Israel: #6 in the 2022 World Index of Healthcare Innovation
Israel has achieved universal coverage through vigorous competition among private health insurers.
By Gregg Girvan and Avik Roy
Introduction
Israel ranks 6th in the 2022 World Index of Healthcare Innovation — and 1st in Asia — with an overall score of 52.69. Israel ranked 5th in 2021, and 6th in 2020. Israel’s performance was consistent across all dimensions, with particular strength in Science and Technology (9th), owing largely to a robust scientific community supported by its world-class university system.
The country ranked 16th in Quality, a drop from recent years. Despite a strong COVID-19 vaccination program early in the pandemic, Israel’s rate has lagged compared to other countries as the pandemic has worn on. It has also struggled to prevent hospitalizations for conditions such as COPD and hypertension.
Finally, the country’s ranking on Fiscal Sustainability (12th), while respectable, is juxtaposed by its relatively strict access to new and essential treatments and a shortage of healthcare staff, particularly nurses.
Background
Health insurance in Israel predates the establishment of the Jewish state. The country’s four private health insurers — Clalit, Maccabi, Meuhedet, and Leumit — were founded in the first half of the 20th century, and modeled after Germany’s sickness funds. By the early 1990s, over 90 percent of Israeli residents had health insurance.
Beginning in 1995, based on recommendations from a commission led by Shoshana Netanyahu, Israel covered the remaining uninsured by mandating enrollment in one of the four private insurance funds. Enrollees are able to switch plans every six months, facilitating vigorous competition among insurers. Each year, the Ministry of Health publishes a standardized list of benefits that all insurers must offer, along with a baseline prescription drug formulary. Many Israelis purchase supplemental insurance to pay for services not covered by the standard benefits package.
Israel’s innovative healthcare sector is dominated by Teva, the world’s largest generic pharmaceutical manufacturer, which also sells a number of branded, innovative drugs.
Quality
Israel comes in at 16th overall for Quality. Israel had gained high praise worldwide for its speedy and highly organized COVID-19 vaccination campaign, effectively halting the pandemic — at least initially. The country was not able to keep the coronavirus out forever, though, and ended up resorting to moderately heavy lockdown measures.
Israel has greatly improved its hospital occupancy rates, which WIHI uses as a measure of infrastructure. Israel tops the rankings in transparency in their healthcare system. Israel scores highly due to its high cancer survival rates and gets moderately high scores on providing patient-centered care (12th). That said, the country faces an acute shortage of nurses that lags all but the poorest-performing health systems in the Index.
Choice
Israel ranks 15th overall for Choice, driven by its score in freedom to choose healthcare services (12th) and an unlimited choice of providers. In addition, insurance premiums are low among the nation’s four insurers. However, though Israel’s system is among the most affordable in the Index, it achieves this, in part, by restricting access to innovative medicines (25th).
Science & Technology
Israel achieves a great deal in Science & Technology (9th) relative to its size. Though Israel approves very few innovative drugs through its Institute for Standardization and Control of Pharmaceuticals, the country is still an incubator of medical advances (10th) due to a continuing surge in the number of healthcare patents. Israel also ranks high in scientific discoveries (5th), with a large amount of cited research and several Nobel laureates — on par with countries like Germany and France. As an example of how Israel’s scientific culture works well with its private healthcare system, in August 2021, researchers from Maccabi published a widely cited study tracking COVID-19 incidence in people who had recovered from a prior SARS-CoV-2 infection relative to those who had received the BioNTech/Pfizer vaccine.
Fiscal Sustainability
Israel ranks 12th — among the middle of the Index — for Fiscal Sustainability. Though Israel generally does well to limit public healthcare spending (13th), growth in public healthcare spending (20th) has picked up in recent years. However, Israel has greatly improved in national solvency (4th) compared to other countries in the Index. This is partly due to Israel’s demography, which allows it to absorb higher healthcare expenses among the elderly. And its efforts to contain growth in new debt heading into 2020, combined with an economy that contracted less than other countries due to the pandemic, has the country in a more fiscally sound position moving forward.
