Israel

Original Editor - Didzis Rozenbergs

Top Contributors - Didzis Rozenbergs, Admin, Fasuba Ayobami, 127.0.0.1, Elaine Lonnemann and WikiSysop   

Patient Access to Physiotherapy or Physical Therapy Services / Entry Point

• How do members of this country access Physical Therapy services?
• What is the entry point or typical path the patient must follow in order to receive services?
• Do PT's have direct access or are they part of a primary care team?
  

The physiotherapy services in Israel are determined by the profession. The physiotherapist determines the clinical intervention of physiotherapy him/herself. Israel offers both public and private physiotherapy services. The insurance cover for physiotherapy is paid mainly through the national health care system, and additional private services are paid privately the patient.

http://www.physio-europe.org/pdf/israel.pdf

Physical Therapists are permitted to:

• Act as first contact/autonomous practitioners
• Assess patients/clients
• Make a diagnosis
• Treat (interventions, advice and evaluation of outcome)
• Refer to other specialists/services
• Offer preventative advice/services

http://wcpt.org/node/24716/cds

Therapist Preparation

      Degree/Credentialing

• What is the education process to become a Physiotherapist or Physical Therapist in this country?

A person who wishes to receive a physiotherapist certificate in Israel must hold a bachelor’s degree (at least) in physiotherapy, and successfully complete the government examination in this profession. In addition, the following minimal conditions must be fulfilled:

• Age at least 18.
• Citizen or resident of Israel.
• Has no dangerous disease.
• Not have been found guilty, in Israel or overseas, of a criminal offense or disciplinary offense that, due to its nature, seriousness or circumstances, renders him unfit to receive a certificate in a health care profession, and not have had a charge or complaint of such an offense laid against him, in respect of which a final verdict has not yet been given.

http://www.health.gov.il/English/Services/MedicalAndHealthProfessions/Physiotherapy/Pages/OccupationLicenseApplication.aspx

Physiotherapists in Israel are professionally educated at the university level and since 2008 are required to be licensed to practice. Upon a completion of the requirements for a bachelor of physiotherapy (BPT) in an accredited school in Israel, the graduate can apply to many of the advanced academic programs related to health studies offered both in Israel and abroad.

http://www.ariel.ac.il/physiotherapy/en

Recognized institutions in Israel for teaching Physiotherapy:

• ​School of Health Professions, Tel Aviv University
• Faculty of Social Welfare and Health Sciences, University of Haifa
• School of Health Sciences, Ariel University Center
• Faculty of Health Sciences, Ben Gurion University, Be'er Sheva
• Zefat Academic College

http://www.health.gov.il/English/Services/MedicalAndHealthProfessions/Physiotherapy/Pages/LearningCenters.aspx

      Specialization

• Do clinicians specialise in certain areas of care and if so how?

Recognised special interest groups:

• Aquatics
• Cardiorespiratory physical therapy
• Educators in physical therapy
• Electrophysical agents
• Health promotion (includes non-communicable/chronic disease management, physical activity)
• Information management and technology
• Intellectual disability
• Management/administration (includes leadership, medico-legal, professional standards and best practice)
• Mental health
• Neurology
• Orthopaedics/manual therapy
• Occupational health and ergonomics
• Older people
• Oncology/palliative care
• Pain (includes pain management, pain research)
• Paediatrics
• Policy
• Private practitioners
• Sports physical therapy
• Womens health

http://wcpt.org/node/24716/cds

Professional Associations

• What are the professional associations associated with Physiotherapy or Physial Therapy in this country?

The Israeli physiotherapy association has one staff employee (plus secretaries) but no managing director employed. The association holds regular executive meetings (meeting period not specified) and furthers liaisons with other health care professions and authorities. The Israeli physiotherapy association is member of a trade union.

http://www.physio-europe.org/pdf/israel.pdf

Information about the Patient Community

• What is the population these PT’s serve?
• What are the major causes of morbidity and mortality in the population served?

Social/Cultural Influences

• What is the influence of the family on a patient's health status?
• What are the typical patient's living conditions, family dynamics, and cultural back ground?

Delivery of Care

• Is delivery of care provided in a timely manner?
• Special methods? Home health etc
  

Rehabilitation is included in the NHI benefits package and responsibility for its provision therefore lies with the health plans. All rehabilitation services, whether provided in the hospital or in the community, incur a co-payment. The co-payment for inpatient services is approximately NIS 100 (€20) per day at the time of writing, and for community clinics it is approximately NIS 30 (€6) for each quarter. Outpatient services include clinics for child development and rehabilitation, and clinics for general rehabilitation. Ambulatory rehabilitation services are provided in special community facilities of the health plans.
At the end of 2006 there were 987 rehabilitation beds in Israel. Of these, 37% were in two rehabilitation centres, 35% in ten rehabilitation wards in general hospitals, 28% in six geriatric rehabilitation centres, and 25% for individuals who were comatose for an extended period of time.Approximately one-third (31%) of the beds were for neurological rehabilitation, 18% for general rehabilitation, 25% for people comatose for an extended period, 13% for children and 13% for orthopaedic rehabilitation.
Approximately one-third of these beds were owned by the Government and one-third by two health plans, while a few of the beds were either publicly or privately owned. Most of the beds are concentrated in the central region of the country, whereas the rate of general rehabilitation beds is low in the southern and northern regions.
The four health plans operate rehabilitation clinics within the community, offering physical, occupational and speech therapy. In order to receive care at one of these clinics, a patient must obtain a referral from a family physician or specialist, and this incurs a co-payment. The clinics provide neurological and orthopaedic rehabilitation services, as well as child development services. Most of the clinics contain the latest equipment and are operated by licensed professionals who remain abreast of the changes within their fi eld. To a limited extent, the health plans also provide rehabilitation services in the home, through the medical home care units.

Critical issues facing rehabilitation
One critical issue is the constant shortage and the high turnover of skilled human resources. As in other parts of the world, this stems from the fact that the majority of these rehabilitation professionals are women: some work only part time, some leave after having children and some leave the profession altogether.
The relatively low salary of these skilled professionals is another incentive for leaving the field and/or the public sector. Moreover, the high wages paid to rehabilitation professionals in the private sector, where compensation is awarded on a fee-for-service basis, also provide an incentive to leave public sector jobs.
Due to the shortage of human resources, poor physical conditions and other factors, most of the community rehabilitation centres have waiting times of months for treatment. Consequently, rehabilitation centres often have two parallel queues: one for acute cases, consisting primarily of younger people after a road or work accident and traumatic-orthopaedic cases, and the other for chronic patients, consisting primarily of older adults who suffer from back pain or neurological diseases such as a stroke or Parkinson’s disease. However, due to the constant pressure on rehabilitation centres, treatment of patients in the latter group is postponed for months or even longer.

http://www.euro.who.int/__data/assets/pdf_file/0007/85435/E92608.pdf

Type of Health System

• Is it a national health system with universal access?
  

The defining characteristic of the health system in Israel is its governance by the National Health Insurance Law (1995).
This law ensures health coverage to every resident of Israel and defines the government's responsibility to provide health services to every person without discrimination. In other words, health insurance
is mandatory, and all residents of Israel must be insured. Every citizen or permanent resident of Israel is free to choose from among four competing, non-profit-making health plans. The health plans must
provide their members with access to a benefits package that is specified in the NHI Law. The system is financed primarily via progressive taxation, and the Government distributes the NHI funds among the health plans according to a capitation formula that takes into account the number of members in each plan and their age mix.

In addition to its planning and policy-making roles, the Ministry of Health also owns and operates about half of the nation’s acute care hospital beds. The largest health plan operates another third of the beds, and the remainder are operated through a mix of non-profit-making and profit-making organizations.

http://www.euro.who.int/__data/assets/pdf_file/0007/85435/E92608.pdf

The National Health Insurance Law

The following are the basic provisions of the National Health Insurance Law:

• Every resident of the State of Israel is entitled to health insurance. Coverage is mandatory, and every resident must be covered.
• The provisions of the Basket of Services (sal sherutei briut) are identical for each individual.
• Health services are provided through the health funds (kupot holim).
• Every resident of Israel must be a member of one of the healthfunds in order to receive health services.
• Every person is entitled to join the health fund of their choice. The funds are forbidden to reject any applicant.
• Any person is entitled to transfer from one health fund to another.
• Services included in the Basket of Services are provided according to the judgment of medical professionals. Care must be provided at a reasonable level of quality, within a reasonable period of time, and within a reasonable distance from the patient’s place of residence.
• The government of Israel is responsible for coverage of the costs of the Basket of Services, which is fixed by law.
• The National Insurance Institute manages collection of health insurance premiums. The rate of payment is fixed according to a progressive scale.
• The Law forbids places of employment to require their employees to belong to any specific health fund.
• The health funds are subject to ongoing governmental supervision and inspections.
• Health services are administered according to guidelines of respect for the patient and the patient’s right to privacy and medical confidentiality.
• Any person who feels that their rights have been violated may file a complaint. The health funds are forbidden to deny this right to any of its members.

The exceptions to this law include the following:

• Soldiers conscripted to obligatory service in the Israel Defense Forces receive medical care through the Army.
• Disabled IDF veterans receive medical care through the Ministry of Defense.
• Persons in jured inwork accidents, hospitalization of woman giving birth and their newborns, and persons injured during enemy actions receive coverage through the National Insurance Institute.
• Disabled World War II veterans and victims of the Nazis may be eligible for coverage from the Ministry of Finance.

The Basket of Health Services

The Basket of Health Services (sal sherutei briut) consists of a range of essential medical services, including treatments, medications, and equipment which each health fund is obligated to provide to its
members. Its contents are defined by law, but are subject to periodic revision. Therefore, residents may find that a treatment or medication that was covered at one point has been discontinued, or that new items have been added.
It is important to note that only those services included in the basket are provided free of charge or at a reduced cost. This means that residents may have to cover at least some of the cost of certain prescriptions and treatments, or fully finance items that are not included in the basket. Residents can also choose to acquire supplementary coverage from your health fund.  
Obligatory services provided by the health funds include:

• Visitstoclinicsforconsultation,diagnosis,andtreatment(including consultations and treatments from family doctors, specialists, and para-medical professionals).
• Prescriptions
• Hospitalization and emergency room services.
• Laboratory services. Each health fund has its own laboratories. If the health fund laboratory does not handle a specific procedure, the patient is referred to an outside facility, and the fund covers the costs either partially or fully.
• Certain medical equipment
• Certain diagnostic procedures, including x-rays and scans.
• Rehabilitation

Also provided in the basket are certain types of paramedical services such as physiotherapy, speech therapy, and occupational therapy

The Health Funds

There are four health funds: Kupat Holim Clalit, Kupat Holim Maccabi, Kupat Holim Meuhedet and Kupat Holim Leumit. Each fund has branches throughout the country.
As stated above, The law requires each health fund to provide its members with all of the services that it mandates. The differences between the funds lie mainly in the location and availability of their
facilities, the types of supplemental policies offered, and additional services offered within the framework of their facilities at a discount or with no charge.
In general, each fund allows its members to choose a primary-care physician and specialists from the list of doctors associated with the fund. Doctors accept patients either at the fund’s own clinics or in
their own independent offices. It is necessary to have your health fund membership card or booklet with you when visiting a doctor. In most cases, you will have to pay a fee for seeing a specialist.
In addition, each fund has arrangements for the hospitalization of its members, whether in government or private hospitals. The funds also offer laboratory services, x-rays, and pharmacies, as well as
paramedical services such as physiotherapy.

http://www.moia.gov.il/Publications/health_en.pdf

http://www.insurance-in-israel.co.il/questions-health-insurance-israel.html#Q1

Payment System

• What methods to patient use to pay for service? (Insurance, bartering etc.)

There is universal coverage via an NHI (National health insurance) system. NHI provides access to a broad benefits package including physician services, hospitalizations, medications and so on; long-term care services and psychiatric services are not included at the time of writing. The NHI system is financed primarily from public sources – a mixed system of payroll tax and general tax revenue. These public funds are distributed among the health plans according to a capitation formula, which primarily reflects the number of members in each plan and their age mix. Cost sharing for pharmaceuticals, physician visits and certain diagnostic tests also plays a role in financing the NHI system.
Services outside the NHI system are financed via VHI (Voluntary health insurance), and direct out-ofpocket payments for private sector services. In recent years, the share of public financing has declined, while the share of private financing has increased.

There are two forms of VHI available in Israel: supplementary VHI offered by the health plans and commercial VHI. In essence, the situation is characterized by competition between private insurers and public–private hybrids.

http://www.euro.who.int/__data/assets/pdf_file/0007/85435/E92608.pdf

The overall NHI system is financed primarily by income-linked taxation. However, approximately 40% of Israel's national health expenditures are covered by households, through a mix of out-of pocket payments and supplemental insurance packages. Payments by households cover copayments for certain services included in the NHI benefits package (such as visits to specialists and pharmaceuticals) as well as services not included in that package (such as dental and optometric care).

http://www.jhf.org/Resources/PaperPdfs/133-11-Israel-Healthcare-US-Audiences-2-REP-ENG.pdf