Health Care: How it Works in Israelby Brie Stimson July 27, 2017
With the future of American health care up in the air, a look at the structure of Israel’s health care system is worth a glance. Israel, like many other industrialized nations, has universal coverage, something the U.S. does not.
“Most everyone is covered for most things; common prescription medicines are inexpensive, and some alternative treatments such as reflexology are covered,” says Alan Abbey, Director of Internet and Media at the Shalom Hartman Institute in Jerusalem. “Overall, quality of care is good. We have many terrifically competent doctors and health-care technicians. As I see and hear from family and friends about the challenges of health care in the U.S., I am glad to be under the Israeli medical system.”
However, Abbey says that doctors are often overworked, appointments with specialists can take a long time, and the bureaucracy can be befuddling for users.
“Computers have improved bureaucratic systems, but we still often have to get numerous pieces of paper shuffled between doctors, hospitals, clinics, and pharmacists to get services,” he adds.
Israel passed its national health insurance law in 1995 to provide universal coverage. Since the passage, health care costs have remained steady around 7.5 percent of the country’s gross domestic product (GDP), with 62 percent of expenditures publicly financed – primarily funded through income-related health taxes. Before the law, the majority of citizens had insurance, but the law stipulated that everyone must sign up for a plan and no one can be turned away, regardless of age or medical history. If an Israeli citizen does not pay the required insurance contributions, the National Insurance Institute charges fines with interest. Also under the law, new immigrants must register when they arrive in the country and are exempt from payment during their first year in Israel. Israel now has both a life expectancy that is higher and an infant mortality rate that is lower than the United States.
Residents can choose between four health plans, which are all similar HMOs. They vary slightly in which doctors accept each plan.
Maayan Jaffe-Hoffman made aliyah to Israel in 2000. She lived there for five years, returned to the states, and then moved back to Israel two years ago. She has had children in both countries.
“I really like the health care system there,” she says from the states on a visit to her parents’. “I think it’s been actually quite good … pretty efficient in most cases.”
But she says the system can be challenging if you need to see a specialist, especially for people who are not fluent in Hebrew.
“Because of time and there’s not as many [specialists]… and to navigate [the system] is sometimes difficult,” she says.
All paperwork is in Hebrew, and although it’s usually translated into Russian and Arabic, Jaffe-Hoffman says English is often forgotten, which can be frustrating for new olim from the U.S.
Gabe Pransky, who emigrated from the U.S. a decade ago, runs a health care nonprofit in Jerusalem.
“We help English speakers navigate the Israeli health care system,” he explains. Pransky lost his wife Shira to Hodgkin’s lymphoma eight years ago. He believes as immigrants they didn’t understand the system well enough to make use of all the resources that were available to them. “Sometime after my wife passed away, reflecting on the kind of support that we needed at the time when we were going through that personal health crisis, and finding more out about the kinds of rights and support that were available that we didn’t know about at the time … it was easy for me to recognize that gap in awareness was sort of a tragic missed opportunity,” he tells me.
Shira Pransky made aliyah with her family from the United States when she was 12. She was first diagnosed with cancer when she was 16. She eventually went into remission, but the cancer came back when she was 20. In remission again, she married Gabe but it soon came back a third time. She passed away when their son was 2-and-a-half years old. Afterward, Gabe started the Shira Pransky Project, in his wife’s memory, to make sure olim don’t struggle in the system like she did.
“I think language is definitely an issue, but it’s not the only issue,” he says. “The other big thing actually, and this is more of a cultural issue than a language issue, that comes up over and over again is the concept of bedside manner and the way that doctor and patient interaction unfolds.”
Pransky says people who come to Israel for the first time are often confused by cultural differences while interacting with people.
“[Immigrants sometimes] interpret native Israelis as yelling at [them] or some sort of adversarial relationship there,” when it’s simply not the case. Medical tourism and the ensuing struggle for resources is also becoming a problem – and a topic of discussion in the country – because of Israel’s high quality of health care, Pransky says. However, medical tourists also bring money into the system, which then benefits residents. The Health Ministry estimates these tourists bring in NIS 200 million each year, which is around $5.5 million.
Private money in the system is increasing too, as residents purchase second and third layers of private medical care from the health management organizations on top of their basic coverage. Private funding for care is at 38 percent, which is the second highest next to the United States among countries in the Organization for Economic Cooperation and Development (OECD). The Israeli government is working to increase coverage under the HMOs to lessen the amount of private insurance people buy.
Jaffe-Hoffman says there are many good doctors in Israel, but getting the right one at the right time can be difficult.
“I don’t think the doctors are better in the U.S.,” she begins. “I feel like if you can get the right specialist in Israel they’re awesome … but if you want to get into something quicker, if it really is pressing, I think it’s … harder to get an appointment.” She says a person can sometimes wait months to see a specialist.
According to the Taub Center’s State of The Nation 2016 report, Israeli hospital staff are constantly overworked, and there aren’t enough doctors or nurses or even essentials like hospital beds to go around. Jaffe says she experienced that when she gave birth to her youngest son.
“I was in … an entryway … where they had people behind different curtains and I was like ‘I’m going to have her really fast,’ and they didn’t really believe me,” she describes. She says she eventually gave birth to her youngest daughter in a room meant for two, but she was the only one in there. She says you typically share a room after giving birth, but she says the lack of privacy doesn’t bother her.
The system is highly regulated and, compared with the U.S., Israel puts a high priority on preventative care.
The country has some of the highest taxes in the world, which are used to pay for health care costs. Taxes are levied on a sliding scale, with higher income earners paying more, while low income earners pay less. Residents also pay a small amount of money each month to their health management organization, and the four insurers receive money from the government, which they in turn pay to the hospitals.
Per capita, Israel has the highest birth rate of any nation.
“They want you to have kids!” Jaffe-Hoffman exclaims.
Two of her children were born in Israel (her other three biological kids were born in the U.S.), and she says giving birth in Israel is vastly superior – as long as there are no complications.
“It’s very natural [at Israeli hospitals],” she explains. “I never take anything [an epidural] and they’re really supportive of that. It was just very flexible and what I wanted to do. She [Jaffe’s eight-month-old daughter] was born there and it was just really easy.”
She refers to giving birth at an Israeli hospital as a warm, family-like experience and says when she gave birth to her 14-year-old son in Israel, “They actually gave me a check when I left the hospital for having him.”
Everything from the ultrasound to the delivery room is covered, Jaffe-Hoffman says. When she had her daughter in the states her pregnancy cost her around $8,000.
“They [the Israeli government] encourage you to have kids, they want you to have kids. That’s probably one of the reasons the birthrate is so much higher also there,” she explains.
Because of its high life expectancy, Israel also has a small but growing elderly population, which is putting strain on the system as aging people generally have more health problems. According to Taub’s data the elderly’s contribution to the disabled population is expected to increase by seven percent over the next 20 years.
Despite its problems, both Jaffe-Hoffman and Pransky say they prefer the Israeli system.
“Oh yeah, thank G-d,” Pransky exclaims without thinking. He says his heart goes out to Americans struggling with the system.
“I would have to navigate [the American] system and worry about what’s covered and what’s not and how to access proper medical care … Here it’s a given. It’s a given that it’s your right and you still need to know how to access it, but it’s understood that you have a right to proper medical care for any medical situation that you encounter.”