Report prepared by Prof. Yaakov Henkin and reviewed by Prof. Avi Porath, Dr. Ronit Endevelt, Dr. Rakefet Bacharach, Prof. Chaim Yosefy, Dr. Robert Klempfner and Prof. Yosef Rozenman
Statistics update 2019 by Dr. Barak Zafrir, National CVD Prevention Coordinator for Israel (2017–)
National CVD Prevention Coordinator for Israel (–2017):
MD, Associate Professor
1. Head, Preventive Cardiology Service, Department of Cardiology, Soroka University Medical Centre, Beer Sheva, Israel
2. Director, Medical Simulation Centre, Ben-Gurion University, Beer-Sheva, Israel
(Note: National CVD Prevention Coordinator for Israel since 2017: Dr. Barak Zafrir)
"Israel is a small, young country whose citizens are constantly threatened by economic and security instability. So how is it that their life expectancy is amongst the highest and their cardiovascular mortality rates amongst the lowest in Europe? Read more about the Israeli Health Paradox and how the Israeli health system provides incentives for coping with cardiovascular risk factors." (Yaakov Henkin, NCPC for Israel –2017)
Documents to download
The state is responsible for providing health services to all residents of the country through four not-for-profit health maintenance organisations (HMO). These HMOs are membership based and operate under the guidance of a National Health Insurance law that determines a uniform benefits package for all citizens (National Health Basket). In addition, the HMOs provide an option to acquire a few layers of private "supplementary insurance", which includes services beyond those covered by the publicly funded system. Funding of the HMOs is provided by Israel's social security organisation according to a formula based on the number of members, age distribution, and a number of other indices.
During the past decade, there has been a significant drop in mortality from heart disease in Israel, and today malignant neoplasms are the leading cause of death. Death rates from diseases of the heart and cerebrovascular disease have declined by more than 80% from the 1970s. Thirty-day mortality from myocardial infarction in Israeli hospitals declined from average of 8.1% to 4.1% between 2000–2009. In the Israeli 2016 ACSIS survey of patients after acute coronary syndrome, the 30–day mortality rates declined to only 3.0%.
Main actors and prevention methods
Ministry of Health: Owner of many public hospitals, supervises the HMOs, auspices the National Health Basket committee, and coordinates the National Program for Quality Indicators in Community Healthcare in Israel (QICH). The latter is a set of parameters that provides information on the quality of community healthcare.
HMOs: Provide all healthcare through multi-disciplinary clinics around Israel, and compete amongst themselves on the performance in each of the QICH parameters.
Israel Heart Society (IHS) and the National Council for Prevention and Treatment of Heart Disease: Provide guidance and practice guidelines for the ministry of health and the HMOs in the area of preventive cardiology. Have endorsed the ESC guidelines.
Other national medical societies provide guidelines and educational activities in specific areas related to preventive cardiology (e.g. hypertension, diabetes, family medicine).
Israel had embraced cardiac rehabilitation (CR) as early as the 1960s. Currently there are about 22 cardiac rehabilitation centres, most of which are hospital based and house both step 1 (in-hospital) and step 2+3 CR programmes. Independent or privately owned CR institutes are relatively few, despite the fact that reimbursement for CR exists at a national level through the “health basket”, as previously described. In 2018, the Ministry of Health published a position paper on standard criteria for home-based CR.
- In previous years, the Israel Heart Society (IHS) had been active in community campaigns for preventing cardiovascular diseases. These activities have virtually ceased in the past 4 years.
- The IHS offers lecturers and lecture templates in preventing cardiovascular diseases for schools and workplaces, but the activity is poorly coordinated and less than optimal. A new online program with learning centres for educating school children in “healthy living” is currently being structured.
- In addition to endorsing recent ESC guidelines in cardiovascular prevention and dyslipidaemia, the IHS initiated and participated (in collaboration with other relevant societies) in the writing of Israeli guidelines for preventive cardiology, preventive nutrition and physical activity.
- The Forum for Preventing Cardiovascular Diseases is a collaboration between the Ministry of Health, the four HMOs and the relevant medical societies and provides educational and medical screening projects in workplaces, schools and other public enterprises.
Aims for the future
- Revitalise the interest of the IHS in prevention activities
- Provide a core curriculum for medical schools in cardiovascular prevention
- Enhance the use of risk calculators for more logical application of prevention strategies
- Enhance activities relating to “neglected” risk factors (smoking, physical inactivity) and target high-risk populations (35-60 year old individuals and certain ethnic groups)
- Promote educational activities in schools
- Preparation of a consensus document on the management of dyslipidaemias, which will be endorsed by all medical societies in Israel that are involved in the treatment of dyslipidaemias.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology