Israel’s health system has often been seen as highly effective. With a relatively young population on the one hand and an aging immigrant population on the other, Israel has demonstrated the importance of what we are all learning in health care management these days – invest in primary care within the context of a universal health system, and your population will live longer and healthier.
Israel boasts a high life expectancy and birth rates due to its emphasis on primary care for managing the life course. This system is essential for managing long-term care for an aging population as well as one that is young. Health systems, particularly in North America and Europe, are attempting to transition to a system similar to the Israelis as they recognize that a focus on hospitals and tertiary care has not served them.
But what is less known about the Israeli health care system is that it is woefully understaffed with an aging group of doctors – with half over 55 years of age – and a dismal number of nurses (one of the lowest per 1000 compared to OECD countries). Moreover, these roles are not evolving fast enough, and community nurses and doctors often lack the coordination and team behavior critical for efficiently managing together. Ironically, in a health system often seen as very progressive, Israel continues to hold on to old roles and solutions regarding the healthcare workforce.
Recruiting doctors and nurses from abroad is not the answer. To start with, it’s unethical for a country to poach talent, such as doctors, from countries with little capacity to develop human capital. Many of these countries in Asia and Africa need those they have invested in to stay in the home market and deliver needed care. In a world that remains very interconnected, a version of the beggar-thy-neighbor policy where one country attempts to remedy its problems by means that tend to worsen conditions for other countries is ill-conceived.
Trying to train more of the young future medical professionals in a country with a declining population is also not easy or cost-effective. Israel has tried to train more health professionals for several years, only to see marginal gains. Europe tried the same approach with similarly disappointing results – there never seem to be enough health professionals regardless of the number trained. Between 2012 and 2019, the UK invested heavily in boosting the number of medical professionals through increased training, only to find that a 4 percent increase by 2019 could not keep up with rising demand.
It is time for policymakers, medical educators, and professional healthcare bodies to reimagine the health system labor force by moving away from traditional roles and focusing more on skills and competencies that widen the definition of various health professionals. Such an approach requires an organizational culture change in how the public perceives the roles of doctors and nurses – and how these health professionals perceive themselves. New organizational thinking is needed to get the most out of innovations like telemedicine, mobile health, artificial intelligence and datadriven support for decision-making.
Given that Israel’s economy is driven by technology – 54 percent of exports are in the technology sector – it is not surprising that high-tech jobs entice away many young medical professionals disillusioned by their chosen profession. De-bundling what various professionals do could give way for more digital health roles and solutions to sit alongside new thinking on health professionals to drive forward better access, lower costs, and the delivery of quality outcomes despite workforce challenges. The health sector is behind other industries in reaping digital opportunities. Like Israel, Denmark has a significant technology sector and has applied its digital prowess to become one of the best in practice among OECD countries for digital health.
If we are to manage to continue to take care of each other effectively, it will be increasingly crucial that we recognize new innovative approaches to health and healthcare. The Israeli health sector needs to be receptive to empowering organizational change that fosters new roles and reshapes those of doctors and nurses to encourage the next generation of doctors and nurses to step up. Digital technologies coupled with care at the right level empowering patients and carers should be the way forward.