The heated discussions going on in Britain and the United States over the future of public medicine and medical insurance has shifted the spotlight to successful systems in other countries.
In Israel, while there is universal coverage for all residents and a generally high level of treatment, there are complaints of slipping standards.
According to a report published this week by the Israel Medical Association, Israel lags behind developed European nations in a number of health indexes such as numbers of hospital beds, medical staff and disease prevention. Its standards in these areas, relative to Europe, are dropping.
It is rated highly for childhood vaccinations, while infant mortality rates are lower than those in Europe.
All Israeli citizens and also permanent residents without citizenship are members of four publicly owned health funds. The funds have to accept any eligible citizen and receive money from the government according to the number of members they have.
For a relatively small monthly sum, citizens can become eligible for additional, optional treatments.
The Health Ministry decides each year which treatments and medications will be covered by the national budget and while private medicine exists, most Israelis are satisfied with the health funds.
“The law in Israel is based on a principle of universal solidarity in which everyone pays whatever they can and receives according to their needs,” explains Dr Yoram Blachar, chairman of the IMA, “unlike the United States where there are hugely differing levels of healthcare.
“The British system is more similar to Israel but the way in which healthcare in Israel is divided between four different health funds which have to compete for clients helps prevent situations like long waiting-lists that exist in Britain.”
While most Israeli health professionals are broadly in favour of continuing with the health system as it is, some of them are wary of duplicating it in other countries.
The current Israeli system, which guarantees coverage for everyone, is the result of the 1995 National Health Insurance Law, but the health funds which form its core are the product of Zionist history and Israeli politics.
They were initially set up before the state’s establishment by various parties and workers’ movements to ensure that their members received proper medical treatment.
Dr Blachar is worried that if current trends continue, it will be difficult to maintain the current standards.
“When the Health Insurance Law was passed 14 years ago, about 76 percent of the national expenditure on health came from the government.
“Ever since, the Treasury has been finding ways of cutting the government’s participation and it now stands at around 66 per cent, with the public having to foot a third of the bill.
“This situation threatens public medicine in Israel and could send more people to sign up to the private sector.”