Healthcare in Israel

Healthcare in Israel is based on the National Health Insurance Law of 1995, which requires all citizens to become members of one of four competing nonprofit health insurance organizations, known as a Kupat Cholim. The system is funded by taxes, with payments deducted from salaries or collected through income taxes. Coverage is universal and participation is mandatory. A Kupat Cholim must accept any Israeli resident for membership. The military and prison systems have their own healthcare systems, and employers of foreign workers are required to enroll them in private healthcare programs.

The government sets a list of required services, known as the Sal Briut (health basket), and all four healthcare organizations must offer the exact same basic coverage at no additional membership fee to all members. The Sal Briut includes primary care, diagnostic testing, prescription drugs, specialty care, maternity care, hospitalization, mental health care, and other services. There are no deductibles, but some payment by the member may be required for prescription drugs, specialist care, or other extended services.

The healthcare organizations offer higher-level plans with lower prescription medication fees, access to a larger practitioner network, or faster access to services. These optional packages are paid for by the insured, and a majority of Israelis purchase some form of additional coverage. Residents may choose from any of the four Kupat Cholim organizations, and are permitted to change between them at six month intervals.

Healthcare organizations operate websites and mobile phone applications that offer varying levels of access to information and services, such as scheduling appointments, requesting prescriptions, and viewing diagnostic test results. These systems are offered in Hebrew, but online translation of the website and familiarity with the mobile apps can make it easier for people with limited Hebrew to access medial services and information. The centralized nature of data storage means that every provider within the organization, external providers and facilities, and even retail pharmacies are connected to the information management systems of the healthcare organizations. Merely presenting your membership card at the pharmacy allows them to see and dispense your prescriptions. Centralized systems keep all providers informed of pre-existing conditions, health history, and assist in patient care matters such as avoiding conflicts in medication or treatment.

A large percentage of Israel’s doctors were born elsewhere, and much training is done using English, which makes it relatively easy to find practitioners who are either native English-speakers, or have sufficient English language skills to provide explanations and advice. Plans offer varying levels of routing patients to practitioners and information in their native language. Access to materials and telephone appointment services in English also varies, and may involve lengthy wait times, making the online and mobile application methods of requesting services valuable options for those with limited Hebrew skills.

The Ministry of Health (Misrad Habriut) is responsible for the health of Israel’s population, and administers a large network of facilities including hospitals, maternity centers, and mental health facilities. Independent facilities, including about half of the hospital bed capacity, augment the Ministry of Health facilities, and are operated either privately or by the healthcare organizations. Additional public health services are also provided by the Health Ministry, including communicable disease screening, preventive care, prenatal care, infant development testing, and long-term institutional care.

The healthcare tax is currently 5% of income and 3% for low income residents, with an annual cap. The unemployed pay a low basic monthly fee of about NIS100. This translates to a much lower cost than what is typical in the USA and many other nations. Factors such as universal coverage, compulsory participation, the nonprofit structure of the healthcare organizations, lower provider salaries, lower prescription drug prices, and the government’s building and operating facilities make the cost of delivering care relatively low.

Access to services and providers is guaranteed, but some geographic areas have fewer facilities and providers than others, and some services may have sufficiently large demand to cause delays. As a result, speed of care may vary considerably. In any location, it may be possible to get routine primary care with almost no delay, but see waits of weeks or months for non-urgent physical therapy or other services. Private practitioners also operate in Israel, so it is possible to seek care outside the insured system, or even to get a procedure scheduled quickly through a private doctor (paid separately) at a local facility (whose fees are covered by the healthcare organization). While imperfect, the general access to basic and advanced care compares favorably to that of many other countries, with positive outcomes.

Israel is home to many institutions conducting advanced research, and it is often possible to receive care through the healthcare system that would be unavailable in countries dominated by fee-for-service delivery and for-profit insurers. However, hospital construction has lagged when compared to population growth, and the result is a shortage of capacity, especially in the North and South of the country. Shortages of providers exist in some areas and disciplines (especially among nurses and physician’s assistants), but the ratio of physicians to population is actually better than the ratio in the USA and Japan.

Israel’s healthcare system is among the most technologically advanced in the world, staffed by well-trained healthcare providers. The system is among the most efficient in the world. In 2015 Bloomberg rankings, Israel was mentioned as eighth in the world for life expectancy and the sixth healthiest country in the world.

The Magen David Adom (Red Star of David) provides emergency care in Israel, and is supplemented by Hatzala, ZAKA, and other voluntary organizations staffed mainly by the Orthodox community. Magen David Adom (MDA) operates a fleet of motorcycles, ambulances, and helicopters to provide rapid response and patient transportation.

Nefesh b’Nefesh offers an overview of the Israeli healthcare system including information specific to Aliyah. Wikipedia has an extensive article including historical information on Healthcare in Israel. The Commonwealth Fund website includes Israel in its international healthcare system profiles.