Last Thursday, we woke up early to attend a lecture on lung transplantation by Dr. Hertz for the staff at Poriya hospital. It was well received and well attended. One thing he discussed that I found to be particularly interesting was a new program that Israel has rolled out over the past year to promote organ donation. The program was pioneered by a transplant surgeon after he spoke with a number of Orthodox Jewish families waiting for transplants. He noted that certain ethnic/cultural groups were ok with receiving an organ for transplant but refused to donate their own organs. Last year, legislation was passed that puts individuals who need an organ and are themselves signed up to be a donor higher on the transplant list than those who are not donors. The donor rates have increased dramatically since this was passed, and may be a solution to our own (US) problems with donor shortages. Here’s a well written NYT article on the issue: http://well.blogs.nytimes.com/2012/02/16/in-israel-a-new-approach-to-organ-donation/
After the lecture, we made our way to Meir hospital–the seventh largest in the country–to witness a mass causality drill. As Dylan mentioned in a previous post, since being here we’ve heard “this is not the Israel you see on CNN,” mentioned to us repeatedly in regard to the political and military situation of the area. While I would agree with this on a day to day level, it’s quite obvious that conflict is always in the back of most peoples minds, as evidenced by hospital requirements to build onsite bomb shelters and to perform disaster drills every two years. We were greeted by Dr. Eran Tal-Or, the head ED physician at Poriya and a disaster relief expert, who led us around the drill. It was an interesting sight, to say the least. The drill itself took place in the hospital parking lot, which had two sets of arch spanning the lot, each about 50 feet long, that could be converted into decontamination showers in the event of chemical warfare. The drill was well organized and there were a lot of “big wigs” present from the Israeli army and health ministry. The drill was a mock chemical warfare senario with live actors being delivered to site by ambulance. They were immediately assessed by hospital staff (all wearing protective suits) and assigned a priority based on severity of wounds/contamination. If they needed to be stabilized, mock life support was provided before they went to the decontamination area and then went to the shower area where the chemical compound, simulated with a white powder, was washed off. After this, they were brought to a marked off “safe area” where hospital staff received them and then sent for further triage. This is where the simulation ended, but in the case of real emergency they would be carted into the hospital and the hospital is further prepared for this. On the roadway leading into the hospital compound there are four painted lines red, blue, green, and yellow denoting the severity of the patients wounds. Let’s just say you don’t want to follow the blue line…
We left the simulation part way through to talk with the hospital director. He gave us a quick lecture on the hospital itself, but the discussion quickly moved to the structure of the Israeli medical system. In my first post I noted that all Israelis are provided healthcare through the government, but it turns out things are slightly more complex. Healthcare is paid for through a 5 percent tax on all earned income; the unemployed still receive healthcare with no penalties. Each citizen is allowed to choose from 4 different HMOs, each with their own clinics and providers, the government then pays the HMO for their care. It is unclear to me whether the HMOs are for profit or non-profit organizations however they are still in competition for patients so each HMO functions as a business rather than a government run hospital.
So if everyone has healthcare, what are the downsides to this system? Much like HMOs in the US you are only able to see physicians hired by your HMO. Also, Israeli physicians acknowledge that there are longer wait times to see specialists and have surgeries performed. To deal with these problems a form of supplementary insurance can be purchased for a very reasonable cost, ~15 USD a month, which enables citizens to see any physician of their choosing and generally decreases wait times. Physicians here make less money, although also work fewer hours than US physicians, so many of them supplement their incomes by having private clinics outside of the hospital that they attend a few days a week. The Israeli medical community members I’ve spoken with seem to agree that healthcare here is quite good and they are proud of their egalitarian system. The US could probably taken some notes from the Israeli system, although an important point is Israel’ is small country when compared to the US – for reference its about the same size as the state of New Jersey.
~Matt
