Overview of the Israeli Medical System
Explore key aspects of the Israeli medical system, including demographic insights, the National Health Insurance Law of 1995, health status indicators, risk factors, strong primary care emphasis, ongoing disease management practices, and COPD treatment patterns. The system's interconnectedness, with a focus on universal coverage and competing HMOs, contributes to the management of health challenges in Israel.
- Israeli healthcare
- National Health Insurance Law
- health status indicators
- primary care
- COPD treatment
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PRESENTATION FOR THE IPCRG SENATE PROFESSOR ANTHONY HEYMANN
ISRAELI DEMOGRAPHIC OVERVIEW 74% Jewish 21% Christian / Muslim 5% other High fertility rate>3.1
NATIONAL HEALTH INSURANCE LAW 1995 Universal coverage Competing HMOs with capitation payments Compulsory employer/employee contribution Health ministry supervises services Standard basket of services Supplementary insurance
ISRAELI HEALTH STATUS Life Life Infant Mortality Rate* Expectancy (Females) Expectancy (Males) Israel 84.2 80.7 2.9 OEC D 83.4 77.1 3.9 * Per 1,000 live OECD (2019),Health at a Glance 2019:OECD Indicators, OECD Publishing, Paris,https://doi.org/10.1787/4dd50c09- en. births
RISK FACTORS Obesity Alcohol Tobacco Israel 18.8 2.6 19.6 OEC D 23.2 8.8 18.5 OECD (2019),Health at a Glance 2019:OECD Indicators, OECD Publishing, Paris,https://doi.org/10.1787/4dd50c09- en.
ONGOING DISEASE MANAGEMENT Calderon-Margalit et al. Israel Journal of Health Policy Research (2018) 7:10
83.8% OF FIRST COPD TREATMENT FOR COPD CONTAIN ICS LAMA+ICS, 1.2% LABA, 4.2% Theop./Rof., 2.2% LAMA, 5.3% LABA+LAMA+ICS, 12.9% LAMA+LABA, 4.5 % Free triple: LAMA + ICS/LABA ~ 5% ICS+LABA, 69.6%
Real World Study Majority of the COPD patients have comorbidities Characteristic Comments 68 Median age (y) 55.6 Male (%) Study population was in the overweight category 27.8 kg/m2 Median BMI Smoking status available for 95% of population 66.2 Current or past smokers (%) Most common comorbidities Hypertension (64.8%), Diabetes (36.7%) Ischemic heart disease (34.6%) The majority of the population had at least one comorbidity in addition to COPD Other common comorbidities Depression or anxiety (28.1%), GERD (22.5%) Congestive heart failure (20.2%) Osteoporosis (19.9%) Heightened levels of HbA1c and glucose Generally laboratory blood test results were within normal range Lab results Identifying and characterizing an incident COPD cohort using electronic medical records. A collaboration between Boehringer-Ingelheim and Clalit Research Institute, 2018.
HOW DO WE SUCCEED WITH COPD? SWAT System strengths EHR Data rich Empowering patients Quality measurements GPs working with teams Previous disease management success Established smoking cessation support System weaknesses Low availability of pulmonologists Variable access to spirometry
SWAT Opportunities LAMA now available for GPs Pharmaceutical industry support Enthusiastic early adopters National quality assurance measurement Threats Primary care teams overworked Difficulty in establishing guidelines for primary care
DOCUMENTATION OF SPIROMETRY TESTING IN PATIENTS WITH COPD OR THOSE AT HIGH-RISK FOR COPD (AGES 50-74 YEARS)
COPD FROM THE GPS CLINIC COPD patient route GPs- Specialist relationship in Israel Team work Pharmacist support Smoking cessation GP education
YOUR CURRENT MEMBERSHIP AND HOW YOU PLAN TO GROW IT AND ENSURE SPREAD ACROSS YOUR COUNTRY There are currently 1500 family medicine physicians in the Israeli Association of Family Physicians.
Your current educational activities, resources and materials and any future plans Starting the process GP training (COPD in the new syllabus which includes visits to lung function clinics) Spirometry training of GPs in one of the four HMOs Many CME programs featuring COPD (supported by pharma)
Any current research activity and plans? Any plans for working with patients and the public? There is an increase in measurement of COPD and spirometry by the Health Ministry and the HMOs who are trying to build disease registers. When these registers are built there will be a database that will allow for research.
How you will plan to build the presence of your group in your country and influence policy The Israeli Family Physician Association organises about ten conferences a year In each conference we have a forum dealing with lung disease
