Basic Demographic Health Data Israel Serbia 7

Basic Demographic & Health Data* Israel Serbia 7. 1 9. 8 Annual Growth Rate: 1998 -2008 1. 9% -0. 4% 60+ as % of total (2008) 14% 19% Life Expectancy at birth – (2008) 81 74 Probability of dying under age 5 years per 1000 live births - both sexes -(2008) 5. 0 8. 0 Physicians per 1, 000 population : (2006) 3. 7 2. 0 Health Expenditures as % of GDP (2007) 8. 0% 9. 9% Per Capita Health Expenditures at International $ rate (2007) 1, 672 769 Private as a % of total Health Expenditures (2007) 44. 1% 38. 2% Total Population – millions (2008) Government health expenditures as % of total gov’t expenditure *WHO 10. 1% 13. 8%

The Israeli Health System Ministry of Health Ministry of Finance Health Funds Klalit 54% Maccabi 24% Meuhedet 12% Leumit 10% Hospitals Acute Care 46 Beds: 14, 582 Psychiatric 14 Beds: 4, 240 Geriatric 310 Beds: 22, 283

Israeli Healthcare System v. Public and Private Financing v. Public and Private Healthcare Services

National Health Insurance Law of 1995 v Universal compulsory statutory health insurance v Financed by earmarked and general taxation v Citizens pay a healthcare tax – 4. 8% of income v “Cost of the Basket of Services” : q q Based on expenditures of the health funds in previous years. Updated yearly based on a health index v 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 1995 v Coverage for health care services is provided by 4 competing nationwide health funds (HMOs) under the National Health Insurance Law of 1995 v Some are quasi public (owned by labor unions), some are private, not for profit mutual companies v Health funds are financed primarily by government via age-related capitation payments (90% of total), patient charges and other income (10%)

The Israeli Public Health Care System v Every citizen is a member of one of these four health funds v Citizens are free to choose and move between health funds v Health funds must accept all applicants for membership v 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). v There are public and private providers of services including physicians, hospitals, pharmacies and other health care professionals.

The Israeli Public Health Care System v Health funds purchase services from outside suppliers or supply services in- house. v 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 v 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 System v 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. v Health funds have purchased collective policies for long term care insurance from private insurance companies v 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 v 11 Ministry of Health Hospitals 46. 5% of beds v 8 Klallit Health Fund Hospitals 30. 4% of beds v 7 Non-profit Hospitals 10% of beds v 2 Hadassah Hospitals 6. 0% of beds v 6 Mission Hospitals 3. 6% of beds v 11 Private for-profit Hospitals 3. 4% of beds v 1 Meuhedet Hospital 0. 1% of beds

Characteristics of Israeli Acute Care Hospital System v All hospitals have outpatient ambulatory services v All public hospitals have Emergency Rooms v In public hospitals, staffing is linked with the number of beds in each department v All medical residency programs are predominantly hospital based v Physicians are salaried employees of the hospital v Hospital physicians may have private practices outside of the public hospital and may contract with health funds as independent doctors v Public hospital outpatient departments are manned largely by senior residents backed up by department doctors

Maccabi Healthcare Services v Second largest and fastest growing Health Fund in Israel v Non-profit mutual. v Recognized health fund - Israeli National Health Insurance Law v Provides public basket of services v Supplies services via own facilities and outside providers (both public and private)

Maccabi Statistics v 1. 9 million members (25% Market Share). v 5000 physicians (85% independent contracted doctors). v Contracts with all public acute care and geriatric hospitals v Owns the largest private hospital network in Israel with 13 facilities all across the country v Contracts with 700 private pharmacies and operates a chain of 53 pharmacies of its own v Maccabi's income budget 1. 7 billion Euro

Maccabi Healthcare Services v v 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 : q Physicians: Quarterly visits within global budget q Hospitals: Maccabi negotiated Caps within a National Cap q Other providers: Fee-for-service v Co-payments exist for medications, visits to physicians, specialist clinics and some other services.

91% of Maccabi Expenditures are Medical

Health Funds Financial Performance 2001 -2009 (Millions NIS) Health Funds Clalit 2001 2002 2003 2004 2005 2006 2007 2008 2009 (472) (413) (106) 4 (143) (63) (74) (422) (185) (5) 28 13 9 (1 ) 3 8 6 4 Leumit (204) (94) (27) 13 (62) (76) 25 27 16 Meuhedet (53) (58) 68 19 19 10 3 0. 4 Maccabi

The Yitzhak Rabin National Prize For Quality and Excellence In The Public Sector This Certificate Attests 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 Highly Computerized v Maccabi Electronic Medical Record v Every transaction computerized v The Central Medical Record v E-Laboratory v E- Prescription v E- Consultation v Telemedicine v Alerts and Reminders v Patient Website