The Top Initiatives in Israeli Health Care in 2019
by Jonah Goldberg
Israel’s health system is recognized internationally for its efficiency and rapid progress. Israel spends less than 8% of its gross domestic product on health care--the US is approaching 18%--but it maintains comparable health status to other developed countries, due to a combination of controlled competition among four health plans and advanced systems of electronic medical records. These strengths in turn stem from Israel’s unique capacity for innovation; the Israeli government is constantly examining new data and reports in order to update its policies and better serve its citizens. It is one of the missions of the Myers-JDC-Brookdale Institute to empower the government’s approach by identifying key societal challenges and providing expert information to contribute to better policy decisions.
These are the three main challenges Israel’s Ministry of Health (MoH) is currently tackling, according to a report from Brookdale researchers Ruth Waitzberg and Ira Yaari.
Access to Digital Records and Prescriptions
The objective: Access to online information has historically been limited. Patients previously needed to pay out-of-pocket to view their medical records, and they lacked reliable hubs for information regarding treatments and medications.
A separate issue was that patients trying to fill digital prescriptions could only have them filled by their own health plan’s pharmacies, which made receiving medications more difficult and costly. Other pharmacies were generally barred from connecting to any health plan’s computer network by high fees, allowing health plans and large pharmacies to dominate the market.
What is being done:
The Knesset updated a law regarding patients’ receiving of medical records. Records are now available for free when requested immediately after care, and for up to NIS 10 when requested retrospectively up to 5 years.
The MoH created an online Israeli Drug Registry (link https://data.health.gov.il/drugs/index.html#/byDrug). Patients can now search for which drugs are included in the health basket, which drugs contain the same active ingredient, and more, allowing them to make better informed choices.
The MoH has begun collecting data on the availability of care and regional wait times for common specialties. With time, patients will be empowered to choose the health plan and clinics that best fits their needs, and clinics will likely expand the scope and quality of their services to stand out on these maps.
The Knesset passed a law requiring all pharmacies to accept digital prescriptions from all health plans and instructing the MoH and Ministry of Finance to set a maximum fee that a health plan can charge a pharmacy for connecting to its network. The new law will increase access to prescription drugs and competition between pharmacies, leading to lower prices for patients.
Public Health
The objective: The World Health Organization warned in 2016 that 39% of adults had become overweight, with a third qualifying as obese. Israel ranks as one of the healthier countries, with a 16% obesity rate, but this number still indicates that tens of thousands of Israeli adults are suffering from this “New World Syndrome” and are at higher risk of heart attacks, strokes (link: https://brookdale.jdc.org.il/en/publication/acute-stroke-forecasts/), and diabetes, among several more illnesses. One cause of this epidemic may be that 22% of Israelis reported drinking sweetened beverages (i.e. juice and soda) every day or almost every day.
Additionally, the MoH is concerned about smoking, which not only drastically increases one’s risk of developing lung cancer, but can also lead to other cancers and heart disease. As of 2016, nearly 19% of Israeli adults were smokers, comprising 27% of men and 12% of women.
What is being done:
The Knesset recently revised its Regulations for the Protection of Public Health, and the changes will take effect on January 1st, 2020. The most salient amendment in the Regulations is that manufacturers will be required to label products exceeding maximum amounts of sugar, sodium, or saturated fats. More importantly, these maximum amounts will decrease in 2021 (in the case of sugar, from 500 to 400 mg in 100 g of solid food). This timeline will ensure that companies re-evaluate their recipes multiple times.
The Law on Restriction on Advertisement and Marketing of Tobacco and Smoking Products was amended for the seventh time; some new restrictions came into effect in January, and others will continue to be implemented through January 2020. The changes include steadily increasing the required size of warning labels on all smoking products--including e-cigarettes--a ban on publicly displaying smoking products in stores, and a ban on using images of fruits or any other plants on product packages.
Public vs Private Care
The objective: While Israel offers universal health care to its citizens, issues of wait times and services excluded from the health basket have led many Israelis to utilize private health services on top of paying for insurance. The deficiencies in public health care partially stem from a shortage of medical professionals. The MoH reported in 2018 that Israel has only 3.1 doctors for every 1,000 people, and only 5 nurses, earning the country a rank of 30th out of 34 OECD (Organisation for Economic Co-operation and Development) countries for nurses per capita.
What is being done:
The 2019 MoH budget expands the scope of services, costs, and populations covered for elderly Israelis (link: https://brookdale.jdc.org.il/wp-content/uploads/2018/02/MJB-Facts_and_Figures_Elderly-65_in_Israel-2018_English.pdf). The new budget includes previously neglected areas of care such as dental health, and adds long-term care insurance, with a subsidy system that is currently being revised to make qualifying for financial assistance easier. This expansion will further an existing trend of improving quality of life among Israel’s aging population (link: https://brookdale.jdc.org.il/en/active-aging-in-israel/).
The MoH released a circular in May defining new roles and responsibilities for nurses, empowering them to perform more clinical procedures, including ordering diagnostic exams, referring patients to specialists, and adjusting medication dosages. The ministry hopes this shift will draw in more nurses and reduce pressure on physicians, making it easier and much faster for patients to receive guidance and care.
What Comes Next?
The 2019 trends show that Israelis are taking an active role in their health care, seeking more information and looking for which services serve their needs best, whether public or private. The Ministry of Health has responded to this movement by breaking down barriers to information access, urging clinics to share medical records and manufacturers to be honest about the health effects of their products. Israel is also pushing to improve public health care by expanding the services and costs covered and by promoting a larger and more flexible medical workforce. 2020 will likely see further steps along this path, with messaging services connecting patients to medical professionals, increased sharing of data between health plans, pharmacies, and patients, and greater public health awareness leading to a healthier population.