The heated debate over health care reform, reignited by the Supreme Court’s decision to uphold President Barack Obama’s plan, has drawn attention, once again, to the issue of government involvement in health care management and the effectiveness of a system based on universal coverage.
For Israel, this is a Rubicon crossed long ago. Despite the country’s mania for most things American, when it comes to health care, Israel chose a system based more on the European model. The government’s role is central as both funder and regulator. Yet, going by many indexes of health outcomes, the result in terms of quality of care is often better — and definitely cheaper than in the U.S. Under the Israeli system, the percentage of the country’s gross domestic product going to health care is less than half that of the United States. And coverage is universal.
Stephen Reingold has observed both systems from up close. He is a pediatrician who practiced medicine in New Jersey before moving to Israel in 2009, where he now sees patients in Modi’in.
“One of the first things I noticed in the emergency room was that we only got severe cases,” Reingold recalled of the time he spent at an Israeli children’s hospital. The reason, he later learned, was that “hey, people here have a doctor to go to” and therefore do not end up in the hospital for minor problems, even if they are poor.
Access to doctors on a regular basis is one of the advantages that the universal health care system offers in Israel. It is commonly referred to as a “socialist” health care system, as opposed to the “private” system in the United States, but as a 2010 study comparing the two approaches demonstrated, these descriptions do not reflect their true nature, since both Israel and the United States have a mix of private and public health care.
One example of this hybrid system is Laniado Hospital, in Netanya. It isn’t state-run — even though most Israeli hospitals are — but rather a fiercely independent not-for-profit institution with a strong identity and a proud history. But there is one major difference from the United States: Doctors never need to worry about bills.
“I have to accept every examination the doctors ask for, and I don’t have a say if the doctors recommend giving the patients a very expensive medicine — which is good,” medical director Avinoam Skolnik said.
Health care provision in Israel is made through not-for-profit health maintenance organizations. Six months after the Jewish state was established, in 1948, just 53% of the population had HMO insurance. Israel steadily increased its financial contribution to HMOs, making membership more affordable, and in 1973 it obliged employers to pay contributions toward employees’ policies.