Good Medicine : Executive Summary

The Israeli health care system boasts impressive social and scientific innovations, some of which could well be "imported" to the United States. In fact, two of the features of the Israeli National Health Insurance Law — universal, compulsory health insurance and a uniform benefits package — were integral to the President's Health Security Plan. Notably, many of the basic assumptions behind Israel's social innovations in the area of health care — like the responsibility of the central government for the general health of its citizenry, the necessity to cater to the special needs of new immigrants, the value of children and the obligation to veterans of Israel's wars — are legacies of the socialist, nation-building ethos of the pre-state (before 1948) period in Israel's history.

Five Israeli social innovations are examined. The first is The National Health Insurance Law, which renders health insurance compulsory for all residents of Israel, guarantees a comprehensive basket of services at the HMO of one's choice, and assigns the central government fiscal responsibility for implementation of the law. The second innovation is a nationwide network of Mother and Child clinics that provides pre-natal and post-natal care for expectant mothers and infants — at nominal fees. The third innovation is a system of provision of personal care services — at home — to senior citizens with functional problems. The fourth is the Patient's Rights Law, new (1996) legislation that guarantees everyone emergency care and access to their own medical records. The fifth innovation is "Beit Halochem," an integrated rehabilitation service for Israeli war veterans and their families. Wherever relevant, comparisons are drawn between Israeli institutions and practices and those current in the U.S.

In an effort to convey the highlights of medical innovation in Israel today, the "state of the art" in six different areas of medicine is examined in some detail: new developments in gene therapy; the wedding of surgery and technology in laser applications and photodynamic therapy; new research into genetic diseases; the latest breakthroughs in fertility research and in reproductive technologies; advances in bone marrow transplantation and the latest innovations in the field of cardiology.

These areas were chosen to demonstrate the characteristics common to Israel's research field. These include the will to unite clinical and basic research in order to find solutions faster; the impact of Israel's national culture, demographics and health care system on medical research; the regular collaboration with research groups abroad; and the variety of institutions involved in medical research in Israel.

The essay also presents a brief review of the development of health care in Israel, as well as a description of the main parameters of the Israeli health care system and the health status of Israeli citizens. Special attention is given to the health of social groups with special needs: women, Arab citizens, senior citizens, and new immigrants from Ethiopia and the former Soviet Union.

At the end of the essay, interested readers are referred to relevant bibliography and web sites.