ICU Management & Practice, ICU Volume 8 - Issue 3 - Autumn 2008
Hospitals
In 2000 Israel had 48 general hospitals, with approximately 14 200 beds, spread throughout the country. The overall general care bed-population ratio is 2.2. Compared to OECD countries Israel is characterised by a low bed-population ratio, an extremely low average length of stay, a mid to high rate of admissions per thousand population and a high occupancy rate. The low bed population ratio is the result of deliberate government policy based on the view that resources should be focused on community care and on the assumption that the greater the number of beds the larger the hospitals’ share of total health resources.In recent decades the average length of stay has declined dramatically, from 6.8 days in 1980 to 4.3 days in 2000, while the admission rate has increased dramatically, from 145 per thousand population in 1980 to 175 per thousand population in 2000, and the number of hospital beds per thousand population has declined slightly. As the decline in average length of stay has been greater in percentage terms than the increase in admission rates, the rate of patient days per thousand people declined somewhat between 1980 and 2000. The volume of day care and ambulatory surgery has increased dramatically over the past decade. Since the outbreak of the intifada in September 2000, hospitals have had to mobilise to care for the casualties, including victims of shock, which requires an increase in both medical and psychiatric services. While Israel does have a few small ‘single specialty’ hospitals, particularly in the maternity area, the vast majority of the beds are in general hospitals. Almost all Israeli hospitals have university affiliations and operate training programmes for medical students, interns and residents. The range and depth of these university affiliations varies. Of Israel’s 30 general hospitals, 6 have been recognised as supra-regional hospitals and they tend to have the greatest concentration of research and training activities as well as centres for complicated and expensive treatments.
Proposals for Hospital Reform
Key issues currently on the agenda regarding hospital care include: • Whether public hospitals should be allowed to offer private medical services;
• How quality of care should be monitored and improved;
• Whether appointments to department chairmanships should be time-limited and subject to rotation-the current system of open-ended appointments is widely believed to have led to over-concentration of power and to have slowed innovation;
• Whether hospital patients should be assigned a personal hospital physician who will coordinate their care-the present situation of ‘ward patients’ is not conducive to effective communication with the patient and has also raised questions regarding quality and continuity of care; and
• The extent to which resources should be invested in expensive and highly sophisticated end-of-life care.
Management Training
There has been a dramatic expansion and improvement in healthcare management training over the past decade. Several major universities now offer degree programmes in healthcare management and the number of staff and students involved has grown substantially. Key employers such as health plans and hospitals are encouraging large numbers of their midcareer employees, including physicians, nurses, administrators and others, to participate in these programmes by offering time off from work to pursue studies and partial to full coverage of tuition costs. There is also an understanding that this sort of training can improve the employee’s career opportunities in the current job and beyond.
