Israel's health system evolved over the past century and achieved universal coverage in 1995. Health status indicators have improved dramatically over the past decades and are now generally excellent compared with those of OECD countries. The Healthy Israel 2020 (HI2020) initiative was launched by the Ministry of Health in 2005 with the goal of creating a preventive blueprint to improve the quality of life, increase overall longevity, and maximize health equity among Israelis. Twenty committees were charged with generating reports that addressed health determinants such as health behaviors, health states such as infectious disease, age-related health states, or infrastructural aspects such as preventive education and training. Reports presented the local and international epidemiologic data, generated objectives and year 2020 targets, and compiled evidence-based interventions to achieve them. Obstacles included uneven committee leadership, redefinition and expansion of focus areas, and the absence of formal prioritization methods, among others. Nevertheless, significant progress occurred, and by 2009, a variety of scientific products had been generated. These ranged from scientific reports to peer-reviewed publications and scientific conference presentations. The first three reports dealt with key lifestyle behaviors: obesity control, enhancing physical activity, and healthful nutrition. These then served as the foundation for a major spinoff of the initiative, the National Program for the Promotion of an Active and Healthy Lifestyle. HI2020 has been a key factor in the development of tobacco control legislation, alcohol control efforts, pediatric injury control, skin cancer prevention, and intervention programs to prevent chronic disease in the disabled. Implementation efforts are refined through workshops attended by key professionals and other stakeholders. Future challenges include the timely updating of the reports, enhancing dissemination of lay and scientific information via traditional and social media, enhanced prioritization and funding of the initiative, and adoption of a cost-effective policy implementation program.
Bibliographical noteFunding Information:
Beginning in 1911, health care began to be provided by Sick Funds created by local labor unions. The Sick Funds were funded through membership fees. In 1973, a law was passed requiring employers to contribute as well. The 1995 National Insurance Law led to provision of government-financed universal health insurance for all Israeli citizens. The four health funds currently in operation are funded by the government on a per capita basis from payroll and general tax revenues. The employer health tax was cancelled in 1997. The National Insurance Institute, the organization responsible for social security in Israel, tranfers funding to the health funds through a capitation scheme that incorporates the number of insurees in each fund, their age, and other factors. These health funds competitively serve the citizenry, with the largest, Clalit, insuring roughly 50 percent of the population, the next largest fund, Maccabi, serving about 25 percent, and the other two (Meuhedet and Leumit) splitting the rest of the population between them. Close to half of the hospitals are owned and operated by the government, about a third by Clalit, and the rest are operated by a mix of for profit and not-for-profit organizations.
Relevant epidemiologic data have become more readily available over the past decade, due to closer cooperation between data generating organizations within Israel. However, lacunae still exist due to issues such as divergent definitions of key variables, proprietary software which prevent linkage of data systems, patient privacy concerns, and others. Closing these gaps will require such innovative projects as the European Union Twinning Project,35 which has was launched in 2013, pairing the Israeli Central Bureau of Statistics with Statistics Denmark, in an effort to improve the quality and international comparability of Israel’s data in key policy-relevant domains. Funding the interventions is a formidable challenge. Thus far, the MOH has succeeded in securing initial funding of the interventions to be fielded by the National Program for the Promotion of an Active and Healthy Lifestyle. Other programs have been funded in part by research grants.
- Disease prevention
- Health promotion
- Health targeting
ASJC Scopus subject areas
- Community and Home Care
- Public Health, Environmental and Occupational Health