As Israel’s public health system underwent feverish changes and pressures during the COVID-19 pandemic, the independent Myers-JDC Institute took its temperature and surveyed Israelis on the level of their satisfaction.
Dr. Michal Laron, Rina Maoz Breuer and Sharvit Fialco examined the functioning of the health system on several key issues — family medicine, consulting medicine, remote medicine, the health funds, emergency medicine, trust in the health system, forgoing health services and using private medical services instead of the public basket of health services.
How has Israel's healthcare system fared during the pandemic?
Institute researchers have been monitoring views of the health system since the National Health Insurance Law was passed and implemented in 1995. This is its 13th report on the subject. The Jerusalem-based institute, established in 1974, is Israel’s leading center for applied research on social policy and services.
The survey was conducted at the end of a global health crisis and presents a complex picture of public opinion on the level of service and health system functioning. The survey, conducted between October 2021 and March 2022, showed a significant increase in satisfaction with the public health system, but the proportion of respondents who felt confident about receiving the best and most effective care when necessary was not high.
While Israelis are generally satisfied with the health services provided by the four health funds, there are still gaps in access to health services among insureds with different socioeconomic and ethnic backgrounds.
What are the stats?
Fully 68% of the representative sample surveyed reported that they were satisfied or very satisfied with the health system, compared to 58% who said so in a survey conducted in 2018. Among the districts, 72% of the residents of Jerusalem and Jewish residents of Judea and Samaria were pleased or very pleased — representing the highest positive verdict – while the lowest satisfaction was 62%, found among residents of southern Israel.
Just 62% of the respondents expressed some level of confidence (feeling “very safe” or “quite sure”) that they would receive the best and most beneficial treatment from the health system if there were a significant deterioration in their health; 42% expressed some level of confidence (“very sure” or “quite sure”) that the public health system would cover the costs of treating them in such a situation, while 75% said they thought it was necessary to use their connections (protektzia) to get better and faster treatment (46% answered “absolutely yes” and 29% answered “yes, to some extent”).
Fully 88% of the respondents said they were “satisfied” or “very satisfied” with their health fund in general, compared to 90% who said so in the survey conducted four years ago. Among the districts, in the south and in Jerusalem and Judea and Samaria, the satisfaction rate with the health funds were the lowest at 84% each, while the most-satisfied (91% each) lived in Tel Aviv and Haifa.
Among the range of services of the health funds that were examined in the survey, the rate of satisfaction with human responses by health fund staffers was is the lowest (62%); tthe highest satisfaction rates related to lab services (95%), the health funds’ physical facilities (94%), nurses (94%) and personal physicians (93%). Three out of four respondents said their health fund did its best to meet their needs during the COVID-19 pandemic.
Among immigrants who settled in Israel after 1989, 17% said they had difficulty getting services from their health fund due to language problems; only eight percent of Israeli Arabs reported difficulty in receiving services at the insurer due to language problems, compared with five percent of the general population.
The new survey found an increase in the proportion of respondents who experienced mental distress in the year prior to the survey, from 20% in 2018 to 24% in 2021. Three out of four people who experienced mental distress reported not being asked about it by their personal physician.
One in three of respondents said that they waited for more than a month to see a specialist from their health fund. The queue was highest for consulting with gastroenterologists (51%), surgeons (43%) and dermatologists.
Israel's bureaucratic lag
In the year prior to the survey, 55% contacted their health insurer through its website or smartphone application about a medical question, a request for approvals, prescriptions, referrals or consent to cover tests and treatments outside the health fund. Using these saved 91% of them the need to visit the clinic. A lower-than-average use of websites and apps was found among people with disabilities (43%), men (52%), ultra-Orthodox Jews (39%), Arabs (36%) and those aged 65 or over.
Waiting times for medical care were the main reason why 19% of health fund members decided not to request from their insurer certain medical services; this was an increase of six percent over the figure 29% figure in the previous survey.