Shifra Shvarts

Health and health care in Israel: an introduction

Starting well before Independence in 1948, and over the ensuing six decades, Israel has built a robust, relatively efficient public system of health care, resulting in good health statistics throughout the life course. Because of the initiative of people living under the British Mandate for Palestine (1922-48), the development of many of todays health services predated the states establishment by several decades. An extensive array of high-quality services and technologies is available to all residents, largely free at point of service, via the promulgation of the 1994 National Health Insurance Law. In addition to a strong medical academic culture, well equipped (albeit crowded) hospitals, and a robust primary-care infrastructure, the country has also developed some model national projects such as a programme for community quality indicators, an annual update of the national basket of services, and a strong system of research and education. Challenges include increasing privatisation of what was once largely a public system, and the underfunding in various sectors resulting in, among other challenges, relatively few acute hospital beds. Despite substantial organisational and financial investment, disparities persist based on ethnic origin or religion, other socioeconomic factors, and, regardless of the countrys small size, a geographic maldistribution of resources. The Ministry of Health continues to be involved in the ownership and administration of many general hospitals and the direct payment for some health services (eg, geriatric institutional care), activities that distract it from its main task of planning for and supervising the whole health structure. Although the health-care system itself is very well integrated in relation to the countrys two main ethnic groups (Israeli Arabs and Israeli Jews), we think that health in its widest sense might help provide a bridge to peace and reconciliation between the country and its neighbours.

Complementary Medicine in Israel

In recent years, the status of complementary medicine in Israel has appeared frequently on the public agenda. The debates and the newspaper headlines concerned with this subject usually deal with legal aspects of the subject, including the relation between complementary medicine and the medical establishment. With the enactment in 1995 of the Compulsory Health Insurance Law, debate over the issue intensified, with the public divided over any proposal to make complementary medicine part of the services guaranteed by law. This paper addresses the current status of complementary medicine in Israel, describes the introduction of complementary medicine to Israel, attitudes toward it of both consumers and medical professionals, and the question of its legal status. While no comprehensive survey describing all aspects of this subject in Israel has yet been undertaken, this paper is based on a survey of the professional literature in Israel, especially that of the Israeli scientific-medical community, a survey of the general press, and an analysis of the health insurance law and its position with respect to the complementary medicine.

The tinea capitis campaign in Serbia in the 1950s.

In this Historical Review we describe the 1950-59 UNICEF-supported campaign to eliminate tinea capitis, also known as ringworm, in Yugoslavia. Medical treatment for this infectious disease involved the use of ionising radiation. We discuss the possible health implications for the treated population. Data were collected from archive documents, newspapers from the 1950s, Yugoslavian scientific reports, interviews with patients who received treatment, and interviews with physicians who gave treatment during the campaign. The campaign screened 878 659 individuals and treated 49 389. On the basis of Israeli tinea capitis research, late health consequences (mainly cancer in the irradiated area) can be expected in the treated Serbian population. The discovery of treatment records for a substantial number of patients makes public-health action and further research possible. The findings are relevant to the Serbian medical community and populations in other countries that used a radiation-based technique for the treatment of tinea capitis.

What Education Means to People with Psychiatric Disabilities: A Content Analysis

This article examines what supported education means to people coping with psychiatric disabilities and tries to understand whether the educational endeavor has an additional personal value for the consumers beyond its instrumental value. It identifies rehabilitation domains that are most important and best achieved within supported education. Our approach is qualitative: we analyze letters written by students with psychiatric disabilities who have successfully completed high school courses and, through content analysis, identify 45 parameters that illuminate the meaning of the experience for the students. We analyze these parameters in terms of Maslows Hierarchy of Needs. We find that for our population education is also a process of recovery of lost roles and capabilities and fulfills self-actualization needs. The shift from the “patient” to the “student” role is a very powerful one. To exchange the patient role for one that brings with it prestige and power promotes rehabilitation in ways that “merely” receiving societal support and acquiring specific skills can rarely achieve.

Application of Porter's generic strategies in ambulatory health care: a comparison of managerial perceptions in two Israeli sick funds.

Abstract: A number of typologies have been developed in the strategic management literature to categorize strategies that an organization can pursue at the business level. Extensive research has established Porters generic strategies of (1) cost leadership, (2) differentiation, (3) differentiation focus, (4) cost focus, and (5) stuck-in-the-middle as the dominant paradigm in the literature. The purpose of the current study was to research competitive strategies in the Israeli ambulatory health care system, by comparing managerial perceptions of present and ideal business strategies in two Israeli sick funds. We developed a unique research tool, which reliably examines the gap between the present and ideal status managerial views. We found a relation between the business strategy and performance measures, thus strengthening Porters original theory about the nonviability of the stuck-in-the-middle strategy, and suggesting the applicability Porters generic strategies to not-for-profit institutes in an ambulatory health care system.

The government of Israel and the health care of the Negev Bedouin under military government, 1948-1966.

Bedouin Arabs in Israel are a Muslim society undergoing dramatic social change. The Bedouin have lived in the Negev desert since the sixth century, having migrated there from the Arabian Peninsula. In the course of the last five decades this traditionally nomadic/semi-nomadic population has undergone rapid modernization and urbanization, and today approximately 120,000 Bedouin Arabs live in the Negev. Traditionally herders and farmers, only about 5 per cent of the Negev Bedouin are still semi-nomadic tent dwellers. Most families are sedentary, living in sub-tribal groups in shacks and houses. The Negev Bedouin population has the lowest socio-economic rating of all localities and social groups in Israeli society.

Universal versus tailored solutions for alleviating disruptive behavior in hospitals

BackgroundDisruptive behavior among hospital staff can negatively affect quality of care. Motivated by a standard on disruptive behavior issued by The Joint Commission (LD 3.10), as well as the desire to improve patient care, minimize liability, and improve staff retention, hospitals are setting policies to prevent and resolve disruptive behaviors. However, it is unknown whether uniform conflict management tools are equally effective among different hospital settings.MethodsWe surveyed residents and nurses to identify similarities and differences among hospital departments in the antecedents, characteristics, and outcomes of disruptive behaviors, and in the effectiveness of conflict management tools. We used a quantitative questionnaire-based assessment to examine conflict perceptions in eight different hospital departments at Rambam Medical Center in Haifa, Israel.ResultsMost participants (89 %) reported witnessing disruptive behavior either directly or in other parties; the most significant causes were identified as intense work, miscommunication, and problematic personalities. The forms of these behaviors, however, varied significantly between departments, with some more prone to expressed conflicts, while others were characterized by hidden disruptive behaviors. These outcomes were correlated by the antecedents to disruptive behavior, which in turn affected the effectiveness of alleviating strategies and tools. Some tools, such as processes for evaluating complaints, teamwork and conflict management courses, and introducing a behavioral mission statement, are effective across many antecedents. Other tools, however, are antecedent-specific, falling into two principal categories: tools directly removing a specific problem and tools that offer a way to circumvent the problem.ConclusionsConflict resolution tools and strategies, based on residents and nurse perceptions, may be more effective if tailored to the specific situation, rather than using a “one-size-fits-all” approach.

The Mass Campaign to Eradicate Ringworm Among the Jewish Community in Eastern Europe, 1921–1938

Between the years 1921 and 1938, 27,600 children were irradiated during a mass campaign to eradicate ringworm among the Jewish community in East Europe. The ringworm campaign was the initiative of the American Jewish Joint Distribution Committee together with the Jewish health maintenance organization OZE (The Society for the Protection of Jewish Health). We describe this campaign that used x-rays to eradicate ringworm and its mission to enhance public health among Jewish communities in Eastern Europe during the period between the world wars. We discuss the concepts behind the campaign, the primary health agents that participated in it, and the latent medical ramifications that were found among children treated for ringworm, many years after treatment--pathologies that can be linked to the irradiation they received as children. Our research is based on historical archival materials in the United States, Europe, and Israel.

Linkage between the Israeli Defense Forces Primary Care Physician Demographics and Usage of Secondary Medical Services and Laboratory Tests

ABSTRACT Background: The primary care physicians in the Israeli Defense Forces, as in the Israeli civilian health system, have two major subpopulations. Graduates of Israeli schools of medicine, and graduates of foreign medical schools, most of them in Eastern Europe. Objective: To evaluate differences in the referral patterns of primary care physicians according to their graduation institution and demographic characteristics. Methods: The study took place in one primary care practice in central Israel. The referrals to consultations and laboratory tests over a period of 1 year were evaluated. Physicians that had less than 37 encounters were excluded from the study. Data were extracted from the central computerized databases of the Medical Corps and Israeli Defense Forces. Results: Sixty-eight physicians had a total of 18,402 encounters that resulted in 23,845 outcomes. There were no associations between demographic and training backgrounds of the physicians and their actual referral rates to consultation...