Israel trip day 2 - 12 December

Everyone met for a very good breakfast at 7:00 at the hotel then we boarded the van to drive over to Hebrew University's campus at Hadassah Hospital in West Jerusalem. We were met by Professor David Chinitz who provided an introduction to the day's speakers. We led off with a summary of payment and delivery of health services in Israel by Dr. Leon Epstein.  Among the things we took away was the passage in 1994 of the National Health Insurance Law that was based on the principles of "justice, equity and solidarity." The law provides for a number of important attributes:

• Universal coverage for all citizens of Israel
• Payment by a progressive health tax paid by individual taxpayers and not employers
• Standardized basket of health services
• Capitation to four HMO's or Kaupt Holim (sick fund)

Of the four Kaput Holim, there is one dominant player with over 50% of the market, one with about 24% and the remaining two splitting the difference. As currently structured, Israel consumes about 8.1% of GDP to cover their 7.1 million citizens. Some of the issues confronting the system are:

• Significant problem with shortages of physicians and nurses
• Areas of major health inequality
• The percentage of out of pocket funding for health care continues to rapidly increase

Dr. Ari Israeli, former Director General of the Ministry of Health and current faculty member at Hebrew University was next and he continued with the discussion about the problems associated with adding new medical students in Israel. He pointed out that the basket of services specified in the National Health Law is overly long and complex including specific indicators, conditions and treatments for literally thousands of health care conditions. He also pointed out that almost 100% of every community physician had adopted electronic health records and that hospitals were approaching the 100% level. The two largest sick funds use the same EHR as do 9/26 hospitals in Israel.

Alex Leventhal, former head of Israel's Public Health Ministry and now in charge of international realtions for the Ministry of Health shared his perspective on the fact that Israel is now part of the OECD and is considered to possess one of the best health systems in the world.

Hagai Levine, a new faculty member in the Braun School shared his perspective on the role that environmental health played particularly around a process called a health impact assessment or HIA. The purpose of the HIA is to examine how policy affects the health of a population and the distribution of those effects in the population. Just imagine how different US health care would be were an HIA done prior to the passage of a particular piece of health legislation.

Finally, we were joined by a large group of International MPH students for the final lecture by Schlomo Mor-Yosef, President of the National Institute for Health Policy Research. He led off with an in depth conversation about the after affects of the recently settled Israeli physicians strike (more on that later). As a result of the National Health Insurance law, 0.1% of the tax is dedicated to conduct research, evaluation and policy oriented studies and seminars on the impact of the law and development of the health care system in Israel. The Institute exists as a independent, non-profit research center beholden to no one.

After a long day in the classroom we were escorted up to Mt. Olives, overlooking the Old City from the East. We heard about the creation of the modern state of Israel along with the history of the Old City from biblical times forward.

At the end of the day, Director Manor hosted a reception for her faculty, our students and the 36 or so students in the International MPH. It was a wonderful evening (thanks to Arthur Shorr for being our expert photographer) capped by a short presentation by Director Manor's husband who serves as a senior official in Israel's foreign ministry and is the former ambassador to Sweeden.

Overall a busy but truly memorable day!