Israel vs. the world at large – an international comparison

Introduction

The level of functioning of any healthcare system is contingent first and foremost upon the human resource inventory operating within it and therefore, today’s main threat to Western world healthcare is the shortage of professionals in the field, particularly physicians. But what are the criteria for determining the existence of a shortage or excess of physicians? What is, in fact, the ideal percentage that physicians should comprise?

One of the widely accepted tools employed by decision-makers for appraising the situation in Israel, is using the data of financially and technologically developed countries as a criterion for measuring the disparity between the ideal and reality. Based on this method, it has become the prevalent assumption that the percentage of physicians in Israel is high compared to the percentage in Western countries, without properly considering this system’s methodological and normative pitfalls. This chapter aims to expose the pitfalls that led to the mistaken assumption that Israel benefits from an excess of physicians compared to other Western countries, and to show, based on new data recently published by the Ministry of Health, that Israel suffers from a significant shortage of physicians relative to developed countries.¹

The problem with the methodology used in making the comparison is twofold:

• Erroneous selection of the comparison group, which includes countries that are severely lagging economically in comparison with Israel and the rest of the developed countries, or countries that do not share Israel’s set of values and laws with regard to social legislation, including universal health insurance. The inclusion of these countries significantly lowers the Western average, which serves as a point of reference for Israel’s data.
• Disparity between the organization’s definitions and Israel’s official data – the Israeli datum relates to the percentage of medical license holders under 65 which is higher than the percentage of actual practicing physicians – the datum to which the OECD country average relates.

To correct these distortions, we have made a new comparison based on the EU15 country average, and on up-to-date information published by the Ministry of Health in 2010, according to which the percentage of practicing physicians in Israel is 2.8 per 1,000 persons. According to this data, the percentage of practicing physicians in Israel is among the lowest in the Western world, contrary to the mistaken impression hitherto created.

This disheartening datum should be viewed as the starting point for any future debate regarding the state of Israel’s healthcare system, especially the state of the human resources at its disposal. If the basic presumption has thus far been that there exists an excess of doctors in Israel, the policymakers must now be prepared to reconsider the future of the healthcare system based on the assumption that there is a significant shortage of human resources in this field.

⁷ This chapter focuses on the general percentage of physicians, but we must remember that despite its paramount importance, this datum on its own cannot prove anything regarding the number of work hours at the disposal of the health-care system. To this end, it is necessary to consider additional factors such as the number of positions, the percentage of working hours, etc. Due to the great difficulty involved in quantifying and comparing this data, it is not generally reflected in international comparisons, and this matter warrants separate and close attention, which is beyond the purview of this document. It is also important to note that the comparison relates to the overall number of physicians, and does not take into account the imparity that exists between the various areas of specialty (there may be an excess of doctors in one field, and a shortage in another.)