Israel Trip Day 5 - 15 December 2011

Today was less hectic than we had experienced previously. We heard two lectures at Hebrew University and the Braun School of Public Health.  The first was jointly conducted by Professor Orly Manor, Dr Amnon Lahad and Dr. Dina Jaffe on the theme of  the Community Medicine Quality Standards. In 2004, the Ministry of Health adopted a program for quality indicators in community health care. It was designed to provide consumers and policy makers with information on the quality of community based care delivered by the four HMO's in Israel. Virtually the entire population is part of the database. The data is developed on the basis of: importance/relevance; evidence based; ability to quantify; available electronically; and possible to be implemented.  There are six broad measures including: asthma; cancer screening; rate of immunizations for older adults; child and adolescent health; cardiovascular health; and diabetes.  A number of quantifiable measures are associated with each measure.  The main findings from 2007-09 were that in most areas, healthcare quality had increased over the prior five years  and that disparities continue to exist.

The second and final presentation was on economic behavior in Israel's health care system. Dr. Amir Shmeli, a very well known and respected health economist here pointed out that the HMO system was based on managed competition and that risk selection is a crucial part of the larger system. Budgets to the HMO's is based on age based risk insurance adjustment. I am certain that what Dr. Shmeli was presenting was very important but I felt like I needed to be a health economist to understand and appreciate what he was sharing with everyone.

The afternoon took us to a flaffel stand downtown for a particularly yummy lunch then it was off to the Knesset. We were given a guided tour of the Knesset by Daniel who explained very clearly the way in which the Israel Parliament was structured and the way in which Knesset members were elected (by party and not as individuals). He took us to the Plenum and pointed out that the seats for the 120 members were arranged like a menorah. We then went into the Great Hall and stood in awe of three Chagall tapestries along with his mosaics on the floor and the wall.  There is a replica of the Proclamation of Independence in the hallway that spells out the key provisions of the State of Israel.

Once done at the Knesset, we headed off for the Old City of Jerusalem and the Western Wall. This was a very emotional time for me when I had the opportunity to leave a note in the Wall for my old friend Steve Elefant and said a prayer for my mother who passed away in April. We were suppose to go through the tunnels beneath the Old City but the reservation was mixed up.  Our tour guide Nathan did a very nice job explaining the history of the first and second temples along with the significance of the Christian and Muslim roles in the Old City.

Tomorrow through Sunday are focused on travel and tourism. Monday, we start up the academic part of the program again with a visit to a hospital and community clinic in Nahariya. I will post my next blog on Sunday and share with you our experiences over the weekend.