The Issue Of Encouraging Medical Students To Provide Primary Care To Rural Areas In Israel
Almost 20 years ago in 1995, Israel started to offer universal health care. Prior to that, the system was situated with a myriad of separately managed Sick Funds. Though the country has been noted as one with one of the best healthcare systems, there are still concerns regarding how this system operates. A substantial issue that has recently come to light highlights the challenge of captivating medical students to provide primary care to rural areas of the country. With that being said, there have been studies that have shown how to resolve the issue at hand.
The Israel Healthcare system can be categorized by four essential criteria: universal insurance coverage, a progressive taxation system, four health care plans, and a blend of ownership types. Israel has universal insurance coverage where all citizens are covered by a government-run national insurance program. The country operates this system so that all citizens have the ability to accept from four competing for healthcare plans, all of which are entailed by the government. Though the government compiles the money, it doesn’t directly supply healthcare for its people. Citizens are approved to exchange from one plan to another at any time. These healthcare plans are extensive in membership, with numbers ranging from 4 million to 1 billion people. They are also very effective and have national, regional, district and clinic level management.
The Israeli Government also has a list labeled the Benefits Package, with all feasible services in which all citizens are entitled to. With the National Health Insurance Law, the four options presented to citizens are called Clalit, Maccabi, Meuhedet, and Leumit. Clalit Health Services is the largest of the four and was established in 1911 as a mutual aid in society. It’s also the only health fund with a countrywide network of state-of-the-art pharmacies, dental clinics, laboratories, diagnostic imaging and specialist centers (Clalit-Global). It also consists of 54% of the Israeli population with around 3. 8 million insured members (Integrated for People), and on top of that, it’s run as a not-for-profit entity. The second choice for all residents is Maccabi, whose services are based upon the Israeli National Health Services Basket and Maccabi Services Basket. Their members can benefit from additional coverage which includes Maccabi Silver, Maccabi Gold, and Maccabi Sheli.
The Health Maintenance Organization currently has over 2 million members who can benefit from a plethora of health services. It consists of six regional centers, including 150 branches and clinics that provide full access to Maccabi Healthcare services for all members throughout the country. The third options citizens have is Meuhedet, which is Israel’s third-largest Health Maintenance Organization. The organization was founded in 1974 as a result of two other HMO’s. Its main services include primary health care, hospitalization, and medications with hundreds of private pharmacists all over the country. Meuhedet also has a foreign members plan that has a specific target audience along with joining terms. The last options citizens have is Leumit which was founded in 1933 by the Revisionist Zionist Movement. It has about 700, 000 members and also operates more than 300 medical centers and 100 pharmacies nationwide. Israel also has a mix of governmental and non-government hospitals. Almost half of the beds are owned by the government, a third is owned by health plans, and the rest are a mix of non-profit and profit hospitals. This health care system is financed through progressive taxation. This essentially means that the tax rate increases as the amount of money taxed are increased. It imposes a lower taxation rate on low-income earners compared to the higher taxation rate placed on those with a higher income. Thus, it takes a larger percentage from high-income earners than it does from low-income individuals.
As compared to the rest of the world, Israel’s economy is very successful and was ranked one of the highest among Middle East economies, remaining in the top 10 from last year’s survey. Its efficiency score stands at a 67. 0 out of 100. A 100 represents a perfect system. This evaluation was based on life expectancy, relative per capita cost of healthcare, and absolute per capita cost of healthcare. On the other hand, the GDP has been increasing rapidly, especially in recent years; this has been the result of health spending growth well above the rate of economic growth. As successful as the healthcare system may be, there are also major flaws that need improvement. One of the greatest challenges facing healthcare systems today involves establishing a sufficient amount of primary care physicians and physicians that are inclined to work in rural or peripheral areas. This has been a problem in Israel regarding young physicians practicing primary care in rural areas. In a recent article published by Charles Weissman, Rachel Yaffa Zisk-Rony, and Howard Tandeter, a bulk of regions in the North and South surround a plethora of rural towns which are in need of these physicians. This category of maldistribution has made it so that infant mortality rates are higher and a lower life expectancy in these regions. In spite of pediatrics and family medicine being prominent professions amidst Israeli medical students, there is still a national deficit of these sort of doctors, especially in the country's peripheral areas. This scarcity is anticipated to grow as the community becomes larger, and as lifespans increase.
The predominant conclusion of this study indicated that the 4th and 5th years of medical school emerged to be an appropriate time to display the distinct specialties to medical students and might also be the time to commence advising these medical students about residency programs. In an effort to countermeasure this matter, the physicians’ union contract of 2011 decided to have pay increases for practicing in the periphery and one-time monetary incentives for moving and committing to work in the periphery. These programs also provided incentives for medical students involved in residencies in specialties suffering personnel defiencies. The earliest program prohibited family medicine residents from both the incentives for work in the periphery and the incentives to work in a few specialties. However, in 2015, the Israel Ministry of Health began to cater economic incentives to family medicine residents inclined to work in peripheral areas (BCM). By having more doctors in these rural areas, some major issues would end up being solved. This includes having lower mortality rates for infants and evidently higher life expectancy.
Another issue that has surfaced recently includes how to combat future issues such as the aging population and increased amount of chronic diseases. By implementing new technology systems and investing in the future, there have been ways to fix this problem. In 2012, the Economist stated how in order to “treat 21rst centuries problems with a 20th century approach to health care would require an impossible number of doctors. ” This sheds light on the fact that Israel has been trying to come up with new solutions. One of these includes shifting healthcare to a Patient’s home instead of a hospital. There is a innovative platform for chronic care management: Tele-monitoring and interventions. WIth this, there could be a nationwide support network that is fully coordinated with patients. Some of the outcomes for MOMA include better diabetes control, decreased hospitalization and over 11, 000 patients being treated. Managing chronic diseases through technology innovative systems has been a potential to benefit both the patients and reduce health care costs. In an article by Amir Bar-Shai and Michal Rotem-Green, they shed light on how the SHL telemedicine system from Chronic Obstructive Pulmonary Disease management uses spirometry and questionaires to monitor patients at their own homes.
With Israel being one of the top ten countries as regards to effective healthcare in the world, it is also very cost-effective for its citizens. Adding to fixed fees, the providers obtain fees for services on a per-use per-item basis; and these fees are quite low. A appointment with a general practitioner can cost around $5 wherein the consecutive three months one is allotted three or four additional meetings for free. The same is true for specialists. A one time $5 fee may typically get one a set of meetings. Distinct examinations such as ultrasounds and labs are also very inexpensive, some free of charge. A majority of providers in Israel have websites and mobile apps were their patients are able to see their lab results, find a doctor by location, availability, gender, spoken languages, specialty, and set an appointment. Most medical files have been digitalized as well. On the other hand, the United States spends alarmingly high amounts of money on health care compared to various other countries all around the world. With costs being at an all-time high, the condition and approach to health care are affected quite a bit. Even considering this supposedly excessive spending, the results of America’s healthcare system have not been better than the rest of the world. It has become a serious problem where the consequences end up outweighing the benefits, to the point that the term “medicine” has simply become a business in today’s society. Rather than being seen as a system made to help people at their time of need and take care of those in need of constant medical care and support, it has become a game of numbers with the main goal of gaining a large profit.
New research, according to the Centers for Disease Control, has shown that even though there has been a large rise in costs, the health of individuals has not gotten any better. With all of that information being said, it can be seen how the United States of America may be able to adopt some of the policies Israel has to offer. To begin with, the United States may be able to implement a universal healthcare system. One largely debated topic revolves around the idea that the government would be controlling everything. Rather than operating as a national health service, a single-payer national health insurance system, or a multipayer universal health insurance fund, the U. S. health care system can best be characterized as a mixed system. For Israel, by having multiple providers, that are in charge of health care, it was quiet beneficial in the long run. Affordability is a large factor and Israel is able to have that while also keeping the quality of their care quite high. Cost-wise, the Israeli system is conveyed as avaricious to the point of being underfunded. The country allocates less than 8 percent of its GDP, and about US$2, 600 per capita on health, beneath the Organization for Economic Co-operation and Development (OECD) average. That being said, it would be a big step for the United States to be able to not only implement universal health care, but also to be able to have multiple providers for it.
