Haim Bitterman. Chief Physician

Transcription

1 Haim Bitterman Chief Physician

2 1850 Otto von Bismarck ( ) 1850

3 The German tradition of welfare programs began in Prussia and Saxony as early as the 1840s Named after the Prussian chancellor Otto von Bismarck, inventor of the welfare state. Bismarck introduced old age pensions, accident insurance, medical care and unemployment insurance. In the 1880s, Bismarck s social insurance programs were the first in the world and became a model for other countries

4 Compulsory nationwide health insurance Principle of Social Solidarity All members should have access regardless of ability to pay The health insurance was managed by sickness funds or mutual aid associations The cost was spread across the population via income-based premiums (usually paid jointly by employers and employees by payroll tax deductions) Patients paid small co-pays for their health care

5 The sickness funds are non-profit insurance organizations which provide most of the health services The responsibility for providing the remaining private or public services is transferred to non-governmental or private providers Tight governmental regulation of medical services and fees

6 Lord William Beveridge ( ) British economist and social reformer Best known for his 1942 report Social Insurance and Allied Services which served as the basis for the post - World War II welfare state

7 Developed by Lord William Beveridge in the 1940s Healthcare is managed and financed by the government, through tax payments Regional health services are provided by the government through a mixture of government-owned and contract private providers Government controls cost as the sole payer

8 Other Models The free market model The US models The French Model.... Various combinations of the Bismark, Beveridge basic basket and free market models with additional insurance tiers

9 1880s 1 st Aliya and establishment of new settlements Till 1882 there were hardly any health care services outsides urban centers : Recruitment of Jewish physicians from Europe to work as doctors in the new agricultural settlements Physicians were occupied on a contractual basis. The medical service was provided for a full fee to the doctor : Second wave of Aliya mainly from Russia. Driven by socialist ideals most of the newcomers became agricultural workers

10 The idea to establish a mutual aid healthcare organization was the result of a work accident in which a laborer named Baruch Priver lost an arm while working in an orchard Prof. Shifra Shvartz

11 Labor Federation of Agricultural Workers in Judea established the first health plan (later known as Clalit ) to provide care to workers and their families and to employ immigrant doctors.

12 Baruch Priver (1893-?) Joseph Trumpeldor ( )

13 Clalit Health Services >1,400 Community clinics (Primary care and specialist services) 14 Public hospitals ( 30% of hospital beds in Israel)

14 1931- Amamit health fund established by Hadassa and the Farmers Association Leumit health fund established by the Revisionist Movement General Zionists fund established by the General Zionists movement Maccabi health fund is established Meuhedet health fund established by the consolidation of Amamit and the General Zionists

15 By the late 1980s approximately 95% of the population were insured in one of the four health plans The health plans both insured their members and provided them with most of the health services

16 In 1990 the Netanyahu Commission was appointed to examine the function and effectiveness of the Israeli health care system. The commission came up with the following list of statements and items that require better regulation: Major inadequacies exist in the services provided to the public The system is organized sub-optimally and lacks managerial tools Financing and budgeting procedures are vague The Ministry of Health s dual role as service provider and regulator Low levels of employee satisfaction and motivation

17 Recommendations: Legislation to introduce NHI Reorganization of the Ministry of Health Regionalization, decentralization and enhanced competition A centralized financing system and capitation payments Introduction of private medical practice in public hospitals Financial incentives for increased productivity

18 The Knesset passed the NHI Law in June 1994 and it came into effect in January 1995 Key components: Universal coverage. Defined package of benefits to ensure access to needed services and to clarify the obligations of the health plans to their members. The institution of a capitation formula to ensure that the health plans have incentives to compete for elderly and poor people A commitment to monitor the Law s impact sets aside 0.1% of the health tax for relevant research coordinated by the NIHP. Responsibility for psychiatric, geriatric and preventive care is transferred to the health plans during a 3-year transition period, ending on 1 January 1998.

19 Key components: Universal coverage Defined package of benefits to ensure access to needed services and to clarify the obligations of the health plans to their members The institution of a capitation formula to ensure that the health plans have incentives to compete for elderly and poor people A commitment to monitor the Law s impact sets aside 0.1% of the health tax for relevant research coordinated by the NIHP Responsibility for psychiatric, geriatric and preventive care will be transferred to the health plans during a 3-year transition period, ending on 1 January 1998

20 Collection of progressive premiums by the NII rather than by health funds The requirement that health plans must accept all applicants, together with the capitation formula, is meant to eliminate or drastically reduce cream-skimming A Government s commitment to fund health services at a level reflecting the cost of the benefits package; this provision is meant to ensure the financial stability of the health care system

21 Following the NHI law = +

22 National health insurance (NHI) system that provides a broad benefits package to the population Free choice among four competing, non-profit-making health plans that receive NHI funds from the Government according to a capitation formula The health plans must provide their members with access to a benefits package that is specified within the NHI Law The system is financed primarily from public sources via payroll and general tax revenues

23 In addition to its regulatory, planning and policy-making roles, the Ministry of Health also owns and operates about half of the nation s acute care hospital beds The largest health plan (Clalit) operates another third of the beds, and the remainder are operated by means of a mix of non-profit making and profit-making organizations The Ministry of Finance has multiple points of significant influence over Israeli health care The NHI system is financed primarily from public sources a mixed system of payroll tax and general tax revenue

24 2 14% Clalit Maccabi 9% Leumit 52% Meuhedet 25%

25

26 According to the NHI law, the Government should be committed to fund health services at a level reflecting the cost of the benefits package however: Standards of care are rising and the financial allocation is insufficient: There is an increasing gap between the Cost of health Care Index and Healthcare inputs cost index טוביה חורב, דניאלה אריאלי, ניר קידר: חוק ביטוח בריאות ממלכתי קובץ נתונים סטטיסטיים 2012.

27 Standards of care are rising and the financial allocation is insufficient: There is an increasing gap between the cumulative demographic growth index and the Cumulative demographic growth of the health benefits basket טוביה חורב, דניאלה אריאלי, ניר קידר: חוק ביטוח בריאות ממלכתי קובץ נתונים סטטיסטיים 2012.

28 Not all the components mentioned in the NHI were included in the capitation formula The portion of health spending out of the total private domestic expenses is rising An increasing share of private health expenditure out of the total expenditure of health 43% 42% 38% 33% 45% 40% 35% 30% 29% 28% 27% שנת 2007 שנת 2001 שנת % שנת % OECD Health Data 2011

29

30 Israel has established one of the most enviable health care systems among OECD countries in the 15 years since it legislated mandatory health insurance Israel has contained growth in health care costs to less than half the average for OECD countries over the past decade Israel is delivering and sustaining high-quality primary health care: Health funds can boast impressive reforms over the past decade that have helped consolidate primary care services into teams and improved support for patients living with chronic disease

31 Health funds play an active role in driving continuous improvement in the quality of care based on a broad range of data on practices and patient outcomes Israel s health system is particularly good at identifying chronic diseases amongst patients early and supporting those living with a health condition to avoid an unnecessary hospital visit Diabetes care is a revealing example of the good performance of Israeli health system. A major strength of primary care in Israel is the extensive range of data that is collected by community health facilities on nearly the entire population

32 Thank you