Socialized Medicine in Israel
Why I Loved Visiting My Doctor in Jerusalem.
-- Rabbi Reba Carmel
Americans who hold dual Israeli-American citizenship often engage in the never
ending ping-pong game of ““x” is better in the old country” – whichever country
one may have emigrated from – to which the second or third generation native
would volley “No, “x” is better here;” and so on. For the small stuff, the game
generally ends in the Talmudic ‘taiku’ or draw. But for the big stuff, the
issues that are approached in different ways in the two countries, we could
learn from each other if only we would listen to each other and consider
adopting that which is helpful.
Health care provides an instructive example. Israel’s health care system is fully
subsidized by the government; it is socialized medicine. There are three HMOs,
each of which offers a ‘basket of benefits,’ which are fairly comparable. The
differences between the three are often administrative – such as location of
doctors or ease of getting appointments. Each HMO assesses a monthly fee for
coverage of every Israeli citizen; the fee increases as the member ages. One can
purchase additional benefits within each plan – such as alternative care,
occupational therapy benefits and so on.
In addition to the monthly fee, every Israeli employee is assessed a health tax
which is determined by income level. A person earning a higher salary is
assessed a higher health tax which is separate and apart from the income tax
assessed. On the whole it is fairly costly. But – and here is the biggest but –
every Israeli citizen has at least basic health insurance. Every Israeli citizen
has access to a physician and a hospital when needed. Society bears the cost of
insuring its members.
Clinics throughout the country care for children until the age of three. These ‘tippat
chalav’ (literally, drop of milk) clinics inoculate children, educate their
parents and serve as a resource for informal parent support groups.
The health basket also includes prescription medication. Admittedly, the cost for
pharmaceuticals has increased over the years. Arguably, there is medication
which should be included but is not; citizens lobby the Ministry of Health
vigorously to have access to cutting edge medication. Sometimes they succeed and
at other times, they do not.
All physicians in Israel must participate in the country’s HMOs. That means that
theoretically, everyone will have access to world class health care. Admittedly,
in reality access will not be the same for a citizen relying solely upon the HMO
as for someone who can pay privately. The former may have to wait longer in a
non-emergency situation. But that citizen will receive care. The system
functions on three levels – the purely subsidized, the quasi-private and fully
private. For a surgical procedure, for example, a patient can rely upon the
physician/specialist on duty at a particular time and the surgeon of choice will
oversee the beginning of the procedure and sign off at the end as the surgeon of
record. Or, a patient can have a participating surgeon of choice and his/her
team perform the surgery for an additional cost at a public hospital. Or, a
patient can enter a private clinic and have the surgery performed entirely at
his/her cost. It is a three tiered system.
I am not adverse to that type of system. People can use their resources however
they choose. But the overarching value is universal coverage.
I loved my doctor in Jerusalem because she loved her patients. A family medicine
practitioner, my doctor arrived in Jerusalem from South Africa about 15 years
ago. Over the years her administrative duties increased because the HMOs sought
to reduce their costs. The HMOs demanded that patients be seen for only ten
minutes, as opposed to the 15 or 20 that had been the norm only a few years
before, that only a certain number of imaging tests be administered monthly and
so on. They required that the attending physician update the patients’ records
by computer while he/she was assessing, examining and diagnosing the patient –
all in ten minutes!
Doctors approached these requirements differently. One pediatrician I knew held
to the ten minute appointment schedule, if that. Patients thought he was
fabulous – in and out. BUT he was always available by cell phone. In contrast,
my doctor dealt with these requirements another way. No matter how crowded her
waiting room (it was!) or how harried she felt (very), she never lost sight of
her sacred duty to heal the sick. So we waited for her, and it was fine. She
circumvented the computer/administrative requirement by hiring a nurse to do
patient intake. This enabled her to read the nurse’s report before seeing each
patient, which provided her with the focus and energy to actually concentrate on
the person sitting before her. She would complete the computerized record after
the patient left. If a medication was not included in the HMO’s basket of
medication, she always found a comparable substitute. She worked within the
system, but to the extent that she was able to creatively manipulate it to serve
patient need, she did.
I have been back in America for a bit over a year and only now, in the midst of
the health care debate, am I absorbing the appalling fact that insurance
companies let people die; that decisions are made for reasons that have little
to do with the patient. I find it shocking that age, income, and race often
determine the value of a human life, or at least, the value of caring for it.
Before our elected officials decide how to vote on including a public option in
health care reform legislation, I would urge them to look into the eyes of their
constituents and tell each citizen whether his or her life is worth healing.
Without a public option an unforgivable number of our citizens will remain
uninsured. I hope public officials will recall that their mandate is to serve; a
physician’s is to heal; and there is nothing more sacred than a human life.
Rabbi Reba Carmel, a former labor law attorney, has taught adult education both
formally and informally in Jerusalem, Sydney and the greater Philadelphia area.
A freelance writer, she is currently teaching in a variety of settings including
synagogues and multi faith groups.
Israel Project's Panel of Experts Discuss Israeli Medical System.
As Americans began debating various proposals for health care reform over the
summer months, The Israel Project (TIP) put together an hour long conference
call on “Healthcare in Israel” to provide an overview of the universal health
care system in Israel. Participants heard the views and experiences of three
distinguished scholars and doctors, two in Israel and one in America. They were:
Dr. Alex Leventhal, Director of the Department of International Relations, Israel
Ministry of Health
Dr. Bruce Rosen, Director of the Smokler Center for Health Policy Research,
Myers-JDC-Brookdale Institute (Israel)
Stephen Zuckerman, Senior Fellow, Health Policy Center, The Urban Institute
(Washington, D.C.)
The program was organized and moderated by TIP.
For extensive resources on this topic
click here.
For the transcript and downloadable MP3 audio of the June 24, 2009 conference
call,
click here.
To view previous editions from our Israel section, please
click here.
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