Health Care: Israeli vs Palestini - Essay Example

? Health care: Israeli vs. Palestinian Introduction: The long conflict of Israel and Palestine is yet to be resolved totally, in spite of sincere efforts made within the region and by outside. One of the serious impacts of this conflict has been on the health conditions of the Palestinians. Palestinians in the West Bank and Gaza are in very difficult situations. Greater than 1.3 million residents in Gaza are confined in a tiny piece of land with limited food, medicine, etc. (Mahmoud) On the other hand, healthcare system of Israel has major relevance and sets quite a high standard example for the healthcare system of the world. Compared to United States, per capita expenses of Israel are half but its results in many areas of healthcare are superior (Rosen). Israeli Medical Condition: Israeli medical condition is approaching North America and Western Europe In Israel, the healthcare services have been developed by nonprofit health plans, other nonprofit institutions, the Israeli government and the British Mandatory regime that existed before 1948. The health plans are called kupot holim alike contemporary US HMOs. The National Health Insurance Law ensures that all the citizens are covered by health insurance and seeks its benefits. By the end of 1980s, about 95% of the people were insured in one of the four health policies. The health system was founded on strong collectivist values which believed in strong egalitarian-socialist ethics and the fact that only joint activity could create, defend and develop a new state. About 50% of Israel's acute care beds are operated by the Ministry of Health. Another one third is operated by “Clalit”, the major health arrangement and the residual is operated by both profit and nonprofit organizations. The government has a good control over entire health care system right from third party players to health professionals. The MoH gives licenses and monitors the quality of total health care system including Israel's hospitals, outpatient surgery centers, dialysis centers, clinical labs and other key healthcare facilities. The licenses given to hospitals are for 1–3 years, and then depending on the results of the latest Inspection these are being extended. The licenses refer to a definite number of beds, by department, as well as these also specify the types of outpatient clinics the hospital is permitted to operate. In 2000s, the Ministry of Health's Quality Assurance Unit started a system of examinations of quality for hospitals and other healthcare facilities (whether or not the facility is run by the Ministry or another provider). The inspections are done annually. For hospitals, these engage a big multidisciplinary group of up to 25 inspectors. The inspections include detailed reviews of a sample of records. Hospitals are informed in advance so that they can prepare for the inspections. The inspections are done quite seriously and those facilities which are not found to be up to the required standards are either closed down or asked to improve maintaining proper guidelines. The Ministry carries out assessment of the health plans' function district wise. Major detailed studies have been carried out on such topics like hospital-acquired infections, coronary bypass operations, ICU care and transplants etc. Another project on Ministry of Health centers on antibiotic-resistant contagion. For several years, though Clalit had a quality-monitoring system in its hospitals, it did not show significant improvements. The organization is now restructuring itself under the orders of the Ministry of Health. Similar efforts are also being taken by the Ministry of Health to develop the required quality measures for the government hospitals. Israel's National Blood Bank is functioned by the national ambulance service (MDA) and maintains the uppermost global safety principles. However, Israel does not have a national procedure for dealing with medical errors, except from those that result in deaths in hospitals or for other very severe outcomes. However, as patients publicize many such cases with the help of media and personal injury lawyers, the Ministry of Health follows up on those cases. Also, The National Quality Measures Program is a fine example of how to translate research findings into policies and action plans. The program undertakes routine and dynamic quality assessment of the preventive, diagnostic, therapeutic and rehabilitative services that are supplied by the health plans. As of now, 69 indicators have been developed in six major medical fields and are regularly assessed in the total Israeli population. Also the project has identified various areas which are in need of improvement. These are the lag time in the availability of main outcome data (like disease-specific mortality rates), and challenges in accessing hospital discharge diagnoses (which are very important for building various registries). (Rosen) Foreign Tourists just need to buy a medical Insurance: People from all over the world including Eastern Europe, Cyprus and the United States have been coming to Israel’s hospitals over the past few years to avail inexpensive, high-quality medical treatment. They just need to buy insurance. Profits earned by foreign tourists are much greater than from Israeli citizens. For tourists, payment is taken in advance, unlike the locals who avail the services in credit. Yet, for the foreign tourists, the treatment prices are much less than in the America and a lot of European nations. Also, though the charges in Israel are higher than those in East, their medical reputation is much better. (Hadassah Medical Center) Hospitals & Beds According to 2005 statistics, Israel had 46 general (acute) hospitals, 15 psychiatric hospitals and 309 chronic disease hospitals (similar to US skilled nursing facilities). The general care bed-to population ratio, as of 2007, stood at 2.1 per 1000 population. Since September 2000, seven hospitals have been equipped to care for the casualties, including shock victims. Almost 46% of all acute hospital beds in Israel are operated by the government. Another 30% of beds are controlled by Clalit. About 4% of acute beds are under the care of private for-profit hospitals and the outstanding acute beds are supervised by nonprofit hospitals. Israel has a few, "single specialty" hospitals, mainly in the maternity sector. Almost all Israeli hospitals have affiliations from universities and conduct training programs for medical students, residents and interns. Leading private hospitals are undergoing serious modernization and up gradation of their facilities every now and then. (Rosen) Doctors Since 1990s, the physician-to-population ratio has been relatively stable. It has increased from 3.6 to 3.75 per 1000 between 1992 and 1997. It again underwent decline to 3.5 per 1000 in 2006. Israel had 2.0 physicians per 1000 population, in 1970. From 1990–1994, Israel granted licenses to around 7,650 physicians. (Rosen) Malnutrition data: The nation is not affected highly by malnutrition. About 5 % of the population is affected by it. Infant mortality rate: The infant mortality rate in 2006 was 3.9 per 1000 live births; it has reduced by 38% since 1996. In 2006, male life expectancy was 78.5 for males and that of female was 82.2. From 1986 to 2006, life expectancy for males has increased by 5.3 years for males and for females by 5.4 years. The main reasons of infant mortality are premature delivery in the Jewish-Israeli population and congenital anomalies in the Arab-Israeli population. The mortality rate of children under five in 2005 was 5.5 per 1000 live births. In 2006, the crude mortality rate was 5.5 per 1000 population, which declined from 6.1 per 1000 population in 1999. (Rosen) The decline is due to improved treatment (both in medication and surgical intervention) and due to increased awareness and prevention and it has been more prominent in the Jewish-Israeli people than among Arab Israelis. However, heart disease is still a major ailment in Israel, among both the genders. Again, the crude death rates for people over age 20, in general, have declined in recent years. Breast cancer is the leading cancer among women. It accounts for about 30% of all cancer morbidity and 20% of cancer mortality. Among Jewish men, the leading cancer is the prostate cancer and among Arab men lung cancer is most prevalent. Among the Arab-Israeli population, the main reasons of morbidity and mortality are heart disease, cancer, stroke and diabetes. Among Arab women aged above 45 risk factors for cardiovascular disease, such as obesity, diabetes and physical inactivity are particularly very common. Lung cancer, which is very common, is mainly due to the higher rates of smoking. Alcohol consumption is quite lower in Israel than countries in Europe. Palestinian Medical Condition: The National Health Strategic Plan 2008-2010, most recent plan of the Ministry of Health focused mainly on improving the building blocks of the health system, particularly in the areas of health service and infrastructure, human resource, and sustainable health financing. Major achievements over these years include national health insurance law drafting, Palestine Medical Complex initiation and state of the art health services for Palestinian citizens in a decentralized way. In addition, clinics have been established in many distant villages. However, Israeli restrictions place severe constraints on Palestinian National Authority to build a state in a proper way. (Palestinian National Authority, Ministry of Health). Foreign tourists have to bring their own medicines with them, in case they visit Palestine: The nation is struggling to improve the minimum facilities given to its own citizens, let alone foreigners. (Palestinian National Authority, Ministry of Health). General Health Status: The population is going through a demographic and epidemiological transition. Beneath the health indicators lays suffering. People are reported to being adversely affected by constant clashes and military subjugation, checkpoint harassment and Israeli blockade. These are contributing to the emerging chronic diseases. In the last ten years, male life expectancy stands at 70.2 years in 2008, while life female life expectancy stands at 73 years. In both West Bank and the Gaza Strip fertility rate is declining. In West Bank, the fertility rate went down to 4.2 in 2007 from 5.6 in 1997. In Gaza Strip, it went down to 5.4 in 2007 from 6.9 in 1997. In West Bank, the percentage of children (below 15) reduced to 41.3 % in 2007 from 45.1 % in 1997. In the Gaza Strip, it was 48.3 % in 2007 from 50.2 % in 1997. In Palestine Ministry of Health (MoH), United Nations Relief and Works Agency (UNRWA), NGOs and private for profit are the main providers of health services. Fifteen hospitals and 41 Primary Health Care (PHC) clinics in the Gaza Strip were damaged in the Israeli invasion. Twenty-nine ambulances were destroyed. However, MoH has been working consistently to strengthen the healthcare services. (Palestinian National Authority, Ministry of Health). Primary care: According to 2008 statistics, in total, there are 542 PHC centers in the West Bank and 130 in Gaza. In 2008, the number of MoH PHC center in the West Bank stood at 370, in Gaza it was 55. UNRWA operates 18 PHC centers in the Gaza Strip and 35 in the West Bank. The NGO sector operates 57 in the Gaza Strip and 121 in the West Bank. In total, there are 672 PHC centers in Palestine. In addition, MoH conducts a number of health programs like health education, community health, immunization and health programs at schools. (Palestinian National Authority, Ministry of Health). Hospitals and Beds According to 2008 data, the number of beds in government hospitals in the West Bank stood at 1289; in Gaza it was1584. Hospitals are run by both government and non-government sectors. There are 76 hospitals in Palestine resulting in 12.8 beds per 10,000 population. (12.2 in West Bank and 14.6 in Gaza Strip). (Palestinian National Authority, Ministry of Health). Doctors According to 2007 data, a total of 40,729 employees worked in the health care services in Palestine, including 8393 physicians and 2058 dentists. So, there were 22.3 physicians and 5.5 dentists per 10,000 population (Palestinian National Authority, Ministry of Health). Malnutrition data: Factors like violence, poverty, high levels of unemployment, politics, urbanization, the stressful subjugation of Israelis are contributing to insufficient and unhealthy diet, stressful lifestyle and lack of mental peace. These are in turn leading to rise in non communicable diseases, diabetes, cardiovascular disorders along with severe malnutrition (Palestinian National Authority, Ministry of Health). Infant mortality rate: According to the Lancet medical report of 2009, mortality rate for infants and for children below 5 years have not changed much since the 1990s. The main reasons of infant deaths are premature delivery, low birth weight, and congenital malformations. Stunting in children is on the rise. Since 2006, Palestinian living conditions have worsened and the Israeli restrictions at checkpoints have resulted in limited and access to health services. Infant mortality rate, according to MoH data of 2008, stands at 25 (Palestinian National Authority, Ministry of Health). Youth and adolescent health: Population in Palestine has two thirds of the people under the age of 24. Early marriage and early pregnancy are high. Complications among young pregnant women are also high. There is no access to proper information or counseling among young people in Palestine. There is no information given to young people about how they should take care of their physical, mental and sexual health. Nor are the health services very user-friendly for the people. Even the high levels of psychological problems caused by violence exposure are not being addressed properly, because young people are not considered to be a vulnerable group. (Palestinian National Authority, Ministry of Health). Chronic diseases: Chronic or non-communicable diseases (NCDs) are a great challenge for the health system here. One in ten people in Palestine and two thirds of those people who are older than 60 years suffer from at least one chronic disease. The major causes of deaths are heart diseases, cerebro-vascular diseases and malignant neoplasms. Breast cancer among women, is the most common cancer while among males lung cancer is the most common one (Palestinian National Authority, Ministry of Health). Communicable diseases These are largely controlled because of the successful immunization program. And some, such as polio have been eradicated. However, communicable diseases like tuberculosis, diarrhoeal diseases and acute respiratory infections, plus zoonotic diseases like brucellosis is incident even in modern times. This is mostly common where poverty level is high and there is overcrowding. (Palestinian National Authority, Ministry of Health). Community mental health Palestinians suffer from acute psychological problems. The issues due to the Israeli occupation are never ending. These include “loss of income, home and land, threats to personal safety, interruption of electricity and water, curfews, bombing and shooting”. Violence also includes constant exposure to humiliation, which affects mental health in a very negative way. Other significant factors are low level of education, poverty, gender based violence etc. There have been a number of reports about high distress, fear, insomnia etc. Incontinence, among children is quite a matter of concern. (Palestinian National Authority, Ministry of Health). Shifting of patients to other countries for treatment: Considering the ailing health care system of Palestine, many patients are sent to other places for treatment. More than 65% of the patients go outside the nation to avail treatment. Conclusion: Thus from the above analysis it may be inferred that Israel is having world class treatment facilities whereas the healthcare system in Palestine is below average. References Bruce Rosen,, Healthcare in Israel for US audiences, Myers-JDC-Brookdale Institute, Smokler Center for Health Policy Research, Jerusalem, 2011 retrieved from http://www.jhf.org/Resources/PaperPdfs/133-11-Israel-Healthcare-US-Audiences-2-REP-ENG. Hadassah Medical Center, Medical Tourism in Israel, Home , Treatment In Israel, 2013 retrieved from : http://www.hadassah-med.com/international-patients/all-about-medical-tourism.aspx Mahmoud, Adel. Health Challenges in Palestine, Science & Diplomacy, 2013, retrieved from : http://www.sciencediplomacy.org/files/health_challenges_in_palestine_science__diplomacy.pdf Palestinian National Health Strategy, 2011 – 2013, Setting Direction - Getting Results, 2013, Palestinian National Authority, Ministry of Health retrieved from http://www.moh.ps/attach/20.pdf Read More