9.87.1 Total Population – millions (2008) -0.4% 1.9% Annual Growth Rate: 1998-2008 19% 14% 60+ as % of total (2008) 74 81 (Life Expectancy at birth –

Total Population – millions (2008) 7.19.8

Annual Growth Rate: 1998-20081.9%-0.4%

60+ as % of total (2008)14%19%

(Life Expectancy at birth – (20088174

Probability of dying under age 5 years per 1000 live births - both sexes -)2008)

5.08.0

(Physicians per 1,000 population : (20063.72.0

Health Expenditures as % of GDP (2007)8.0%9.9%

Per Capita Health Expenditures at International $ rate )2007)1,672769

Private as a % of total Health Expenditures (2007)44.1%38.2%

Government health expenditures as % of total gov’t expenditure10.1% 13.8%

IsraelIsrael SerbiaSerbia

Basic Demographic & Health DataBasic Demographic & Health Data**

*WHO

The Israeli Health SystemThe Israeli Health System

Israeli Healthcare SystemIsraeli Healthcare System

Public and Private Financing

Public and Private Healthcare Services

National Health Insurance Law of 1995

Universal compulsory statutory health insurance

Financed by earmarked and general taxation

Citizens pay a healthcare tax – 4.8% of income

“Cost of the Basket of Services” :

Based on expenditures of the health funds in previous years.

Updated yearly based on a health index

If the earmarked taxes not sufficient, the government must

add funding to guarantee that the updated “cost of the

basket of services” is maintained.

National Health Insurance Law of 1995National Health Insurance Law of 1995

Coverage for health care services is provided by 4

competing nationwide health funds (HMOs( under the

National Health Insurance Law of 1995

Some are quasi public (owned by labor unions(, some are

private, not for profit mutual companies

Health funds are financed primarily by government via age-

related capitation payments (90% of total(, patient charges

and other income (10%(

Every citizen is a member of one of these four health funds

Citizens are free to choose and move between health funds

Health funds must accept all applicants for membership

Health Funds provide a uniform legally defined basket of

services to which every citizen is entitled ( which amounts

to about 60% of total health expenditures(.

There are public and private providers of services including

physicians, hospitals, pharmacies and other health care

professionals.

The Israeli Public Health Care SystemThe Israeli Public Health Care System

Health funds purchase services from outside

suppliers or supply services in- house.

Services in the basic basket not currently covered by

the health funds include much of mental health, long

term nursing care, maternity (hospital( care, dental

care for adults

Health funds can provide -for a premium which they

collect directly- additional services not in the basic

basket (supplementary health insurance(

The Israeli Public Health Care SystemThe Israeli Public Health Care System

The Israeli Public Health Care SystemThe Israeli Public Health Care System

Supplementary services include choice of doctor in

private hospital, second opinion from senior

consultants, dental services, alternative medicine,

medications not in in the public basket, medical

accessories, medical care abroad, etc.

Health funds have purchased collective policies for long

term care insurance from private insurance companies

Health Funds also offer their members travel insurance

through a contract with a private insurance company

Composition of Israeli Acute Care Hospital System

Number of Beds = 14, 582 – 2.05 beds/1000 population

11 Ministry of Health Hospitals 46.5% of beds

8 Klallit Health Fund Hospitals 30.4% of beds

7 Non-profit Hospitals 10% of beds

2 Hadassah Hospitals 6.0% of beds

6 Mission Hospitals 3.6% of beds

11 Private for-profit Hospitals 3.4% of beds

1 Meuhedet Hospital 0.1% of beds

Characteristics of Israeli Acute Care Hospital Characteristics of Israeli Acute Care Hospital SystemSystem

All hospitals have outpatient ambulatory services

All public hospitals have Emergency Rooms

In public hospitals, staffing is linked with the number of beds in each department

All medical residency programs are predominantly hospital based

Physicians are salaried employees of the hospital

Hospital physicians may have private practices outside of the public hospital and may contract with health funds as independent doctors

Public hospital outpatient departments are manned largely by senior residents backed up by department doctors

Second largest and fastest growing Health

Fund in Israel

Non-profit mutual.

Recognized health fund - Israeli National Health

Insurance Law

Provides public basket of services

Supplies services via own facilities and outside

providers (both public and private(

Maccabi Healthcare Services

1.9 million members (25% Market Share(.

5000 physicians (85% independent contracted doctors(.

Contracts with all public acute care and geriatric

hospitals

Owns the largest private hospital network in Israel with

13 facilities all across the country

Contracts with 700 private pharmacies and operates a

chain of 53 pharmacies of its own

Maccabi's income budget 1.7 billion Euro

Maccabi StatisticsMaccabi Statistics

Supplies services via its own facilities and outside providers.

Selectively contracts with providers

Free patient choice of physician and other providers

Methods of payment to providers :

Physicians: Quarterly visits within global budget

Hospitals: Maccabi negotiated Caps within a National Cap

Other providers: Fee-for-service

Co-payments exist for medications, visits to physicians, specialist clinics and some other services.

Maccabi Healthcare ServicesMaccabi Healthcare Services

91% of Maccabi Expenditures are Medical91% of Maccabi Expenditures are Medical

Other medical7%%

Development1%

Diagnosis 9%

Administration8%Drugs

21%Hospitals

30%

Physicians24%

Health Funds Financial Performance 2001-2009 (Millions NIS)

HealthFunds

2001 20022003200420052006200720082009

Clalit(472)(413)(106)4(143)(63)(74)(422)(185)

Maccabi(5)(5)2828131399(1)(1)33886644

Leumit(204)(94)(27)13(62)(76)252716

Meuhedet)53)(5)(58)6819191030.4

The Yitzhak Rabin

National Prize For Quality and ExcellenceIn The Public Sector

This CertificateAttests that

Maccabi Healthcare Services

has won

The Israeli National Prize for Quality and Excellence for year

2009 for Health care Organizations

The Maccabi Healthcare System is The Maccabi Healthcare System is Highly ComputerizedHighly Computerized

Maccabi Electronic Medical Record

Every transaction computerized

The Central Medical Record

E-Laboratory

E- Prescription

E- Consultation

Telemedicine

Alerts and Reminders

Patient Website