Ministry of Health

2 Ben-Tabai St.
P.O. Box 1176, 91010 Jerusalem
Tel. (02) 6705705
Fax. (02) 6786491
Website: http://www.health.gov.il
E-mail: revital@matat.health.gov.il

Functions and Structure

Israel's complex system of health services is organized by sectors, as follows:

• Hospitalization - general hospitals, mental hospitals, and chronic-care hospitals;

• Outpatient clinics: in hospitals, as well as outside the hospital setting in the Health Funds;

• Preventive environmental health services - preventing environmental pollution, environmental health hazards, and the spreading of disease;

• Community services - psychiatric, geriatric, day care, and home care;

• Supplementary services - first aid, emergency transport, and other specific services.

These services are provided to the public by government, public, and private agencies - the Health Ministry, Health Funds, public institutions, and local authorities.

The Health Ministry is responsible for providing health services for the country's population and for overall planning, supervision, and coordination of the system. The Ministry is also the direct provider of around 50% of the various kinds of hospital beds, as well as of most personal preventive health services.

To protect public health, the Health Ministry performs the following activities:

• Planning, licensing, directing, and supervising health services in Israel;

• Promoting and updating health legislation;

• Assuring the provision of general, psychiatric, rehabilitation, and nursing hospital services;

• Assuring the availability of preventive and therapeutic medical services;

• Licensing medical and paramedical personnel as prescribed by law;

• Supervising, monitoring, and regulating the pharmaceuticals sector, by licensing medicinal preparations and setting standards for medicinal and cosmetic preparations, as well as for toxic substances;

• Monitoring food production, processing, and marketing for the domestic and export markets;

• Monitoring and preventing environmental health hazards, and enforcing air- and water-quality legislation and solid-waste regulations;

• Preparing a medical research master plan, to promote research and optimize resource allocation;

• Training nursing and paramedical personnel for medical institutions.

Health Funds: Organized on a voluntary basis, the health funds provide 96% of the population with ambulatory health care and hospitalization services. The National Health Insurance Law, which went into effect on January 1, 1995, guarantees equal medical care to all the residents of Israel and accords all health plans equal status.

Public Institutions: This group includes public hospitals such as the Hadassah Medical Center, Sha'are Zedek Hospital, and Bikkur þHolim Hospital. It also covers agencies such as the Magen David Adom emergency and ambulance service (comparable to the Red Cross), the Israel Cancer Society, and the Anti-Tuberculosis League.

Local Authorities: Local authorities' involvement in health services focuses on preventive care and municipal outpatient clinics.

The Health Ministry employs over 19,000 workers in some 60 medical, paramedical, engineering and technical, administrative, and housekeeping professions, covered by 2,000 job descriptions.

Hospital System

Institutions included in the hospital system provide general medical care, psychiatric care, geriatric care, and rehabilitation services.

General hospitalization services are provided by government and Kupat Holim Clalit (General Health Fund) hospitals, and other public and private institutions. The Ministry runs nine government hospitals and two municipal-government hospitals, providing general hospitalization services. Kupat Holim Clalit owns eight general hospitals. There are ten other public hospitals and nine smaller private hospitals. Excluding day beds, there are 2.69 general-care beds per 1,000 population.

Geriatric and Chronic Care

Services for chronic and elderly patients include acute, rehabilitative, and chronic hospital care; ambulatory care; and home visits and follow-up. These services are provided by the government, public, and private sectors; all chronic hospital care is in the hands of the Ministry.

Hospitalization: There are several institutions for chronic and elderly patients, each with its own characteristics. The Ministry operates three geriatric hospitals (Shmuel Harofeh, Flieman, and Pardes Katz) as well as three geriatric centers (Pardes Hannah, Natanya, and Rishon Lezion). The total number of beds in the government system stands at 2,650 beds plus 92 day beds. Kupat Holim operates three facilities with a total of 829 beds.

Long-Term Hospitalization is not included in the medical services covered by the health funds. A citizen requiring such hospitalization is asked to pay part of the cost, although the Ministry provides the bulk of the financing. Long-term hospitalization is provided in various organizational settings: geriatric centers run by the Health Ministry; public retirement homes with nursing departments, and chronic-care hospitals, both public and private. The lack of adequate answers to the needs of long-term patients in community and institutional settings has overburdened general hospitals and rehabilitative hospitals and adversely affected the medical needs of the elderly. At present, chronic-care patients are still to be found in general and rehabilitative hospitals. The Ministry is contributing to the construction of nursing homes through Eshel (the Association for the Planning and Development of Services for the Elderly) along the lines of the geriatric centers. In this context, attention should be drawn to supervision of all institutions hospitalizing long-term patients in both the private and public sectors.

Ambulatory care focuses on diagnosis, treatment, and rehabilitation. Treatment is carried out in consultant outpatient clinics attached to geriatric hospitals, special clinics attached to the geriatric wards of general hospitals, or in day hospitals operating in conjunction with government geriatric hospitals.

Integrated day centers are another type of diagnosis, care, and medical and social rehabilitation framework set up by the Health Ministry (together with Kupat Holim and the local authorities). The newest of these was opened in Eilat.

Home care falls into two categories: long-term medical and rehabilitative care, and personal nursing care. In April, 1988, the Nursing Insurance Law became fully operative. Subject to the means tests stipulated, those entitled to such benefits receive a nursing allowance through the National Insurance Institute. The Health Ministry budget continues to finance the care of handicapped individuals who were in care prior to April 1988, and who do not qualify under the Nursing Insurance Law, as well as of children below the age at which they become entitled pursuant to the Nursing Insurance Law (according to current practice).

Rehabilitation apparatus is made available to those needing it in two ways: from lending bureaus attached to the health offices; and by Ministry participation in the purchase of such appliances, subject to evaluation of the family's economic status.

Mental Health

The Psychiatric Service coordinates the activities of the hospitals, community centers, and mental-health centers. The Service is organized so as to assure the availability of general services (prevention, treatment, rehabilitation); continuity of care; supply of services on a regional basis (by integration of regional care facilities) to prevent overlap and save resources. This organization is designed, inter alia, to facilitate treatment of the patient within the community, follow-up after discharge from the hospital, and close links between hospital facilities and outpatient/community services. To this end, community mental health centers are increasing their follow-up of mental patients released from hospital, as well as their involvement in mental health problems in the community.

There is a continuing trend toward opening occupational units for patients with limited employability; a network of halfway houses exists for patients released from hospital, and club activities are also run in the community. The idea of developing alternatives to hospitalization failed to make headway this year due to budgetary problems.

Treatment in the Community: Special emphasis is placed on rehabilitation on all levels, from transitional rehabilitation-occupational units, through sheltered workshops, designed for patients with limited employability on the free market.

The mental health services support the development of voluntary activities in the community for mental patients and their families. Notable in this context is the Enosh Association, bringing together patients and families for treatment and helping patients cope in the community. In the ten years of its existence, the association has opened clubhouses in 30 communities, with a permanent membership of 1,570.

Public Health

The public health services, intended to prevent disease and promote individual health, include: the Food Service; Environmental Health Administration; Epidemiology and Laboratories; Mother and Child Care; Dental Care; and Health Education. The district and regional health offices are the active units in the field, operating the services and supervising overall medical and health services at the district and regional levels.

Food Service

The Food Service assures proper standards of composition, quality, and cleanliness in food. It focuses on three areas: legislation and regulations, monitoring, and instruction. Legislation designed to assure food hygiene has been passed in two areas: under Public Health Regulations (Food) - primarily on topics related to food safety, and related health aspects; and under the Standards Law, which sets Israeli standards for food products, dealing with quality, composition, labeling, wrapping, weight, and health aspects. Regulations regarding aflatoxins in food were promulgated under the Public Health Regulations (Food), and eight regulations were revised under the Standards Law (e.g., labeling of prepackaged foods, pasteurized milk, beer, dried fruits, etc.). Both locally produced and imported foods are monitored.

Enviromental Health Department

Following the establishment of the Ministry of the Environment and the transfer of some of the Health Ministry's areas of jurisdiction to the new ministry, the activities and responsibilities of the Environmental Health Department were scaled down. The Department will henceforth be involved in the following areas: the quality of drinking and swimming-pool water; food marketing sanitation; sanitary conditions in public institutions and businesses involving public health; sanitary standards at youth camps and beaches; sewage-treatment regulations and standards; and irrigation using treated effluent.

Drinking Water Quality: High priority has been given to assuring the quality of Israel's drinking water. The Ministry requires drinking water suppliers to install special quality-control equipment at all boreholes at high risk of sudden contamination, in order to ensure the automatic cessation of drilling in such an event. At the end of 1989, regulations were issued that required the regular disinfection of all drinking water in the country in order to further improve drinking water quality and reduce the risk of drinking-water-borne diseases. Thanks to Ministry information activities, the heads of the water system have become aware of the need to improve the quality of surface-water sources (Sea of Galilee, rivers, and springs) of drinking water. All possible efforts are being made to set up facilities to this end, particularly the establishment of sanitary requirements for treatment facilities and for the quality of treated water.

Swimming Pools and Beaches: The Department (together with representatives of the health offices) has completed the professional draft of updated regulations on sanitary standards for swimming pools. The regulations have been completed from a legal standpoint, with the aim being to gazette them prior to the next swimming season. In conjunction with the Environment Ministry, an organized water-sampling system is being set up at beaches, in order to obtain an overall picture of water quality there and provide residents with proper information.

The Institute for Research on Environmental Health Hazards assists the Ministry directorate in setting policy regarding environmental issues, particularly areas such as air quality, radiation, noise pollution, and toxicology. The Institute also carries out service and applied research activities to help Ministry field units find solutions for specific environmental problems. Air quality is monitored by the mobile laboratory and other monitoring devices located in areas where health hazards and nuisances have been discovered. Procedures for the use of low-sulfur fuel at power stations burning liquid fuel continue to be monitored successfully.

This year, too, major attention was paid to arrangements for dealing with incidents involving hazardous substances. In the course of the year, a number of such incidents in various areas were handled; systems for gas dispersion were acquired abroad and found to be effective in dealing with these incidents; and the existing database on hazardous substances in Israel was expanded. A national information center on asbestos and harmful dusts has been established within the Institute, and a start made on a computer program for inputting and tracking details of personnel and groups exposed to asbestos. Equipment has been acquired for the Institute and the health offices, and the offices have been briefed by the Institute's officer with responsibility for hazardous substances.

Ongoing activities include the licensing of radioisotope users. As part of the environmental radiation program, equipment for checking background radiation and levels of radioactive substances in the air, soil, plants, food, and water has been acquired and put into service.

Medical Road Safety Institute

The Institute's primary task is to achieve the maximum possible reduction in the number of road accidents liable to be caused by drivers' health. For this purpose, the Institute carries out health checks and measures the suitability for driving of the following: candidates to drive public-transport vehicles; driver's license applications whose health is apt to affect their driving; handicapped drivers recognized by the IDF and NII whose vehicles must be fitted with special devices to permit them greater independence; drivers who have been involved in a fatal accident; elderly drivers with health impairments; drivers referred to the Institute under the Mandatory Reporting Law, which requires physicians to report drivers who are likely to endanger their own or others' lives due to a health problem. The Institute acts both as an advisory body to the Transport Ministry on health issues that may affect driving ability and accident prevention, and as a professional agency that recommends remedial accessories for handicapped drivers and assesses their ability to drive without endangering their lives or those of others.

The Epidemiology Department monitors infectious diseases and other outbreaks of illness having national significance. The monitoring process consists of three activities carried out simultaneously: ongoing delineation and assessment of the morbidity pattern; discovery of new trends in the morbidity pattern; and routine or ad hoc (in the case of unexpected episodes) preventive measures. The Department drew up guidelines for supervising the absorption of hundreds of new immigrants from Ethiopia, of whom over 200 arrived with malaria (most of the Plasmodium falciparum strain, and a significant number of these chloroquine-resistant). Field supervision, laboratory follow-up, and monitoring of the anopheles mosquito have played a role in preventing the spread of the disease in Israel; there has not been a single secondary case.

There has been a significant upsurge in the incidence of rabies in animals, primarily foxes, including cases in the southern part of the country. This situation made it necessary for a larger number of citizens to receive prophylactic treatment following exposure.

A new polio-immunization program has been instituted, using a combination of killed and attenuated live vaccine. A serological follow-up program on the children who received the above immunizations was proposed.

PUBLIC HEALTH LABORATORIES

The public health laboratory system includes regional and central laboratories, as well as national institutions and centers. Bacteriological, virological, and parasitological diagnostic tests are carried out in the laboratories on samples of body fluids and secretions to diagnose dangerous pathogens, as are special entomological and immunohematological tests. In addition, toxicological, chemical, and microbiological tests are conducted on samples of water, food, and wastes. Checking the efficacy and safety of medication and cosmetics is part of the public health laboratories' routine work.

Mother and Child Department

This Department is responsible for family planning, prenatal care, the care and treatment of infants and toddlers, and health of schoolchildren. These activities are carried out in 580 family clinics throughout the country, and in the compulsory education system starting at age five. These clinics work together with the child development centers to diagnose, treat, and rehabilitate handicapped children. Special efforts are made to deal with waves of immigration, including the preparation of guidance programs for target groups on specific topics relevant to them, in order to ensure the smoothest and healthiest absorption of the new families and to help them adapt to the Israeli way of life. So as to reduce disparities in the level of medical care, the activities of the committees examining infant mortality were expanded to include all health offices, and Arab-language hearing tests were instituted for toddlers.

Nutrition Department

The Department collects information on the population's nutritional status and provides instruction and advice to the entire population and special groups on topics ranging from infant to geriatric nutrition. There is a strong link between food consumption and the emergence of disease, be it tooth decay, cardiovascular diseases, or cancer. Consequently, the Nutrition Department, along with the Health Education Department, participates in the Shanani program, nutritional instruction programs throughout the country for public health nurses, nutritional programs at nursing schools, symposia for employees of various government ministries and other workplaces, and instructional programs for interning dieticians.

In conjunction with the Food Service, the inclusion of nutritional information on the labels of packaged food was expanded.

Dental Health Department

This Department plans and implements prophylactic dental programs, plans and trains personnel, regulates and educates for dental health, and supervises the level and scope of services. In the area of prevention, progress has been made in the fluoridation of drinking water, in addition to the installations supplying fluoridated water to 1,700,000 people.

The computerized register of dentists in Israel was updated and a computerized register of dental technicians created. The Department supervises 120 dental clinics for schoolchildren in local authorities, and the Ministry participates in the operating costs of 97 of them.

Health Education Department

The Department prepares instructional and information programs on health matters for the general public and for caregivers, in an effort to reinforce behavior conducive to better health. The Department provides instruction to teachers and nursery personnel, nurses, attendants and caregivers, food-industry workers, and volunteers in various settings. The main Department foci are: smoking prevention; correct nutrition; dental health; home accident prevention; hygiene; etc. The Department also focused on developing programs for health education through other ministries, such as the health education program in the schools, in conjunction with the Education Ministry, and developing special programs on the aforementioned topics for schools and preschools. The Department worked to promote community programs: health education for young children in pre-schools and day-care centers (particularly dental hygiene); health education in schools (a comprehensive experimental program for health education in elementary schools, an anti-smoking program for junior high schools, and a program to instill good dietary habits for junior and senior high schools); health for the elderly within the community; the community health project, run via the Community Centers Corporation; encouraging various community activities in the context of programs to promote good health according to the guiding principles of the Ministry and the World Health Organization.