MOSHE PRYWES DAVID M. MIRVIS
The professional training of physicians is one of the most challenging educational tasks a nation can undertake. The educational institutions are highly elaborate and sophisticated, the Faculties are highly specialized, and the sheer volume of material to be taught is prodigious. Responses to these challenges vary widely from country to country. This variability reflects not only differences in fiscal and personnel resources, but also distinctive national educational philosophies, cultural values and health care systems. In this chapter, we describe key elements of the medical education system in Israel and consider several important challenges currently facing the Israeli medical educational establishment.
Health care is provided to virtually the entire population of Israel through a complex matrix of governmental and nongovernmental organizations. Over 95 percent of the population is enrolled in one of four national sick funds. These function as health maintenance organizations, providing or funding comprehensive services in return for prepaid membership fees. The largest of these, the General Sick Fund or Kupat Holim Clalit of the national labor federation, the Histadrut, serves over 75 percent of the population. The small segment of the population not covered by one of the sick funds is protected by various governmental, charitable, or private health care programs.
These sick funds either provide care directly in facilities they own and operate, or they fund such care through contractual arrangements with independent physicians or facilities owned either by the Ministry of Health, by another sick fund, or by a private agency. Kupat Holim Clalit, for example, delivers care directly to its members through over sixteen hundred neighborhood primary-care clinics, eight acute-care hospitals (30 percent of all acute-care beds in the nation), three psychiatric hospitals, three long-term-care hospitals and numerous other types of facilities, all of which it owns and operates. Other