Akademik

   Palestine at the beginning of the 20th century was a backward area with substantial diseases, including malaria and numerous other ailments, as well as high infant mortality rates and other indicators of poor medical circumstances. Contemporary Israel's situation is quite different. When the state was established in 1948, the government created a Ministry of Health to serve as an administrative organ to supervise the functioning of the existing health organizations and to deal with the needs of the new state. Numerous health care-related organizations have been created. These include voluntary organizations, such as the Kupat Holim, the Hadassah Medical Organization, the Magen David Adom, and various other groups.

   The basis of Israel's health care system was developed during the British mandate by the British authorities as well as by Jewish organizations in Palestine and in the Diaspora. The tradition of health care provision antedates the founding of the state and in some instances even the Zionist Movement. Jewish clinics established in Jerusalem in the 19th century provided services to all citizens of the city, and some have evolved into modern hospitals, such as Bikur Holim and Shaare Zedek. In 1913, Hadassah sent two trained nurses to work in Jerusalem; from this small beginning, there eventually evolved the massive Hadassah-Hebrew University of Jerusalem Medical Center with its attendant hospitals, clinics, and schools of medicine. Kupat Holim, Israel's first health insurance arrangement and the largest today, was established by the Histadrut soon after the latter's founding in 1920 to provide health care for its members. Thus, by the time Israel became independent, there was a substantial health services infrastructure.

   However, the postindependence wave of new immigrants (see ALIYA) that included Holocaust survivors from Europe as well as substantial immigration from developing countries brought with them health problems that challenged the existing system to meet the needs and to expand to provide services that were new and different from those prior to that time. From that starting point, Israel has created a modern health care system that rivals many of those in the most developed states, and Israel's achievements in the health field are among the most impressive in the world.

   There are some 50 general hospitals in Israel in addition to a highly developed network of community-oriented primary care clinics throughout the country operated by the Ministry of Health, private health care providers ("sick funds"), or municipalities. There are some 26,000 physicians in Israel, most of whom are salaried employees of hospitals and sick funds. The ratio of physicians to 1,000 persons is 4.6 (2002), one of the highest levels in the world. One of the factors contributing to the high numbers of physicians is the recent mass immigration from the former Union of Soviet Socialist Republics.

   Israel has four medical schools, each affiliated with a major university. In addition to medical schools, there are 2 schools of dentistry, 1 school of pharmacology, and some 20 nursing schools in the country.

   Even though health insurance was not mandatory in Israel until 1995, 96 percent of the population was insured through one of the private sick funds that had evolved in the early years of statehood.

   However, by the early 1990s it was recognized that the national health care system was in dire need of financial restructuring and modernization. The exponential increase in medical procedures, combined with the addition of close to 1 million new immigrants from the former Soviet Union beginning in the early 1990s, accelerated the budgetary crisis confronting Israel's health care system.

   On 1 January 1995, the National Health Insurance Law went into effect. The law made health insurance coverage mandatory for all citizens and permanent residents and sought to establish a more equitable partnership between the state, employers, and private sick funds in the provision of health insurance coverage.