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Israel’s Health Care System: Long Wait for Elective Surgery

May 18, 1988
See Original Daily Bulletin From This Date

An Israeli injured in a traffic or work accident, or who falls out of a window, has a heart attack or needs surgery for cancer, is assured of rapid and first-rate treatment in an Israeli government or Kupat Holim Histadrut sick-fund hospital.

But woe be the Israeli who needs “elective” surgery for a cataract or prostate or hernia operation. The State Comptroller’s Report on the health services published last week discloses that as of last November, 37, 131 people had been waiting for up to three years for elective surgery at government hospitals.

Kupat Holim patients, waiting to see a doctor at one of the hundreds of sick-fund clinics for even the most minor ailment, must spend most of the day sitting in a chair in the corridor, awaiting his or her turn for the minute or so of consultation talk or examination by a doctor.

Reducing the long wait for elective surgery was the ostensible reason for recent strikes and work sanctions by the Histadrut and government hospital doctors — though many patients charge that this was only an excuse for demanding higher incomes.

The doctors have long been complaining that using the operating facilities only in the morning hours was a waste of expensive equipment. They said that using those same facilities in the afternoons and evenings, on a two-or even three-shift basis, would considerably reduce the lengthy wait for surgery.

Anesthetists have also been demanding the training and employment of more of their colleagues, to be able to provide adequate care for all surgery patients.

The comptroller’s report noted that in addition to the over 37,000 patients awaiting elective surgery, another 10,000 had not even been given an advance date, because the anticipated time was too far in the future.


This situation has given rise to a “gray market” in surgery, under the officially-approved “sharap” (private medical service) system. Patients needing operations on cataracts, hernias, artificial hip joints or requiring other types of elective surgery are informed that the treatment can be carried out within a month or so, for payment of some $2,000 on a “private” basis.

Israel has no government health service, though the Likud-led governments would like to introduce one.

The country’s public health and hospital service is based on the pre-state Histadrut labor federations’s Kupat Holim (sick fund) program. It was adopted as an official system by the pre-state Vaad Leumi and the Jewish Agency, which served as an operational parliament of the Yishuv (Jewish community of Palestine) prior to 1948.

As most national leaders were then automatically members of the Histadrut at that time, they accepted the Kupat Holim as the natural and only way to operate a health service.

Revisionists who could not accept the socialist theory behind the Histadrut’s plan established their own small “national sick fund,” which still exists but has never been an important factor.

The general Zionists and non-socialist liberals also established their own “Maccabi” sick fund and Maccabi Sports Club, in competition with the Histadrut’s Hapoel Workers Sports Club.


Maccabi still exists as an important and popular sick fund and is, indeed, the second largest health fund in the country. Many Histadrut members prefer it to their own “general Kupat Holim,” which they must join to be members of the trades union federation.

Maccabi operates through a system of “family doctors” employed by Maccabi and operating out of their own clinics, backed up by a wide system of specialist clinics — a system the general fund has sought to emulate by adding “family doctors” to its clinic doctors.

Like the Maccabi Sick Fund, which today has no connection with any political party, the Maccabi Sports Club has also dropped its party affiliation. Fans of Maccabi Tel Aviv basketball team, the current and for many years the national basketball champion, almost certainly do not know of its original political affiliation.

Likud attempts to introduce a national health service have always been fiercely fought by Labor, which sees the attempt as a way of breaking the power of the Histadrut trades union federation. Many members join the Histadrut for its Kupat Holim benefits. To offer an alternate government health system would almost certainly mean the desertion of many Histadrut members.

Despite the drawbacks of the present public health and hospitalization services, which are beset by frequent strikes, work sanctions and treatment delays, Israel can be proud of its record of one physician for every 340 members of the public. That is one of the highest ratios in the world, and there is a 16 percent increase in new physicians a year, higher than the population growth.

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