Warnings about Israel’s impending doctors’ crisis – opinion

It used to be said that every Jewish parent wanted at least one of their offspring to become a doctor. Regretfully, in the contemporary Jewish state we are not living up to the aphorism – and a growing doctors’ shortage threatens to become a major problem.

Israelis do some things well, others much less so. Healthcare is one of the former. A few years ago, Bloomberg’s global health review ranked Israel sixth in the world for efficiency and seventh in quality of service. The OECD forum of developed economies has stated that “Israel has established one of the most enviable healthcare systems.” And other countries can indeed be jealous of Israel’s statistics for life expectancy, infant mortality, vaccination rates, and waiting lists.

Israel’s healthcare prowess was demonstrated during the recent COVID-19 pandemic. Pfizer chose to prioritize supplying vaccinations to Israel not merely because of company chair Albert Bourla’s warm Jewish heart and Prime Minister Benjamin Netanyahu’s “obsession” to expedite vaccinating the public. 

Rather, the American-based multinational pharmaceutical corporation had solid professional reasons for giving Israel preferential treatment, primarily the network of community health clinics that reaches all parts of the country and guarantees rapid mass inoculation, and the digitized medical data bank allowing for expeditious and detailed information on the efficacy of the vaccine for the different demographic segments. 

The reasons for Israel’s high marks

Of course, success can be by design or chance, and the Israeli public health system’s high international ratings perhaps stem from an accident of history.  

Like many things in Israel, healthcare was once highly political, with party affiliation dictating a person’s medical provider. 

Clalit Health Services, Israel’s largest Health Maintenance Organization (HMO), has its roots in the socialist Labor movement. Originally founded for worker-pioneers in Ottoman-ruled Palestine, Clalit expanded with the growth of Labor Zionism. It became an integral part of the once all-powerful Histadrut Labor Federation whose leader, David Ben-Gurion, went on to become Israel’s first prime minister.

Maccabi Healthcare Services, today Israel’s second largest HMO, was established during the British Mandate by the non-socialist liberal-centrist Maccabi movement. 

Meuhedet Health Maintenance Organization was born in a merger between two smaller health funds, one originating in the federation of independent farmers, the other in the right-of-center free market General Zionist movement. 

Leumit Health Care Services was part and parcel of Revisionist Zionism. Refusing to accept Labor hegemony, the nationalist-Right, under the ideological leadership of Ze’ev Jabotinsky, founded its own independent institutions for the Revisionist faithful.

Although born in the pre-state period, the party-affiliated HMOs continued to operate in the decades following independence. Only in the 1990s were they depoliticized when the National Health Insurance Law created a system of universal healthcare coverage based on compulsory HMO membership, with Israelis free to choose which fund to belong to.

This established a system of comprehensive healthcare that nonetheless contained built-in competition, with the different HMOs providing a government-guaranteed basket of medical services while competing over members and the accompanying public funding. 

In addition to the government-dictated minimum healthcare basket, some 80% of the Israeli population opts for supplementary insurance offered by the different HMOs. This insurance, although private, is regulated by the state in terms of price and services provided.

The end result is a unique Israeli hybrid that combines the security offered by European-type socialized medicine with the advantages of American-style competition – safeguarding and empowering Israel’s healthcare consumers.

Not enough physicians

NATURALLY, ISRAELIS may routinely complain about their public health system’s shortcomings. But griping aside, earlier this year, the same OECD that had previously praised Israel’s “enviable healthcare” issued a damning report about the current realities, raising fears about an impending shortage of trained physicians. 

According to the study, “While the number of doctors in Israel has increased over the past decade, it still remained about 10% below the OECD average.” This, when Israel’s aging population “will require a growing number of doctors.” 

Furthermore, it warns that “nearly half of all licensed doctors in Israel in 2020 were aged 55 and over (up from less than one-third in 2000),” highlighting “the urgency to train new doctors to replace those who will retire in the coming years.”

Worryingly, “the number of new graduates in 2020 remained the lowest across all OECD countries and almost two times lower than the OECD average.” 

The report also notes that “the growing number of doctors in Israel over the past decade has been driven mainly by the large number of Israeli-born doctors who have obtained at least their first medical degree abroad.” 

However, this intake is threatened by the 2019 Health Ministry Yatziv reform. Designed “to ensure minimum quality standards” from international universities where Israelis study medicine, Yatziv will reduce by “nearly 30%” the number of foreign-educated graduates who will enter Israel’s healthcare system.  

The OECD concludes that there is a compelling demand for “increases in student intakes in undergraduate medical education.”

Today it is possible to study medicine at six Israeli universities, the newest medical school opening in 2019 at Ariel University. But this available inventory is clearly not meeting the required demand, making an expansion of capacity inescapable. 

The decision of Reichman University, Israel’s sole private university, to open its own medical school may therefore prove crucial. In the words of the university’s founding president, Prof. Uriel Reichman, the new program was “born out of a national need.” 

Established with the support of the Recanati family’s philanthropic foundation, Reichman University’s medical school will aim to provide a competitive alternative for the many Israelis currently being forced to study medicine abroad due to the lack of available places in Israel. 

The founding dean of the new school is Prof. Arnon Afek, director of Sheba Medical Center, ranked one of the 10 best hospitals worldwide. His selection indicates a desire to duplicate that international success in educating the next generation of Israeli doctors.

There is an additional benefit. When young Israelis study at foreign universities they can become attached to their host communities and decide to stay abroad. In having them study locally, the chances increase of them remaining here. 

Reichman University’s Dina Recanati School of Medicine plans to open its doors to students in October 2024, and will play its part in meeting the OECD’s call for expanding the cadre of skilled, Israeli-trained physicians.

The writer, formerly an adviser to the prime minister, is chair of the Abba Eban Institute for Diplomacy at Reichman University. Connect with him on LinkedIn, @Ambassador Mark Regev.

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