A recent study published shows that Israel is among the top 10 countries in longevity, projected to 2040. Israel already ranks high in other indices for longevity, with an average lifespan of 82.5 as of 2016.

Other countries on the longevity list – Canada, Sweden, Italy, and Japan – are tranquil, wealthy and at peace. But for Israel, confronted over its 70-year history with war and perpetual conflict, a seven-fold increase in its population including a large and diverse immigrant base, these findings may come as a surprise. So what gives?

One answer is a diet high in fruits, vegetables and fish – the so-called “Mediterranean diet.” Another is low alcohol consumption. Still another, and quite important reason, is the close family structure in Israel. But probably the single most important factor is the lean and efficient Israeli health care system.

By many measures, domestic and international, Israel delivers one of the most efficient, effective and comprehensive health care networks in the world. All its citizens receive health care services – a broad basket ranging from neonatal to geriatric care – regardless of income or pre-existing health conditions.

Elderly man at Jerusalem’s Mahane Yehuda market, on January 2, 2014.
(Flash90/Mendy Hechtman)

In 2016, the World Health Organization (WHO) ranked Israel as ninth in delivering health care in its list of countries achieving Sustainable Development Goals. The Bloomberg Global Health Index gives Israel an overall “health index” of 88.14, far ahead of the US and most European countries.

Israel spends just 7.4 percent percent of its GDP on healthcare yet delivers one of the most inclusive and efficient systems worldwide. Compare that to the US, which spends about 18 percent of its GDP, still leaving out large numbers of people; or Europe, which averages around 10 percent GDP spending per year on health care. How does Israel manage to achieve this?

Government largely funds health care with income-based taxes earmarked for health purposes. While there are private health plans, all Israeli residents are covered by one of four major health funds. Excellent public hospital care is available equally to all sectors of society. Israeli health plans are integrated with care delivery as well as preventive medicine. Costs are kept down through a combination of government controls, purchasing power by the health funds, incentives and competition. Health care innovation has been a major driver in Israel’s emergence as a “start-up medical nation.”

For example, Rambam Medical Center in Haifa has 1,000 beds and a total staff of about 5,000. This 1 to 5 ratio of beds to staff is quite efficient, especially when compared to large urban hospitals in the US and other countries.

Efficiencies are also achieved in the operating room. Our surgeons complete 3-5 operations per session — a number that is very high — at 95 percent capacity, while delivering results that are similar to those of the leading US hospitals. After 3 pm, when most ORs have shut down, our surgeons are operating at 70 percent capacity, utilizing facilities and incentivizing staff.

Israeli doctors and medical personnel are well-trained and highly regarded in their fields, at home and abroad. Most are trained at top-flight medical centers and universities in the US. Almost all return. Despite the constraints in which they must work, including lower salaries by foreign standards, the motivation is high to practice medicine and conduct clinical research in Israel.

Not everything is perfect in Israel. The system is too lean and there is a shortage of hospital beds and personnel. We need more doctors, especially to replace those now retiring who arrived at the peak of the immigration wave nearly three decades ago from the Former Soviet Union, which brought many medical experts in the surge of one million new immigrants. More nurses, and many more hospital beds are also needed. Israel needs to raise its GDP spending on health an equivalent of 9% to optimize treatment and prevention strategies and keep pace with its growing population.

Because of tight budget controls from the Ministry of Health and health plans, it is necessary to raise funds from individual donors for critical and modern equipment, medical facilities and research projects. These donations are vital not only to our medical centers and health networks, they also provide an important link between Israel and the Jewish diaspora.

With about 8.5 million people, Israel is a small country. Comparisons with large populations, like the US, can be skewed. However, there are lessons to be drawn from the Israeli experience in managing and delivering efficient healthcare. Even Israelis, who are known to complain about much, usually are complimentary about their health care. And with many now living well into their 80s, they should be.

An elderly couple walking on Jaffa street in central Jerusalem on February 20, 2017.
(Flash90/Nati Shohat)

About the author:
Prof. Rafael A. Beyar is Director General and CEO of the Rambam Health Care Campus, located in Haifa, Israel.