On May 14, 1948, the State of Israel was established. Government ministries were organized; a Ministry of Health replaced the Mandatory Department of Health; and regional health bureaus and an epidemiological service were formed. The state extended its responsibility for health services, by taking over existing hospital facilities inherited from the Mandatory authorities; by building and operating hospitals; and by establishing mother-and-child health care services. At the same time, an IDF Medical Corps was formed to serve the Israel Defense Forces. Kupat Holim Clalit also enlarged its hospitals and expanded its network of clinics, in the wake of an October 1948 government decision to share in the cost of hospital beds, which increased Kupat Holim Clalit's budget by 20%.
At the end of 1948, only 53% of the Jewish population were insured, with the majority - some 80% - insured by Kupat Holim Clalit, the remainder by several smaller sick funds. During the following two years, the population of the state of Israel doubled to 1.2 million people due to the mass immigration of Holocaust survivors from Europe and Jewish refugees from Arab countries. Within a decade, the population reached 2.1 million. The percentage of those insured increased dramatically during those years, to an estimated 90%. Both the Ministry of Health and Kupat Holim Clalit expanded their medical facilities to cope with the increasing demand for health services.
In 1953 all military hospital facilities were transferred to the Ministry of Health to enhance financial and management efficiency, and the ministry become the major provider of hospitalization services. Kupat Holim Clalit also took steps to expand its services - building more hospitals and community clinics. Smaller sick funds tried to follow Kupat Holim Clalit's example and compete, by opening more clinics. In order to finance their growth, the sick funds demanded an increase in government financing.
The Health Care System
Israel has today a population of nearly six million people - 81% Jews and 19% non-Jews, mostly Arabs. The majority of the population is urban and Israel is rated among middle-income countries. Some 8.7% of Israel's GNP is allocated to health (1995), similar to levels among Western European countries. Average life expectancy is relatively high: 79.5 years for females and 75.5 years for males.
Forty-seven general hospitals presently operate in the country, with a total of some 13,000 general beds. Forty-five percent of the beds in general hospitals are in hospitals operated by the government and municipal government; 30% are in hospitals run by Kupat Holim Clalit; 6% in two hospitals belonging to the Hadassah Medical Organization; and the rest (19%) are in hospitals run by non-profit organizations and religious organizations (such as the Christian churches in Nazareth). The health system also includes some 14,000 beds for chronic care patients (including geriatrics) and some 7000 for psychiatric patients. The ratio of all hospital beds to population is 5.95 per thousand.
The health system has over 2000 community-oriented primary care clinics throughout the country, operated by the sick funds, the Ministry of Health or the 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 1000 persons is 4.6, one of the highest levels in the world. One of the factors contributing to the high number of physicians is the recent mass immigration from the Soviet Union.
The Ministry of Health operates a successful community health service: a nation-wide public network of 850 mother-and-child-care centers, which offers low-cost easily-accessible services. About 460 centers are run directly by the Ministry of Health; others are operated by municipalities or the sick funds, with the financial support of the Ministry of Health. The services provided include health education programs, regular checkups to monitor child development and a comprehensive immunization program (newborn to 5 years). Ninety-five percent of all babies and children are immunized - a proportion higher than that in western Europe. The inoculation system has changed over the years, with the changing incidence of diseases; some diseases, such as diphtheria and polio, have completely disappeared. The nation's comprehensive immunization program is a major factor contributing to the low infant mortality rate - approximately 6.3 per 1000 live births.
Israel has four medical schools, each affiliated with a major university. They are the Hebrew University Medical School associated with the Hadassah Medical Organization; the Tel Aviv University Medical School; the Technion Medical School in Haifa and the Ben-Gurion University Medical School in Be'er Sheva. The Ben-Gurion Medical School, affiliated with Kupat Holim Clalit, runs a special program in community-oriented medical education with an emphasis on specialization for family physicians. In addition to medical schools, there are two schools of dentistry, one of pharmacology and some 20 nursing schools, four of which also grant academic degrees, in the country. Courses for physiotherapists, occupational therapists and nutritionists, as well as for x-ray and laboratory technicians, are available at a number of institutions.