How does healthcare compare? People with both Israeli and American healthcare experience see stark differences | Wisconsin Jewish Chronicle

How does healthcare compare? People with both Israeli and American healthcare experience see stark differences 


Milwaukeean Ophir Ben-Yitschak has a small, but unique place in the history of socialized medicine in Israel. In 1993, when he was a student at the University of Haifa, he attended a public administration class where an official from one of the nation’s HMOs paid a visit and gave the students the challenging task of finding ways for it to be competitive with several other newly formed networks. 

“They were bleeding clients left and right, by the tens of thousands of people,” said the 55-year-old, who owns a local travel company. “The word was out that the other HMOs gave better service.” 

It was at a time of great change for health care in Israel. For years, the national health care system in Israel had only one HMO, a monopoly of sorts. The lack of competition created apathetic clinics and hospitals that were decorated with hard benches and cold ceramic floors. In 1993, Israel created several additional HMOs that jockeyed for a competitive edge as they found new cost-efficient ways to practice medicine and practice medical care.  

The HMO official who came to Ben-Yitschak’s class wanted to know how to attract and keep young adults, a prime demographic the HMO hoped to target due to their earning potential.  

“They divided us into different clinics, or hospitals,” he said. “I went to one of the clinics and sat there for three weeks, like two or three hours per day and looked at everything going on.” 

After three weeks, Ben-Yitschak came back with a list of suggestions to the HMO. 

“Amazingly, within a year or two, they started to implement some of them, which I think was probably my biggest contribution to Israeli society,” he said chuckling. 

Ben-Yitschak suggested the HMO move pediatrician hours to the afternoon and evening, making them available for working families who have children in school. He also recommended they place televisions and play areas in waiting rooms, make the seats more comfortable and provide water to those waiting. 

“I was bringing my ideas from the United States, which I remembered,” said Ben-Yitschak, who was born and raised in Israel before he came to the Milwaukee area, where he went to high school before returning to Israel. 

Ben-Yitschak’s experience shines light on the vast difference between the health care systems in the United States and Israel. The U.S. health system is built on a complex market of insurers, providers and consumers in which the government plays a major role in funding Medicare and Medicaid, programs for the poor and elderly. On the other hand, all Israelis, regardless of their income or age, are provided health care through a tax-funded system. Israelis can also now choose from a handful of HMOs rather than just one. 

“The HMOs in Israel are constantly looking at ways that they can reduce costs,” Ben-Yitschak said, noting some offer holistic medical options along with cooking and yoga classes. “One of the ways is showing people how to live a healthier lifestyle and all of this came about because of competition.” 

Even with several HMOs, the system in Israel remains centralized, especially compared to health care in the United States. Just look at how patient information is kept in each nation. In the United States, data is kept by each provider, network and insurance company across fragmented and disjointed systems. In Israel, there is just one centralized database that contains the patient’s records and referrals, which can be accessed by any provider across the nation. 

“There’s a centralized network, and there’s data and there’s manpower, which is national, and not just little piecemeal islands,” said Jeff Green, an emergency Physician at Assuta Ashdod, who splits his time between the Israeli hospital and the Milwaukee VA Medical Center. 

“This data infrastructure makes working as a doctor smoother and more efficient,” he added.  

Israel also has a national ambulance service, the Magen David Adom. The service is staffed by more than 26,000 volunteers, including 14,000 teenagers between the ages of 15 and 18. According to Green, it quickly deployed to the front lines when the pandemic struck, which by many measures exposed fractures and frailties of America’s health care system.   

“They took care of testing. They went out and tested people in their homes. Instead of having people come to the ER, when they were feeling a little sick, and then spreading COVID and breaking the lockdown and exposing workers and other patients, they would stay home, and the ambulance crew would come in and test them,” Green said. 

Originally from New York, Batsheva Tzadok now works as an emergency room doctor at the Poriya Baruch Padeh Medical Center in Israel. When a patient comes to an emergency room in her country, no one asks them for their insurance and there is no discussion about cost of care. 

“Maybe some of the tradeoff is, because it’s not privatized, it’s a lot more no frills. Family members have to stay with you at night. It feels more primitive, but you definitely get more care. Everyone’s covered,” she said. 

Access to medical care is the same for everyone, regardless of economic status or race in Israel. The lack of dichotomy resulted in fewer deaths during the pandemic, Tzadok said. 

“If someone needs to have to be ventilated, they’ll get it. You don’t have to send anyone home that shouldn’t be sent home.  I think that as a country, we came together pretty well” Tzadok said. “We are very organized when it comes to disasters and wars and stuff. With COVID, I feel we were very organized.” 

Cultural differences also persist. Green said Israeli personalities are different and the “culture and vibe in Israel is very much in your face and direct” while Americans tend to be more formal and orderly. 

One just needs to look at the physicians’ area, where medical staff work and discuss treatments, in Israeli hospitals to understand the difference. Tzadok said frosted glass partition is placed around the counters so patients and their family members would not hover over busy doctors and nurses. 

“Families are constantly coming up to you” in Israel, said Tzadok, who visited emergency rooms in Milwaukee and in the region a couple of years ago. “You can get people yelling at you. It’s very common. There’s a certain lack of formality.” 

Another cultural difference appears in medical school. Medical school in Israel is communal with a sense of camaraderie among students, compared to medical school in the United States, where it is every man for himself, Green said. 

“I think that’s just the sort of socialized society compared to this sort of capitalistic, entrepreneurial privatized society of the states,” he said. 

Where doctors sit in society is also different in Israel compared to the United States. Because it is a public system, physicians are viewed as public sector workers. The pay is not as good and the job is not as prestigious in Israel, Tzadok said. 

The doctor-patient relationship also plays out differently in both countries. While Israeli medicine tends to be more hung on old European traditions of medical care, that results in a paternalistic, almost patronizing relationship doctors have with their patients, Green said. 

However, in the last five to 10 years, the health field in the U.S. has embraced shared decision making, a concept in which the doctor does not tell the patient what they need but rather, asks the patient what they want in terms of tests and treatment plans, he noted. 

“I think this sort of shared decision making and more of a human touch in medicine is starting to infiltrate the Israeli medical system,” Green said. 

Another stark difference is the use of point-of-care ultrasound. In Israel, ultrasound is becoming a favorite tool of practitioners, but less so in the United States. It is not unusual for a doctor to keep one in their examination room, plugged in and ready to go as he or she sees patients throughout their day, Green said. 

But older doctors in Israel tend to resist new technologies and there is not demand for them to stay up to date with the latest in medicine, Tzadok said. 

“You can have a doctor that hasn’t opened the book for 30 years and he’s treating you,” she said, noting that there is no relicensing exam in Israel. “In the States, you have supply and demand, you have this marketing, and because we don’t have it, we also don’t have standards, which is a problem.”