This report is the second of a new series of publications reviewing the quality of health care across selected OECD countries. As health costs continue to climb, policy makers increasingly face the challenge of ensuring that substantial spending on health is delivering value for money. At the same time, concerns about patients occasionally receiving poor quality health care led to demands for greater transparency and accountability. Despite this, there is still considerable uncertainty over which policies work best in delivering health care that is safe, effective and provides a good patient experience, and which quality-improvement strategies can help deliver the best care at the least cost. OECD Reviews of Health Care Quality seek to highlight and support the development of better policies to improve quality in health care, to help ensure that the substantial resources devoted to health are being used effectively in supporting people to live healthier lives.

This report reviews the quality of health care in Israel. It begins by providing an overview of the range of policies and practices and the role they play in supporting quality of care in Israel (Chapter 1). It then focuses on three key areas: strengthening community based primary care (Chapter 2), tackling inequalities in health and health care (Chapter 3), and improving care for people living with diabetes (Chapter 4). In examining these areas, the report seeks to highlight useful practices and provide recommendations to improve the quality of health care in Israel.

Israel has established one of the most enviable health care systems among OECD countries in the 15 years since it legislated mandatory health insurance. While most OECD countries have been grappling with rapidly rising health costs, Israel has contained growth in health care costs to less than half the average for OECD countries over the past decade. Health care spending in Israel absorbed 7.9% of GDP in 2009 – the eighth lowest among OECD countries. While low levels of health spending are likely to reflect successive years of tight control over spending and the lesser demands of a younger and healthier population, Israel has also made the most of tight budgetary circumstances to build a health care system with high-quality primary health care.

This chapter provides an overview of policies and strategies to improve the quality of care in Israel’s health system. It seeks to profile key quality of care policies and benchmark the extent to which Israel has deployed various policies that are commonly used across OECD countries to assure the delivery of high quality care. The chapter covers system wide policies such as legislative and administrative arrangements. It then profiles efforts to assure the quality of inputs into health care, such as education and training of the health workforce and accreditation of health facilities. The chapter then focuses on policies to monitor and drive improvements in the quality of care, which vary considerably in their maturity between hospitals and primary care. In general, Israel’s approach to quality of care places considerable faith in collecting information and relying on dialogue between health care service providers and health funds to drive ongoing improvements in the services they provide.

This chapter provides an overview of Israel’s well-developed communityoriented primary care system and its exceptional contribution to improving the quality of health care while containing costs. It describes its strengths and weaknesses and focuses on the challenges that now face Israel. The chapter starts by acknowledging Israel’s world-class quality monitoring mechanism for community care which sets a blueprint for others to follow, but which has the potential for further development. It then highlights the need to strengthen co-ordination between community and hospital care. Recent changes to the resource allocation formula signal Israel’s commitment to redressing geographical differentials in health care capacity between central regions of the country and the North and South, but they need to go further if real change is to be realised. Attention is drawn to serious shortfalls in numbers of physicians and registered nurses, and the need to develop strategies that bolster their numbers and ensure staff are drawn into Israel’s periphery. The chapter also notes that public health and primary prevention services need strengthening.

Israeli society is characterised by deep economic and social divisions, with poverty rates that are greater than in most other OECD countries. The government and health funds are taking serious steps to address prevailing inequalities in health and health care quality by population group, socio-economic status and geography. The government has recently developed an ambitious action plan and taken significant steps for reducing inequalities in health care. This is highly commendable, especially considering the challenging social-economic environment within which inequalities in Israeli society are nested. Despite this, further improvements can be made. Information on access to and the quality of hospital care for different groups is lacking, for example. Other key issues deserving closer attention are the growing financial burden of out-of-pocket payments; the need for strengthening the focus on culturally tailored primary prevention and health promotion services among high-risk groups; and the need to monitor how changes in the capitation formula impact on geographical variations in staffing and infrastructure. The government will need to monitor carefully the outcomes of the reform plan, and continue to strengthen incentives, rewards and penalties for providers and funds. Importantly, achieving the government’s goal of reducing health inequalities will require action across government departments and measures to reduce wider socio-economic differentials driving health inequalities.

This chapter reviews the quality of diabetes care in Israel. Diabetes care is mainly provided and co-ordinated in the community care sector. As a result of improvements made in the community care sector at large, quality of care provided to patients with diabetes has been improving in recent years, as shown by decrease in long and short-term complications. Today, quality of care appears to be good in the general population, but remains a problem in some population groups. Scaling-up and widening diabetes prevention programmes, especially amongst disadvantaged populations and some ethnic groups will be required in the context of a rising disease burden. Moreover, these population groups might also suffer poorer health outcomes than the rest of the population and may require specific tailored care. Care co-ordination and continuity, especially between the community care sector and hospital sector will also need to be improved, especially as patients with diabetes are likely to experience complications. A particular focus on diabetes co-morbidities, including mental health, will be required to move towards greater patient-centred care and better outcomes.