The Israeli Health Care System and Maccabi Healthcare Services: Public –Private Mix

1. The Israeli Health Care System and Maccabi Healthcare Services: Public –Private Mix Dr. Rachelle Kaye March 2011

2. Basic Demographic & Health Data* Israel Serbia *WHO

3. The Israeli Health System

4. Israeli Healthcare System • Public and Private Financing • Public and Private Healthcare Services

5. National Health Insurance Law of 1995 Universal compulsory statutory health insurance Financed by earmarked and general taxation Citizens pay a healthcare tax – 4.8% of income “Cost of the Basket of Services” : Based on expenditures of the health funds in previous years. Updated yearly based on a health index If the earmarked taxes not sufficient, the government must add funding to guarantee that the updated “cost of the basket of services” is maintained.

6. Coverage for health care services is provided by 4 competing nationwide health funds (HMOs) under the National Health Insurance Law of 1995 Some are quasi public (owned by labor unions), some are private, not for profit mutual companies Health funds are financed primarily by government via age-related capitation payments (90% of total), patient charges and other income (10%) National Health Insurance Law of 1995

7. Every citizen is a member of one of these four health funds Citizens are free to choose and move between health funds Health funds must accept all applicants for membership Health Funds provide a uniform legally defined basket of services to which every citizen is entitled ( which amounts to about 60% of total health expenditures). There are public and private providers of services including physicians, hospitals, pharmacies and other health care professionals. The Israeli Public Health Care System

8. Health funds purchase services from outside suppliers or supply services in- house. Services in the basic basket not currently covered by the health funds include much of mental health, long term nursing care, maternity (hospital) care, dental care for adults Health funds can provide -for a premium which they collect directly- additional services not in the basic basket (supplementary health insurance) The Israeli Public Health Care System

9. The Israeli Public Health Care System • Supplementary services include choice of doctor in private hospital, second opinion from senior consultants, dental services, alternative medicine, medications not in in the public basket, medical accessories, medical care abroad, etc. • Health funds have purchased collective policies for long term care insurance from private insurance companies • Health Funds also offer their members travel insurance through a contract with a private insurance company

10. 11 Ministry of Health Hospitals 46.5% of beds 8 Klallit Health Fund Hospitals 30.4% of beds 7 Non-profit Hospitals 10% of beds 2 Hadassah Hospitals 6.0% of beds 6 Mission Hospitals 3.6% of beds 11 Private for-profit Hospitals 3.4% of beds 1 Meuhedet Hospital 0.1% of beds Composition of Israeli Acute Care Hospital SystemNumber of Beds = 14, 582 – 2.05 beds/1000 population

11. All hospitals have outpatient ambulatory services All public hospitals have Emergency Rooms In public hospitals, staffing is linked with the number of beds in each department All medical residency programs are predominantly hospital based Physicians are salaried employees of the hospital Hospital physicians may have private practices outside of the public hospital and may contract with health funds as independent doctors Public hospital outpatient departments are manned largely by senior residents backed up by department doctors Characteristics of Israeli Acute Care Hospital System

12. Maccabi Healthcare Services • Second largest and fastest growing Health Fund in Israel • Non-profit mutual. • Recognized health fund - Israeli National Health Insurance Law • Provides public basket of services • Supplies services via own facilities and outside providers (both public and private)

13. 1.9 million members (25% Market Share). 5000 physicians (85% independent contracted doctors). Contracts with all public acute care and geriatric hospitals Owns the largest private hospital network in Israel with 13 facilities all across the country Contracts with 700 private pharmacies and operates a chain of 53 pharmacies of its own Maccabi's income budget 1.7 billion Euro Maccabi Statistics

14. Supplies services via its own facilities and outside providers. Selectively contracts with providers Free patient choice of physician and other providers Methods of payment to providers : Physicians: Quarterly visits within global budget Hospitals: Maccabi negotiated Caps within a National Cap Other providers: Fee-for-service Co-payments exist for medications, visits to physicians, specialist clinics and some other services. Maccabi Healthcare Services

15. 91% of Maccabi Expenditures are Medical

16. Health Funds Financial Performance 2001-2009 (Millions NIS)

17. The Yitzhak Rabin NationalPrizeFor Quality and Excellence In The Public Sector This Certificate Attests that Maccabi Healthcare Services has won The Israeli National Prize for Quality and Excellence for year 2009 for Health care Organizations

18. Maccabi Electronic Medical Record Every transaction computerized The Central Medical Record E-Laboratory E- Prescription E- Consultation Telemedicine Alerts and Reminders Patient Website The Maccabi Healthcare System is Highly Computerized

19. Thank You