Israel: excellent primary health care, but hospitals must improve
Israel has world class-primary care services and should now focus efforts on bringing its hospitals up to the same high international standards, according to the OECD Reviews of Health Care Quality: Israel.
While most OECD countries grapple with rising healthcare costs, Israel has maintained tight control – limiting health spending to about 8% of GDP, the eighth lowest across OECD countries – and still offers universal coverage and high-quality primary health care services.
Medical teams in community-based health clinics allow patients access to a broad range of health expertise and support in a one-stop-shop, offering care that helps avoid expensive hospitalisation. For example, though Israel has the same rate of diabetes – 6.5% of the adult population – as many other OECD countries, it has the second lowest rate of hospitalisation for poorly controlled diabetes.
Clinics are held to account through the Quality Indicators in Community Health Care Programme which tracks performance across thirty five key measures. Unlike the United Kingdom, Australia and France that offer financial incentives to providers that meet performance targets, Israel’s health plans help clinics by showing them what they are not doing well and how they can improve.
In contrast, there is insufficient public information on the quality of care patients receive when they visit a hospital and no system-wide monitoring to improve the quality of hospital care. Compounding this unsatisfactory situation, co-ordination between primary care and hospitals is poor, with no single electronic data system to track and share patient information.
The Health Care Quality Review of Israel also flags the persistent inequalities in Israelis’ health outcomes and access to healthcare. Israeli-born Jews in urban centres and those able to pay the rising out-of-pocket costs are getting better care, and living longer, than immigrants, Arabs, and poor people.
Pressure on the health care system will continue to rise as medical professionals who emigrated from Russia after the collapse of the Soviet Union reach retirement age, young doctors choose to specialise, the elderly population grows, and the rate of chronic disease rises. To help the Israeli government make prudent reforms to prepare the system for tomorrow, the OECD’s report recommends:
● Improving care in hospitals through a quality monitoring programme and by obliging hospitals to develop their own plans to improve the quality of their services.
● Improving co-ordination of care, including through the electronic transfer of patient information.
● Boosting current efforts to tackle inequalities by rolling out programmes that target disadvantaged groups, providing cultural appropriateness training to doctors and nurses, limiting further increases in co-payments and ensuring that healthcare is accessible to people in the north and south of the country.
● Enhancing primary care services by expanding the number of chronic disease conditions covered through data monitoring and encouraging younger doctors to work in primary care.
Source: OECD
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