Israel - Dov Chernichovsky

Israel’s population is aging quickly; the share of seniors in the population, especially those aged 70 and over, is projected to double by 2035. Due to this, functional impairment — which is naturally higher among the elderly — is expected to rise 16 percent faster than growth in Israel’s population. This will increase the need for in-home as well as institutional long-term care. The changing ratio between age-groups — more people aged 70 and over, in relation to those aged 15-69 — is expected to increase the long-term care challenge as well as the burden on households and on the economy as a whole.

This paper discusses the main challenges currently facing long-term care in Israel: (A) the lack of universal coverage; (B) the multiplicity of authorities charged with overseeing and managing the sector; and (C) the lack of preparation for the changing demographics of the future. This paper also looks at current Israeli government proposals for regulating the field, and points out the inconsistencies and weaknesses in those proposals.

The health indicators of Israel are high, while relative spending on healthcare is low. The enactment of the National Health Insurance Law (NHIL) in 1995 entitled all Israeli residents to free or nearly free health coverage via access to a socially determined “basket” of medical care. However, the NHIL recognizes that universal health coverage (UHC) transcends “the numbers,” or shares of population coverage. According to this law, UHC also embodies a series of qualitative attributes. This paper highlights the UHC attributes achieved in the Israeli healthcare system, beyond population coverage: equitable coverage, progressive contributions, access depending solely on medical need, accountability, and free choice. It also demonstrates particular implementation and continuance challenges: the lack of a firm state commitment to equitable UHC, leading to persistent disparities across Israel.

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This introductory chapter is divided into several sections. The first part is about developments in financing of Israel’s healthcare system. The second part discusses several of the stated goals for improving the system, as they are outlined in the Ministry of Health Plan for 2016 (Ministry of Health, 2016b):

• Increasing access to services and choice in the public system (Goal 1.1 in the plan)

• Preparing the healthcare system for the aging of the population (Goal 4.1 in the plan)

• Adjusting the healthcare system to changes in the characteristics of the population due to chronic illness (Goal 4.3 in the plan)

Avialable in Hebrew here.

The health of the Arab Israeli population is improving, along with that of Israel’s Jewish population. In terms of life expectancy and infant mortality rates, the Arab Israeli population ranks highest in the Arab and Muslim world. However, there are still sizable gaps in infant mortality rates (4 per 1,000 live births) and life expectancy (4 years) between Jewish and Arab Israelis — especially Muslim Arabs. Moreover, these gaps are not shrinking in absolute terms; with regard to life expectancy, particularly for men, the gap is actually widening.

The relatively high incidence of congenital disorders in the Arab Israeli population may explain the infant mortality gap between the sectors. This gap is a major factor in the life expectancy disparity between the two populations, and in the disparity’s persistence. Additionally, a relatively high incidence of road accidents and chronic, smoking-related lower respiratory disease among Arab Israelis may explain the growing life expectancy gap between the two populations, especially for men. Diabetes also appears to be a major cause of mortality that distinguishes between the Arab Israeli and Jewish populations — accounting for a 2.25-fold difference in fatality rates.

In general, the socioeconomic advancement of Israel’s weaker populations, and the narrowing of economic gaps, with all of its implications for healthy behavior and healthcare services, will help reduce the average health disparities between the two groups, since the Arab Israeli sector is disproportionately represented in the country’s weaker populations. This long-term mission requires intensive preliminary activity on the part of the state to improve accessibility to healthcare services, especially to medical specialists, in Israel’s geographic periphery, through allocation mechanisms (risk adjusted capitation and investment) and incentives (specialist wages).

At the same time, the particular cultural issues and needs of Israeli Arabs and the various sub-populations among them cannot be ignored. Attention should be focused on quality care, including prevention, of risk and mortality factors that characterize the Arab Israeli population — congenital disorders, accidents and smoking-related diseases. No less important is a focus on obesity and diabetes. Community clinics in Arab Israeli areas should be invested in to implement this care. Regarding challenges in medical access related to language, the large-scale presence of Arab Israeli employees in the Israeli healthcare system should be utilized across the system’s entire array of professional services, to improve the health status of this population.

English version available here.

  • Country: Israel
  • # Pages: 1-15
  • Publication Year: 2016
  • Type of Media: Article
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