Residents' choice of a placement in periphery hospitals in Israel: The significance of personal/family and professional considerations.

Physician maldistribution affects remote and rural population health indicators and as such constitutes a major concern for health systems. Various countries, including Israel, have sought to remedy this problem, often by implementing more than one intervention simultaneously. In this paper, we explored the considerations that motivated Israeli residents to opt for a position in the periphery, as well as potential factors that could facilitate their retention in these underserved areas. We found that the motivation driving young physicians to specialize in a specific hospital includes personal- and family-oriented considerations (proximity to the nuclear family, perceived quality of life and lifestyle) as well as professional considerations (prior acquaintance with a hospital and a specific hospital department, department characteristics, availability of a residence position in a preferred specialty, prospective professional advancement). We therefore argue that the key to recruitment and retention of young physicians in remote areas lies in tailored interventions that take personal, professional and regional issues into account, preferably in consultation with the physicians themselves. The prominence of personal issues in the interviews with young physicians suggests that effective interventions should support a work-life balance. Hence success in attracting residents as a first step towards correcting physician maldistribution hinges upon coordinating policies in the medical field with policies in non-medical arenas - education, welfare, local authorities.

[Job satisfaction, intention to leave and leaving the practice of medicine among physicians in Israel: a survey of physicians receiving their licenses in 2000, 2002, 2004, 2006].

INTRODUCTION: There is recent evidence that physicians are increasingly dissatisfied with the medical profession and are leaving the profession. GOALS: To measure job satisfaction and the rate of Leaving the profession among physicians recently licensed in israeL. METHODS: A telephone survey among 733 doctors; graduates of medical schools in Israel who received their license in 2000, 2002, 2004 and 2006. FINDINGS: A total of 5.5% of the physicians interviewed had stopped practicing medicine. However, among those graduating in 2000 and 2002, 8% Left the profession. Furthermore, 6.5% live abroad, suggesting that 12% of those receiving Israeli Licenses in 2000-2006 are not currently employed as physicians in Israel. In addition to the physicians who actually left, a further 9% had made contact with human resources companies, and 13% reported often thinking about leaving. Satisfaction with external professional factors (physical conditions, work relations, wages, career-family balance) was significantly Lower among those who remain in the profession, compared with those who left. Satisfaction with internal professional factors (significance of work, interest/challenge) was slightLy higher among those staying than those Leaving. The internal factors were the best predictors of intentions to Leave the profession. CONCLUSION: (1) Discontinuation of medical practice among physicians in Israel has increased in recent year. (2) Satisfaction from work conditions among physicians is lower than among those who Left the medical profession for other positions (e.g., hi-tech, research, medical firms). SUMMARY AND DISCUSSION: Intentions to leave the profession, combined with dissatisfaction with working conditions (e.g., wages and work relations), paint a gloomy picture of the attitudes towards medicine reported by those remaining in the profession, and of the likelihood of staying, in light of the more prestigious and rewarding employment alternatives.

[Medical ethics and economics in the era of insufficient resources].

BACKGROUND: During the Golden Age of Medicine (20th Century), scientific and technological breakthroughs enabled physicians to cure people's illnesses. The idealist, romantic approach of medical practice believed in the right of every human being to receive the best treatment possible, regardless of cost. However, the rise in health care expenditure at the end of the 20th Century made this impossible, therefore other approaches were adopted. The aim of this study is to investigate the causes of the change in medical approaches while distinguishing between the different methods practiced by nations in order to deal with the disparity created by ethical dilemmas caused by scare resources and delivery of medical treatment. METHOD: This study is based on the evaluation of macro economic data and the comparison of international health data. Special emphasis was given to the evaluation of Israeli health economics since the National Health Insurance Act (1995). RESULTS: The study shows two different approaches to the problem of scarce resources: the liberal approach, as practiced in the USA, and the Social Democratic approach which is common in many European countries, including Israel. The Social Democratic ideology believes in public financing of defined health care services to all citizens. This method implies rationing and managed care in order to absorb medical expenses. DISCUSSION: The ethical dilemmas arising from the necessity to add economic considerations to a physician's care of his patient, demand that any given healthcare system find the right equilibrium. This balance between clinical, social, and economical considerations is not easily achieved. Only dialogue within the health care system itself, and with the public, can achieve the best possible balance.

What should be given a priority - costly medications for relatively few people or inexpensive ones for many? The Health Parliament public consultation initiative in Israel.

BACKGROUND: In the past two decades, government and civic organizations have been implementing a wide range of deliberative public consultations on health care-related policy. Drawing on these experiences, a public consultation initiative in Israel called the Health Parliament was established. GOALS: To implement a public consultation initiative that will engage members of the public in the discussion of four healthcare policy questions associated with equity in health services and on priorities for determining which medications and treatments should be included in the basket of national health services. METHOD: One hundred thirty-two participants from the general population recruited through a random sample were provided with background materials and met over several months in six regional sites. Dilemma activities were used and consultants were available for questions and clarifications. Participants presented their recommendations in a national assembly to the Minister of Health. OUTCOMES: Across the regional groups the recommendations were mostly compatible, in particular regarding considering the healthcare system's monetary state, even at the expense of equity, but for each policy question minority views were also expressed. A strong emphasis in the recommendations was pragmatism. CONCLUSION: Participants felt the experience was worthwhile; though the actual impact of their recommendations on policy making was indirect, they were willing to participate in future consultations. However, despite enthusiasm the initiative was not continued. Issues raised are whether consultation initiatives must have a direct impact on healthcare policy decisions or can be mainly a venue to involve citizens in the deliberation of healthcare policy issues.

Private health insurance policies in Israel: a report on the 2012 Dead Sea Conference.

The private health insurance (commercial and supplementary health insurance) sector has undergone a revolutionary transformation in recent years, both in the number of individuals who own private plans, and in the financial scope of these plans. With these developments in the background, leaders of the Israeli healthcare system convened in December 2012 at the Dead Sea for a discussion on "Private healthcare insurance plans in Israel: Developments, concerns, and directions for a solution". This meeting report summarizes the main issues discussed at the conference.