Medical manpower in Israel: Political processes and constraints

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‘Health manpower development, an interconnected set of activities dealing with planning, production, utilization and support of manpower, transcends all other issues in health development. It is a critical factor for the economic efficiency of the health care system, and an important response mechanism for attaining the goal of health for all through primary health care’ [45]. However, a realistic appraisal indicates that the political reality in most countries has made effective planning in this area rare because of competing interest groups seeking resources and power [31,34]. The Israel case study demonstrates the role of these pressures in determining the training, allocation, utilization and planning of health manpower in a health care system characterized by on-going processes of political compromise among a variety of groups. Perhaps the most distinguishing social facts about Israel are its small size and the heterogeneity of its population. Since its formal establishment in 1948, there has been a constant stream of immigration from a wide variety of countries which has resulted in a mixed ethnic population which is among the most differentiated in the world. In 1985, 40% of the Jewish population was born in other countries, and among the Israel born, only 18.5% are second-generation Israelis. About 18% of the population is not Jewish: 77% of these are Moslems, and the remainder are Christians, Druze and members of other small religious groups. While Israel does not have a nationalized health care system, 94.5% of its population is covered by comprehensive health insurance which includes curative and preventive ambulatory care as well as hospitalization. Regional hospitals are located within no more than 30 kilometers of most communities; primary, curative and preventive services are easily accessible on a neighborhood basis. A strong egalitarian welfare ideology has traditionally provided support for a broad network of health care institutions giving extensive curative and preventive services to the population. Indeed, sensitivity to health needs is widespread in all segments of the population of Israel.