Doctors perform surgery [illustrative]..
(photo credit: REUTERS)
Israel enjoys a world-renowned reputation on healthcare, and the facts justify the reputation. Despite spending less on healthcare than most countries in the OECD (a group of 34 developed economies), life expectancy is more than two years higher (82 rather than 79.7). One key reason Israel has maintained stronger health outcomes despite lower spending is because it has benefited from a comparatively young population. Currently, just 10 percent of Israelis are over 65, whereas the OECD average is 15%, meaning that relative to its population size Israel has fewer elderly people – the most expensive and resource-draining group to take care of, than its OECD counterparts. However, the demographic tide is turning. Israel is set to grow old fast, and without bold action, the healthcare system, as it currently stands, is facing a crisis.
Israel’s elderly population is expected to double from 833,000 this year to 1.64 million in 2035, one of the highest growth rates in the over-65 category in the Western world. As a result, the over-65s will go from 10% to 14% of the population in the space of just 20 years. What makes the situation all the more concerning is that there is already overcrowding, before the demographic shift has fully taken place. The OECD has proportionally twice as many beds designated for the more serious health issues (“acute care”) than Israel. It is thus unsurprising that almost all Israeli “acute care” beds are occupied, whereas most OECD countries have about one quarter spare capacity. Clearly, Israel is, at least when it comes to the most serious health issues, already at capacity and is worryingly unprepared for the kind of pressure an increase in the elderly population will apply.
As the population gets older, more people retire, and the medical profession is no exception. The 1990s brought a huge influx of nurses and physicians to Israel following the collapse of the Soviet Union. From the late 1980s to early 1990s, the number of doctors doubled, but 20 years on many are heading toward the end of their careers, leaving a stark human resource gap. The number of physicians per 1,000 people is set to drop from 3.4 in 2010 to 2.6 in 2025, a remarkable fall in just 15 years.
The Health Ministry must undergo reform regarding its policy toward domestic and foreign medical professionals in order to boost the supply of medical staff. The government must encourage rather than deter physicians from enjoying lucrative private sector work. The newly installed “punch-card” system to record physician arrival and departure times reflects a growing distrust that staff are prioritizing private-sector work at the expense of their NHI commitments. This deters ambitious new entrants, fearing they will be stigmatized for undertaking prestigious and well remunerated private-sector work.
Policy toward foreign-born medical staff must also change. New immigrants who come to Israel already possessing a medical license should be allowed to practice without requiring a new license, under the assumption that their country of origin has reputable standards of healthcare training. Requiring re-licensing creates such despondency among foreigners who trained assiduously for a license in their home country that they may give up medicine all together as a result. Israel can no longer afford for well-trained foreign-born medical staff to drop out of the profession due to an archaic bureaucratic demand.
Healthy lifestyle promotion can be particularly fruitful in tackling various age-related diseases that can be avoided by making better lifestyle decisions when young. Diabetes for instance has become a “major public health concern” among Israeli Arabs according to the OECD. Arab men smoke twice as much as Jewish men, and the proportion of Arab women doing physical exercise is four times less than Jewish women.
Unsurprisingly, almost 40% of Israeli-Arabs over 65 report diabetes compared to half as many Jews in the same age category, which itself is rather high.
In 2011, The National Program for Promoting an Active and Healthy Lifestyle was set up as the government’s foremost initiative on health promotion, increasing the awareness of unhealthy foods and lifestyles. The Health Ministry launched the program with lifestyle-related diseases like diabetes in mind. While such programs might work effectively in most of the Western world, Israel paints a complicated ethnic picture. The nationwide efforts included in the program are unlikely to be successful across all ethnicities, given their own individual cultures and norms. Instead, the ministry must resist the temptation to over-indulge in “one size fits all” policies and instead shift resources allocated to the program to what works well among various ethnic groups. For example, a local initiative that offered a multi-faceted approach for Israeli-Arab women, combining consultation sessions with physical activity, was deemed particularly effective according to research by a leading medical journal.
For decades, Israel has enjoyed an enviable reputation for healthcare, but the demographic reality propping up this reputation is about to collapse. Israel must directly confront the daunting reality of an aging population. Waiting until the demographic shift has fully taken place and leaving patients without a hospital bed would be deeply regrettable.The author is a Research Fellow at the Jerusalem Institute for Market Studies.
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