Paull Radu, MD and Jacob Atsmon, MD
Solly Mizrahi, MD, FACS and Michael J. Bayme, MD, FACS
Philip Sax, PhD
Background: It is not clear to what extent the drug economy in Israel's health maintenance organizations is responsive to major healthcare reforms.
Objective: To provide information on how drug expenditures, revenues, net costs and drug utilization have changed in the wake of the 1995 National Health Insurance Law in Israel.
Methods: This study compares trends in aggregate sick fund expenditures, revenues (patient co-payment) and net costs (expenditures less revenues) in Israel's four health maintenance organizations for the 3 year period 1992-1994 prior to the introduction in 1995 of the NHI Law, with that of the 4 year period 1995-1998 following its introduction. This analysis is similarly carried out for Israel’s largest HMO, Clalit Health Services, and for the three smaller HMOs combined.
Results: The pace of growth in the pre-NHI era in drug expenditures and particularly in drug revenues was drastically reduced in the NHI era - whether measured as totals or as per insured person (age-adjusted) or in real terms at constant medicine prices. These trends were mirrored to a large extent in
Conclusions: The impact of the NHI Law on the HMO drug economy has been substantial. The evidence suggests a decline in both the qualitative (basket of drugs consumed) and quantitative (volume of drugs consumed) elements of growth. These changes in expenditure and revenue trends are discussed in the light of the evolving involvement of the Israel Ministry of Health in drug policy within the framework of the NHI, with emphasis on the basket of drugs reimbursed and copayments for prescriptions.
Rachel Wilf-Miron, MD, MPH , Kareen Nathan, MSc, Fabienne Sikron, MA and Vita Barell, BA
Background: Investigation of causes of death can help inform intervention policy aimed at reducing preventable mortality.
Objectives: To assess mortality causes and trends over time and identify target groups with excessive mortality rates among Israeli youth aged 10-24, in order to formulate an intervention policy for prevention of adolescent mortality.
Methods: Mortality data for Israeli residents aged 10-24 were extracted from the Central Bureau of Statistics computerized death certificate file for the period 1984-95. Trends were evaluated by cause of death and demographic characteristics.
Results: The crude mortality rate among Israeli youth aged 10-24, during 1993-1995, was 39.6 per 100000. Rates were 2.7 times higher among males, increased with age, and reached a peak among 18-21 year olds. Rates were 1.4 times higher among Arabs than among Jews. The sharp increase in mortality among Jewish males of military service age (18-21 years) was due mainly to motor vehicle crashes and suicide. Although overall mortality decreased by 9.4% from 1984-86 to 1993-95, the gap between the subgroups increased. MVCrelated mortality increased over time by 100% among Arab males. The rate of completed suicide among Jewish males increased by 110%. Although injury-related mortality is lower in Israel compared with the U.S., similar demographic differentials and trends were found in both countries.
Conclusions: Suicide among Jewish males of military service age, as well as MVC fatalities among Arab males, present a growing public health issue. Intervention strategies should therefore be targeted towards these subgroups in order to minimize the rates of preventable death.
Marwan Shinawi, MD, Riva Brik, MD and Drora Berkowitz, MD
Altoon Dweck, MD, Ayala Abrahamov, MD, Irith Hadas-Halpern, MD, Ari Zimran, MD and Devorah Elstein, PhD
Dan Bar-Zohar, MD, Yoram Kluger and Moshe Michowitz, MD, MSc,
Irit Chermesh, MD, Ofer Ben-Izhak, MD and Rami Eliakim, MD
Yehuda Shoenfeld, Dror Harats and Georg Wick
Hisham Darwish, MD, Walid Sweidan, MD, Michael Silberman, MD, Abdil Rahim Abu-Saleh, MD and Nadir Arber, MD