israel has an excellent socialized healthcare system for its citizens,
arguably one of the best in the world. early zionism was very idealistic and
socialist, and quality and universal healthcare has always been a central
theme. the current system uses an interesting model – it is single payer (the
government), but there is an element of competition as well. there are three
not-for-profit “sick funds” which receive a set monetary amount from the
government for each citizen who is insured with them. the government requires
that these funds provide a “basket” of medical services and treatments for
their enlistees. for the most part, the basket includes what would be considered
the standard of care in the western world. it generally does not include things
such as procedures or treatments for aesthetic reasons or overpriced or
experimental new drugs. typically only the generic version of a drug is covered
as part of the basket if it is available. generous allotments for services like
physiotherapy are also included in the basket. the lump sum payment to the sick
funds for each patient, termed “capitation,” provides incentive for the fund
to invest in preventative measures for its patients, as if they can keep them
out of the hospital or prevent them from becoming sick in the first place then
significant money can be saved. each fund receives money for their patients
according to the same formula (age, gender, medical conditions, disability, area
of the country in which they live, etc.). in addition to the required basket of
services and drugs, the funds can provide additional services as well to
attract more patients/customers. citizens can choose their sick fund and can
switch between funds at any time at no penalty,, and the funds cannot refuse to
insure a patient. the funds are also the operators of the hospitals and clinics,
which technically keeps the government out of the business of healthcare though
there is obviously close collaboration.
though required healthcare is free for the citizenry, targeted fees are
permitted that aim to reduce inefficiencies. for example, due to the universal
problem of overuse of emergency rooms for minor issues, a fee was introduced
for emergency visits that are not either first referred by a primary care
physician or do not result in a hospital admission. likewise, a large levy
exists for those who call an ambulance but are not subsequently admitted to the
hospital. these efforts of course sometimes result in further inefficiencies, such
as people feeling the need to first contact their primary care physician when
they should probably just go straight to the emergency department, or doctors
admitting patients when they medically don’t need it to help them avoid the fees.
overall though it is a very fair balance that allows everyone to get the
healthcare they need without having to go bankrupt to do so, and attempting to
limit unnecessary overuse of the system.
of course, socialized care has its limitations. while it is excellent
for the poor, the rich do not appreciate waiting in line, getting a generic
drug rather than the brand name one, or not being able to hand-pick their
surgeon. thus, over the last few decades a robust private healthcare system has
developed in parallel with the public one. the merits and drawbacks of these
two-tiers are beyond the scope of this blog post, but private healthcare has
become a major sector of the israeli economy and a very contentious issue for
all involved.
prioritization of the family is a major focus. things like maternity
leave and government transfer of money to parents is a priority, as it is a
strategic goal of the government to keep the birthrate high. so much so that
invitro fertilization for all israeli citizens is free, at tremendous cost to
the state.
emergency medicine and disaster response are huge in israel. due to
everyone spending required time in the military, most people have some training
in responding to emergencies, and many have firsthand experience from wars they
have fought in. israel also sends medical teams to major worldwide disasters,
either privately or as a military delegation, and are world leaders in this
regard.
it must be noted that healthcare benefits extend only to israeli
citizens – not to asylum seekers living in israel or to palestinians, except
official east jerusalem residents. still sounds pretty good though, right?
israel has its huge problems, but overall i’d say healthcare is one of its
gleaming achievements.
