Israel's health system is operating at full capacity and increasingly depends on private funding, a report released Thursday by the Organization for Economic Cooperation and Development reveals. While Israel ranked relatively highly in indicators such as life expectancy and obesity, death rates from breast cancer are the sixth highest in the OECD, according to the report, which compared 2011 figures from 34 countries.
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The dependency ratio in Israel - the ratio between the number of working age people, children and the elderly - is the highest among OECD countries. In effect, the dependency ratio represents the burden carried by the working population. This statistic is explained primarily by the fact that Israel is one of the younger countries in the OECD, with the percentage of children below the age of 14 the second highest (behind Mexico) at 28 percent. The OECD average is 17.6 percent. With an average of three children per woman of childbearing age, Israel's birthrate is the highest in the OECD, compared to an average of 1.7 children.
The percentage of people in Israel above the age of 65 relative to the entire population is among the lowest in the OECD, with a rate of 10 percent compared to an average of 15.4 percent. However, the Central Bureau of Statistics estimates that the percentage of the elderly as part of the population will rise in the coming years.
"The dependency ratio is expected to continue to rise in the coming years due to the aging of the population and birthrates continuing in line with CBS forecasts, something that is expected to increase health expenditure," explains Nir Kedar of the Health Ministry's Strategic and Economic Planning Authority. "This is no doubt a warning sign that indicates the need to increase public resources for the health system in the future," he says.
The dependency ratio in Israel is 61.8, while the OECD average is 49.2.
As in the past, national expenditure on health in Israel continues to be much lower than other OECD nations, standing at 7.7 percent of GDP compared to an OECD average of 9.3 percent. In addition, the mix between private and public expenditure on health is worrying. Public expenditure as a percentage of total health expenditure in Israel is among the lowest in the OECD. In 2011, the public share of total health expenditure was 60.8 percent, compared to an average of 72.7 percent.
Israel's health system infrastructure is already overloaded, according to the report. The number of beds for general hospitalization is lower than other OECD members, with Israel third from the bottom of the list. There are 1.9 beds for every thousand residents, compared to the OECD average of 3.4 per thousand. As a result, Israeli hospitals operate a 'hot bed' system, a fact reflected by the short hospitalization length - 4.3 days in Israel, compared to an OECD average of 6.5 days. In addition, occupancy rates are the highest in the OECD – 98 percent, compared to the average rate of 77 percent.
The number of MRI scanners in Israel is significantly lower than the OECD average, with 2.5 scanners per million residents, compared to an 18.7 average in other member states. Israel's average is expected to rise to 3 scanners per million residents in the coming years, but this would still be much lower than the OECD average.
Is there a doctor in the house?
Despite the sense that Israel suffers from a shortage in doctors, the rate is actually higher than other countries, with 3.3 doctors per thousand residents, compared to the OECD average of 3.2. Still, according to Health Ministry officials, the number is expected to drop beneath the average in the coming years. Meanwhile, the number of doctors is expected to rise in other member states.
When it comes to nurses, the situation is much worse, with 4.8 nurses per 1,000 residents, compared to 8.8 in other OECD countries. These figures refer to 2010, however, and Health Ministry officials say the ministry is taking steps to train more nurses.
Despite this data, Israel is ranked quite highly in most health indicators. Life expectancy is higher than the OECD average, for example. Israeli men live 79.9 years compared to an average of 77.3, ranking fourth on the list. Israeli women, meanwhile, live only six months longer than the OECD average (83.6 compared to 83.1), ranking 13th on the list.
Another indicator in which Israel ranked highly is the number of infant deaths per 1,000 births. Israel's average is lower than other countries (3.5 compared to an average of 4), including the U.S. and Britain, but higher than Spain, Greece and the Scandinavian countries.
For the first time, the report compares data on the number of caesarean sections in OECD member states.
Despite the feeling that Israel has a high rate of caesarean sections, the report reveals that the average is actually one of the lowest in the OECD - only 198 caesarean sections per 1,000 births, compared to the OECD average of 254. In the decade between 1999 and 2009, the number of caesarean sections in Israel grew by 80 percent, a trend visible in other OECD states as well.
The report further reveals that despite ranking highly as to mammography examinations for early detection of breast cancer (73 percent of women between 50 and 69 have been examined in Israel, compared to the OECD average of 56 percent) the death rate among breast cancer sufferers is among the highest in the OECD. There are 31.2 deaths a year per 1,000 women, compared to an average of 26 deaths per 1,000. Israel has the sixth highest death rate per 1,000 women in the OECD.
In contrast, death rates from prostate cancer are among the lowest: 17.2 deaths per 100,000 men, compared to the OECD average of 33.4 deaths. The Health Ministry's director general, Dr. Ronny Gamzo said that the ministry intends to thoroughly study the reason for these gaps.