I met Michael Aviad a few years ago at a diabetes event on the East Coast. He was diagnosed in 2002 at age 32, very similar to my story. He and his wife are both type 1 (!), and run the online D-magazine ASweetLife.org. They are both the sweetest people — living in a tiny, controversial country that’s always making 
headlines, mostly in a bad way.
For this edition of our Global Diabetes series, we were particularly curious what it’s like to deal with diabetes on a daily basis in Israel.
A Guest Post by Michael Aviad
I was born in the United States, but have lived in Israel most of my life. I have dual citizenship and have enjoyed being part of two cultures. There are many things I love about the United States but when it comes to healthcare, without a doubt, I prefer Israel. That being said, having type 1 diabetes sucks no matter where you live. Dealing with diet, continuous monitoring of blood sugar, the endless injections and the emotional ups and downs that come with type 1 diabetes are more than difficult.
At the port of Tel Aviv
The one thing that’s been comforting for me, from the day I was diagnosed until the present, is that in Israel I have never had to worry about whether or not I will have the supplies I need to keep myself alive. Here, medical care is considered a basic right, and the country has a very good public healthcare system.
Healthcare in Israel is administered by the Health Maintenance Organizations (HMO), most of which were set up by the labor unions before the founding of the State (1948). The HMOs are membership-based organizations. Originally, the members paid membership fees to these funds, and received in return a set guarantee of health services.
In 1995 the government passed the National Health Insurance law, which made membership in one of the four existing HMOs compulsory for all Israeli citizens.
The law determined a uniform benefits package for all citizens — a list of medical services and treatments which each of the HMOs is required to fund for its members. This list of therapies and benefits is determined by an advisory committee, updated annually and passed as part of the national budget.
Although the HMOs have to balance their budgets, they cannot decide which therapies they offer. They may negotiate with companies to get better deals or offer only generic brands of some medications, but they do not have the right to deny anyone anything that the committee has approved.
The National Health Insurance law set out a system of public funding for healthcare services which is a progressive health tax, administered by Israel’s social security organization. In short, you pay for healthcare according to what you earn. The HMOs also receive direct financing from the government. This means that you do not negotiate with an insurer but just pay a tax, which is collected like social security (taken out of your paycheck).
Because the system is publicly run and benefits are uniform, public opinion and lobbying can affect which therapies get added each year to the list. Once approved, such therapies are seldom removed.
JDRF Israel has been very successful in persuading the committee to add diabetes devices and medications to the list. A few years ago the committee, under pressure from JDRF, made CGMs available for all type 1 children. Then two years ago women, pregnant or trying to get pregnant, were included. And in 2012 the committee decided that anyone with proof of hypoglycemic unawareness (needing two documented episodes) can get a CGM.
I still do not qualify for a CGM, but I did receive a free pump (currently I can choose either a Medtronic Veo or an Aminas Vibe) and I get plenty of infusion sets every month. All of my other supplies and medications are paid for too, with only a small monthly co-pay of around $50.
But not only do I get all my supplies, I also get as much medical care as I need. If I need to see my doctor three times in one week I can, without paying anything extra. I go once every 3-4 months to a diabetes clinic, run by my HMO, where I see a nurse, a nutritionist and an endocrinologist — all for free. I do not have to pay for X-rays, ultrasounds, or lab tests. I can go to any of the specialists who work for my HMO (there are plenty of them) as frequently as I want and if I need to go to someone privately, my HMO will cover some of the expense.
Having good and affordable health insurance is important but only as long as the medical care is good. And generally speaking, in Israel it is good. There are no pampering extras here and bedside manners tend to be harsh, but people get what they need. At the end of the day, that’s what really matters.
Diabetes care in Israel is probably on par with the best in the world and the amount of medical research and the number of studies taking place here are surprisingly large considering the size of the country (7 million people). Of course, there are plenty of reasons not to live in Israel. Healthcare just isn’t one of them.
Very interesting account of Israel”s healthcare system. It seems so logical and compassionate at the same time. I’m fortunate to have good insurance, but I cringe when I hear of the financial choices that some Type 1s have to make concerning their health care here.
I’m intrigued by the harsh bedside manner and no pampering. Is that a cultural difference or are you alluding to the fact that you don’t receive things that you probably don’t really need?
I so envy the health care systems in other countries. Even with good health insurance in the U.S., god forbid you get sick, because just the co-pays can run into thousands of dollars (as happened to me a few years back.). One is double punished for being sick! The stupid co-pays (originally designed to benefit insurance companies under the guise of making patients better “consumers” – as if we had a choice to consume health care services or “goods” like insulin) are killers themselves. Why have we allowed this to happen? It’s mind blowing to me that so many are scared of universal health care – the insurance companies, who spend millions to misinform us, have clearly done a good job. If the money earned by shareholders went to our taxes, we would be much better cared for! The middle man needs to go.
Sorry, but the Israel health care system was terrible in the 80s and contributed greatly to my wife’s death at 35.
First of all procuring insulin and blood testing strips was a full time job. She had to run around from place to place getting stamps, paying fees and often after this journey, something was not in stock.
Then there was her specialist, the late Professor Bar-On of Hebrew University. When it was suggested there was a connection between her sugar and period, he claimed this was impossible. My wife suffered from 5 more years of undiagnosed PCOS until she made it to England several years later. Nevertheless this same professor published an article in 1995 – the year of my wife’s demise – all about the connection between diabetes and PCOS.
No doubt things have gotten better – perhaps because those in my late wife’s family (who happen to be at the highest level of Israel’s government – use your imagination) – have since made significant changes to the process for treating diabetics.
There is also a minimed representative in Israel. I have it on good authority (my best friend) that he will even deliver a loaner pump or supplies in an emergency!
The Minimed agent here in Israel is agentek. Last year while traveling in the U.S. my pump had a critical failure. Within 48 hours I had a new pump in hand – they used the FedEx world courier service with next-day delivery. The other time my pump failed here in TLV, they had a loaner to me within a few hours, and a replacement shortly thereafter.
GREAT service!
Wishing you a Good Shabbos and good health.
[...] a great overview of the Israeli healthcare system from Michael Aviad, founder of the ASweetLife.org online diabetes [...]