Child Health Care in Israel.

Israel is a relatively rapidly growing country with a high fertility rate and a young population. These data emphasize the importance of an efficient and appropriate pediatric service for its population. Although the pediatric service in Israel has attained several achievements, such as a relatively low infant mortality, high vaccination rates, and a primary care service that is mainly based on licensed pediatricians, several challenges, such as overcoming inequalities in health care and health indices between different regions and different populations within the country and the provision of a more organized mental and dental health care service to children, need to be addressed.

Extracorporeal membrane oxygenation in pediatric patients: our experience in the last ten years.

BACKGROUND: The use of extracorporeal membrane oxygenation (ECMO) in children after cardiac surgery is well established. ECMO support is becoming an integral tool for cardiopulmonary resuscitation in specified centers. OBJECTIVES: To review our use of ECMO over a 10 year period. METHODS: All children supported with ECMO from 2000 to 2010 were reviewed. Most of these children suffered from cardiac anomalies. The patients were analyzed by age, weight, procedure, RACHS-1 when appropriate, length of support, and outcome. RESULTS: Sixty-two children were supported with ECMO; their median age was 3 months (range 0-216 months) and median weight 4.3 kg (range 1.9-51 kg). Thirty-four patients (52.3%) needed additional hemofiltration or dialysis due to renal failure. The children requiring ECMO support represented a wide spectrum of cardiac lesions; the most common procedure was arterial switch operation (27.4%, n=17). ECMO was required mainly for failure to separate from the heart-lung machine (n=55). The median duration of ECMO support was 4 days (range 1-14 days); 29 (46.7%) patients were weaned successfully from ECMO during this time period, and 5 of them died during hospitalization, yielding an overall hospital survival rate of 38.7%. CONCLUSIONS: ECMO support has significant survival benefit for patients with post-cardiotomy heart failure. Its early deployment should be considered in cardiopulmonary resuscitation.

Circumstances leading to the formulation and implementation of a new TB control program in Israel: a case study in public health and policy.

We describe how Israel effected new tuberculosis programs and policies beginning in the early 1990s. We explain how the epidemiology of the disease, particular events, and a small number of people influenced the creation of new policy. We believe that this story may be useful to other program managers and policymakers interested in changing course.

[Migrant workers: evolution of the Israel health system approach to the new social issue].

The immigration of workers from poor countries to Israel began in earnest in 1993, and by 2003 their number had reached 250,000, the majority without work permits. In this article we describe the evolution of the Israeli approach to providing health services to migrant workers, noting particularly the swings between exclusion and inclusion, ranging from providing only the most minimal services to providing a complete health services package. The National Insurance Institute was the first to provide benefits to documented migrant workers, mandating compensation benefits for those injured at work or in terrorist incidents. The health care sector provided an ever-increasing package of health benefits for documented migrant workers, culminating in the Foreign Workers Law of 2000 obligating employers to insure workers with a health package similar to that of Israeli citizens. The provision of health services to undocumented migrant workers and their families arose more gradually, but ultimately included the full range of mother and child preventive health services, school health services, provision of ambulatory medical care by volunteer physicians members of human rights organization, the possibility of enrolling their children at a reduced premium in Meuchedet Health Fund, free diagnostic and treatment services for tuberculosis and sexually transmitted diseases, free antiretroviral treatment of HIV-positive pregnant women, and, finally, the ability to obtain gas masks for a token deposit prior to the Iraq War of 2003

[The new national program for tuberculosis elimination in Israel].

BACKGROUND: The rise in the incidence of TB in Israel, mostly due to immigration from endemic areas, led to the establishment of a new TB control program which follows the guidelines of the World Health Organization (WHO). Reorganization of the TB infrastructure was enabled by specific legislative, administrative and budgetary measures initiated by the Ministry of Health (MOH) in conjunction with the Sick Funds. AIM: To present the theoretical and practical aspects of this new program to the physicians of Israel. PROGRAM OUTLINE: The essence of this program is the use of directly observed therapy (DOT) for all patients together with centralization of TB care in nine national centers, closely supervised by the MOH. This centralization allows a critical mass of patients to be seen in each clinic, thus enabling the labor-intensive task of modern TB treatment, including the supervision and/or the administration of DOT, to be performed in a cost-effective manner. Day to day treatment is conducted by general community clinics and supervised by District Health Offices. Hospitalization, a relatively rare necessity in the new program, is available in two dedicated centers with modern isolation facilities. Centralized laboratory services provide timely susceptibility testing. Billing is simplified according to disease categories, using a global assessment of costs negotiated with the Sick Funds. Management and quality control of the program are carried out on an ongoing basis by the Department of TB and AIDS at the MOH. PRELIMINARY OUTCOME: In the first two years that have elapsed since the inception of the program, almost 93% of cases have documented evidence of completion of treatment (under DOT), compared to 54% (without any treatment supervision) before the program came into effect.