Kupat Holim Research Articles

A simulation of a multi-item drug inventory system

A simulation model can be used for determining inventory order ing policy in a regional drug warehouse of Kupat—Holim — the largest provider of health services in Israel. This is a multi-item system with stochastic demand and lead time, periodical order ing, fixed ordering costs, and shortage and holding costs vary ing from drug to drug. Current ordering policy takes place monthly according to the subjective judgment of the regional chief pharmacist; this can lead to a high frequency of shortages. Two important points - to minimize the total costs and to decrease the probablities of shortages - were studied by this model. Two policies were considered: <QT> where at each period T, a fixed quantity Qi of drug i is ordered; and <r,R,T> where at each period T the inventory level of each drug i, is reviewed if it is under r i an order is placed up to the level Ri. It was found that the <r,R,T> policy is preferred, the total cost is reduced significantly, and the probabilities of shortage for most drugs dropped to zero.

Estimated prevalence of glaucomatous blindness in the Negev region of Israel.

An estimate of the prevalence of glaucomatous blindness in the Negev region of Israel was obtained by pooling two sources of available data: a state-run regional registry of blind people and the records of the glaucoma clinic of the Soroka Medical Centre, Beer Sheva. The denominator was the total population insured with the Kupat Holim (Sick Fund) of the Histadrut (General Federation of Labour). Glaucoma was the cause of blindness in only 10% of registered cases. Ninety-five individuals fulfilling the blindness criteria (3/60 or less, or a reduction of the visual field to 20 degrees or less in the better eye) were identified from both sources: this represents a total population prevalence of 39 per 100 000 population and 153 per 100 000 for those aged 41 and over. Glaucomatous blindness was more frequent in males than females, but the risk appeared to increase exponentially with age in both sexes. These data provide a previously lacking quantitative estimate of the prevalence of glaucomatous blindness in the Negev region.

Workload involved in routine breast examination and instruction in breast self-examination in the primary care clinic.

This study evaluates the impact of breast examinations and instruction in breast self-examination as a routine for women aged 30 years and over on the workload in a primary care clinic of the Workers' Sick Fund (Kupat Holim) in Israel. It covers a three-year period from 1977 to 1980. Clinic sessions of four hours duration with an average of 21 patients each were held five times a week. Women who were considered high risk for breast cancer were to be examined twice a year, low risk women once a year. A first breast examination with instruction required on average 10 minutes, a subsequent examination seven minutes. A total of 696 breast examinations were performed, averaging 1.2 breast examinations per clinic session. This resulted in a maximum extra workload of 12 minutes per clinic session of four hours.

Do malignant lymphocytes mimic erythroid and/or monocytoid (macrophatic) dynamic behavior? : E. Nir, A. Berrebi∗, B. Prezentey∗∗, Y. Shimron and P. Resnitzky Laboratory for Blood Morphology and Cytology, ∗Hematology Unit, Kaplan Hospital, Rehovot; ∗∗District Laboratory, Health Insurance Institution, Kupat Holim, Rehovot 76100, Israel

Do malignant lymphocytes mimic erythroid and/or monocytoid (macrophatic) dynamic behavior? : E. Nir, A. Berrebi∗, B. Prezentey∗∗, Y. Shimron and P. Resnitzky Laboratory for Blood Morphology and Cytology, ∗Hematology Unit, Kaplan Hospital, Rehovot; ∗∗District Laboratory, Health Insurance Institution, Kupat Holim, Rehovot 76100, Israel

The integration of health education services into a comprehensive health insurance organization

The development of health-education services in Israel's Kupat Holim Health Insurance Institution is recounted. It was recognized at the outset, in 1964, that the primary target for attitude and behavioral change should be the system itself and its professional staff. Today health education has achieved formal integration into the services and is recognized as an organic part of the delivery of health care.

Development of maternal and child health services in the minority communities of Israel.

TO get to the maternal and child health station in Mahamadia, a Moslem Arab village, you alight from the bus at the foot of Mount Tabor, slide down a hill, and find yourself in a courtyard with children and sheep. Bahija, the practical nurse, greets you and laughs as she tells of the Jewish paediatrician who, because of religious tenets forbidding touching a strange woman, refused to take her helping hand and proceeded to fall all the way. From the entrance shed you are led to two rooms with light coming from the open doors. The rooms are clean with stone floors that are easily washed and with the standard blue and white furniture seen in every Ministry of Health or Kupat Holim (General Sick Fund of the Federation of Labor) station in Israel.

Truth: A Concept in Emergence

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsE. H. RosenbergE. H. Rosenberg, Ph.D., head of the Department of Behavioral Sciences at the Tel Aviv University Medical School; coordinator of the Institute of Psychotherapy attached to the Tel Aviv University, and senior clinical psychologist in Kupat Holim (The Labour Sick Fund in Israel).G. MediniG. Medini, Ph.D., coordinator of clinical psychology in the Department of Psychology, Tel Aviv University; member of the Advisory Board of the Institute of Psychotherapy, and senior clinical psychologist in Kupat Holim.

National health planning and the “medical model”: The case of Israel

In 1968–1969 a special committee elected by the Israel Medical Association prepared and submitted a report on the organization of health services in Israel. The committee recommended a broader definition of health and a comprehensive health-care approach for its implementation. In spite of the expectations of its compilers the report proved to be ineffective policy-wise and did not create even a forum of discussion. The report sufferes from some fundamental inconsistencies. The committee chose a comprehensive concept of health but abstained from examining the relationship between health, health services and socio-economic development. Isolating the health delivery system from the major system—the Israeli society—and proposing the solution to the crisis in the Israeli health system without specific discussion of the latter, the report inevitably created the impression that what was wrong in the health-care system was wrong within the health-care system itself, and not a reflection of the social milieu in which the health services function. By trying to be objective and strictly professional the committee adopted a neutral “medical model”; the result was that instead of generating change, the status quo was secured. The recommendations of the committee, if accepted, would have affected first of all the network of primary health care which has always been the domain of the Sick Fund (Kupat Holim) of the Labor Federation (Histadrut), dominated by the Labor Party. Introducing comprehensive health care would have meant replacing the solo Kupat Holim physician with a health team, giving to welfare and other agencies, represented in the team, a share in rights and duties. For such partition of power Kupat Holim was not ready. Reflecting the actual location of power, the medical profession lost its battle for redefinition of health and health services. The Mann Committee recommendations exemplify an attempt at innovation. The manner in which its conclusions were formulated and later “shelved” illustrates the way that many such attempts, not only in the health field, were dealt with. The case of the committee report indicates that significant changes in the health field cannot be expected without radical changes in Israeli society itself.

The management of health care organizations--medical vs. administrative orientation: the case of Kupat Holim.

The management of health care organizations--medical vs. administrative orientation: the case of Kupat Holim.

Intensive psychotherapy for acute psychiatric patients in a day hospital setting in Israel. Theoretical considerations.

The psychiatric services in the field of community psychiatry in Israel have developed in a number of directions over the past decade. Following the establishment by the Workers' Sick Fund (Kupat Holim) of a Rehabilitation Unit for chronic psychiatric patients (Wijsenbeek and Lindner (53)) and the opening of a Day Hospital for acute cases in conjunction with a psychiatric hospital (Ramot and Jaffe (45)), a Day Hospital was established in October 1968, at the Out-Patient Mental Health Clinic (Ramat Chen), to serve acute psychiatric patients. This represented the first attempt of its kind in Israel. The professional literature on Day Hospitals, which in the main describes a ‘half-way out’ type of hospital (Farndale (16); Epps and Hanes (14); Kramer (32)), also reports the existence of a ‘half-way in’ type of institution, operating as an autonomous service catering to a particular geographical region, without being attached directly to a mental hospital. This kind of Day Hospital, specifically designed for acute cases, has not yet been tried in Israel.

The doctor-patient relationship in an ethnically heterogeneous society

This paper concerns aspects of the physician's role performance which are associated with two latent functions of the medical institution for its client: provision of status and provision for catharsis. The institutional context of the study is Kupat Holim, the Workers' Health Insurance Institution of Israel which provides preventive, diagnostic and curative treatment for approximately three-quarters of the Jewish population of Israel. Clinics are usually located in local communities or neighborhoods and access to the physician is free to members during clinic hours. 342 Kupat Holim physicians with experience treating Rumanian and Moroccan patients in rural and urban settings completed a systematic questionnaire and the present material is drawn from the analysis of these data. The findings suggest that these two latent functions of the Kupat Holim clinic are differentially ‘activated’ by physicians for different types of clients. Physicians tend to ‘give’ more status to Rumanian than to Moroccan clients possibly because of the latter's tendency to conform less to the prescribed role of Western patients or because of physicians' own internalization of prejudice norms which are prevalent in the larger social system. At the same time it is of interest to note that physicians do not differentiate between ethnic groups of clients in their readiness to ‘provide’ for catharsis. There is therefore no evidence to support the contention that cultural closeness increases the physician's willingness to ‘provide’ for catharsis. There is no evidence for more particularistic doctor-patient relationships in rural as compared to urban clinics. The findings suggest a revision of our originally proposed hypothesis to the effect that physicians in urban practices will be under greater professional, colleagual scrutiny and will therefore be more likely than their rural counterparts to conform to norms of the profession.