Statistics

1.9 million members (25% Market Share).

5000 physicians (85% independent contracted doctors).

Contracts with all public acute care and geriatric hospitals

Owns the largest private hospital network in Israel with 13
facilities all across the country

Contracts with 700 private pharmacies and operates a
chain of 53 pharmacies of its own

Maccabi's income budget 1.7 billion Euro
Maccabi Healthcare Services




Supplies services via its own facilities and outside providers.
Selectively contracts with providers
Free patient choice of physician and other providers
Methods of payment to providers :
 Physicians: Quarterly visits within global budget
 Hospitals: Maccabi negotiated Caps within a National Cap
 Other providers: Fee-for-service

Co-payments exist for medications, visits to physicians,
specialist clinics and some other services.
91% of Maccabi Expenditures are Medical
Physicians
24%
Hospitals
30%
Other medical
7%%
Development
1%
Diagnosis
9%
Drugs
21%
Administration
8%
Health Funds Financial Performance
2001-2009 (Millions NIS)
Health
Funds
Clalit
2001
2002
2003
2004
2005
2006
2007
2008
2009
(472) (413)
)106(
4
)143(
)63(
(74)
(422) (185)
(5)
28
13
9
)1(
3
8
6
4
Leumit
(204)
)94(
)27(
13
)62(
)76(
25
27
16
Meuhedet
)53)
)5(
)58(
68
19
19
10
3
0.4
Maccabi
The Yitzhak Rabin
National Prize For
Quality and Excellence
In The Public Sector
This Certificate
Attests that
Maccabi Healthcare Services
has won
The Israeli National Prize for
Quality and Excellence for year
2009 for Health care
Organizations
The Maccabi Healthcare System is Highly
Computerized

Maccabi Electronic Medical Record

Every transaction computerized

The Central Medical Record

E-Laboratory

E- Prescription
 E- Consultation

Telemedicine

Alerts and Reminders
 Patient Website