MORBIDITY, MORTALITY, AND HEALTH OF THE POPULATION

THE POPULATION OF ISRAEL 5755 / 1995

Health Insurance

The National Health Insurance Law, effective from 1 January 1995, provides for a standardized basket of medical services, including hospitalization, for all residents of Israel. The law stipulates that all medical services will continue to be supplied by the country’s four comprehensive health insurance schemes; enrollment will not be limited or made conditional in any way.

The sources of funding include a monthly health insurance tax, of up to 4.8% of income, collected by the National Insurance Institute; employer participation in the cost of insurance for their employees; the state budget; and consumer participation payments. The insurance schemes will be reimbursed according to a weighted average number of insurees, calculated by age, distance of home from a population center, and other criteria determined by the Ministry of Health.

Israel’s HMOs provide primary and secondary care in more than 1,200 clinics, and more than 30,000 hospital beds were available countrywide in 1992. The ratio of beds per 1,000 of population is 5.9. Of these, 2.45 beds are for urgent care, including maternity hospitals and psychiatric wards in general hospitals. The total hospital bed occupancy rate in 1992 was 92.6%.

The system also has a national network of family-health centers that provide mother-and-child care (prenatal and postnatal) and meet other family-health needs. According to a health-services survey, Israelis are intensive users of health services for regular and preventive care, visiting family physicians and specialists more than ten times per year per capita.

Decreases in Morbidity and Mortality

After independence was declared, the health authorities found themselves face-to-face with challenges and complex problems. The doubling of the population within three-and-a-half years generated substantial new pressure on the health services. Many immigrants arrived with health impairments, poor hygienic habits, and miscellaneous contagious diseases. To care for this new population group, it was necessary to build a comprehensive medical infrastructure.

In developing the health system, the strongest emphasis was placed on improving the quality of medical services, adding human resources, delivering health services in every locality, developing research, providing more health information, and enhancing preventive services. To improve the quality of medical service, large fiscal investments were needed. In 1990, 7.8% of the Gross National Product was invested in the health system. The Israeli medical services face new challenges in the 1990s: improving the organizational structure of health services, caring for aging population groups, implementing national health insurance, planning the deployment of human resources in the health services, developing the dental-health system, and seeing to the planning needs of other health services.

Mortality by Causes

It is interesting to compare the changes in various components of the gross mortality rate (1:100,000) in order to discern changes in the incidence of the main causes of death (Table 9).

Heart disease, malignant tumors, and cerebrovascular disease are the main causes of death. The number of deaths caused by myocardial infarction and cerebrovascular disease is decreasing, but that caused by malignant tumors is rising slightly. The rate of deaths from contagious diseases and complications of childbirth is decreasing, but some contagious diseases

(e.g., hepatitis) and diseases of the digestive system are still problematic.

Health Policy

In 1985, Israel joined the European region of the World Health Organization and adopted the WHO policy of "Health for All by the Year 2000." In the specific Israeli perspective, the main goals of this policy are to mitigate inequality, improve the level of health, reduce environmental and occupational health risks, and promote healthful lifestyles.

In 1990, a state commission of inquiry on the performance and efficiency of the health system prescribed far-reaching reforms to solve the problems of the health system. In its main recommendations, the commission advised the Government:

a. to assure fairness and take action to improve system efficiency and response to patients’ needs;

b. to enact a national health insurance law, with said insurance funded progressively by employers, workers, and government; and

c. to organize the health system on a regional basis, with fiscal resources allocated to the regions according to a formula that reflects interregional differences.

Progress in many respects has encountered new problems stemming from the recent waves of immigration. Mass immigration from the former Soviet Union and Ethiopia has reintroduced diseases that had almost vanished from the Israeli scene, such as tuberculosis, malaria, and various intestinal ailments. Immigrants from the former Soviet Union suffer from chronic illnesses chiefly because of their lack of health-maintenance awareness, inappropriate behavior patterns, and inadequate access to specific medical services such as effective contraception for family planning.

To meet the immigrants’ special needs, the Government mounted a comprehensive effort to pinpoint the problems, train professional caregivers, insure the immigrants during their period of acculturation, introduce programs for specific care, and provide health education. Emphasis was placed on service in clinics, hospital out-patient facilities, and day-treatment centers. Further emphasis was given to long-term care programs, development of geriatric medical services, and care for infants, the disabled, and children with impairments.

Training programs were introduced to enhance public consciousness in various respects. Examples are the war on drugs; lifestyle education; intelligent and correct nutrition; promotion of medical care and preventive medicine; family planning; mother-and-child care; environmental hazards; prevention of heart disease, cancer, AIDS, and blood-pressure problems; and non-smoking programs.

Preventive-medicine services, under the responsibility of the district offices of the Ministry of Health, reach 90% of the population. Services include inoculations, mammography for early discovery of breast cancer, a program to prevent congenital defects, blood testing for HIV, prevention of thalassemia, and family-planning counseling.

New Legislation

In pursuit of the goals of health policy, several laws have been amended in the past few years:

Persons with Disabilities

1. In 1989, the legal limits were expanded to allow disability benefits for the motor-disabled, orphans, women and children with impairments, bedridden pregnant women, dialysis patients, and persons following kidney transplants.

2. The Employment of the Disabled Law requires any enterprise with more than 100 employees to hire at least one disabled person.

3. The Special Education Law ensures testing, treatment, education, counseling, and medical and paramedical services for people aged 3- 18.

Prevention of Smoking

The law has been expanded in order to ban smoking in public areas such as workplaces and places of entertainment.

Child Safety in Automobiles

In 1991, the law was amended to require the use of seat belts in the back seats of cars and the installation of infant-safety seats.

Dangerous Drugs

An amendment to a 1989 order requires the courts either to confiscate the property of any person found guilty of drug trafficking or to explain in writing why they refrained from doing so.

Treatment of Drinking Water

In 1990, the Ministry of Health issued new instructions requiring the chlorination of drinking water to the strength of 0.1-0.5 milligrams per liter or alternative purification of equal effect.

Water Pollution

New legislation prohibits pollution of seawater from land sources; recently issued regulations prohibit pesticide pollution of water sources.

Air Pollution

Orders issued in 1992 prohibit damage to air quality and emission of pollutants at levels exceeding those set forth in standards.

Food Regulations

New orders issued in 1990 pertain to the licensing and regulation of food manufacturers.

Hazardous Waste

The legislation, dating from 1981, enjoins industrial enterprises from discharging untreated toxic waste into sewage systems. The provisions constrain the haulage of hazardous waste to vehicles driven by specially trained personnel and equipped with special tanks. Special disposal sites for hazardous waste were designated in 1990.

Occupational Hazards

The law requires employers to apprise employees of occupational health hazards. Orders concerning work with hazardous substances have been gazetted, and procedures for prevention and medical examinations for workers have been set forth.

  Table 9: Mortality per 100,000 by Cause of Death          (in Selected Periods)  Cause of Death                   1970-1972  1987-1989  Total                               684        653 Infectious and parasitic diseases    19         12 Malignant tumors                    114        123 Ischemic heart disease              187        136 Cerebrovascular disease              88         59 Pregnancy- and childbirth-related    26         10  (perinatal) Other diseases                      196        269 All external causes                  55         45