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A Look at the Israeli Healthcare System

In the quest to create a healthcare system that provides universal health coverage to all Americans, it is important to evaluate other healthcare systems throughout the world. While conversations typically focus on the European Union’s health insurance programs, I believe that further investigation of the universal healthcare system in Israel is necessary.

Under collaborative supervision by the Israeli Ministry of Health and the Palestinian Authority, all citizens and residents of the state of Israel receive compulsory health insurance and medical services. This means that all people inhabiting the state of Israel, even those who accept Palestinian Authority citizenship and deny Israeli citizenship, receive health insurance regardless of religion, gender, race, or socioeconomic status. Not only do all people residing in Israel receive health insurance, patients have the freedom to choose from one of four competing health plans on the market, allowing them to select the program that best fits their medical needs.  Besides giving patients freedom of choice, the competition amongst the health insurance plans drives down costs. Further ensuring the success of the system, all persons are required by law to enroll in a health insurance plan.  Because it is illegal to be unenrolled in the health insurance program, high-income low-risk individuals subsidize low-income high-risk individuals.  In the United States, many opponents of the Affordable Care Act fear that the lack of competition on the market will cause prices to sky-rocket for patients. More so, they fear that high income low risk individuals will chose to pay the small fee associated with not enrolling in the health insurance, thus threatening the financial stability of the U.S. healthcare system. Israel’s healthcare system addresses these concerns, while still maintaining a system that reflects the fundamental ideals of the Affordable Care Act: providing healthcare for all people.

In addition to the distinctive structure of the Israeli healthcare system, Israel’s Magen David Adom and their method of caring for senior citizens make the healthcare system unique and particularly interesting in its own right. Magen David Adom (MDA) is the Israeli version of the Red Cross and acts as Israel’s emergency medical service providing first aid assistance by ambulance, a blood bank, and first aid and disaster relief courses. While the government mandates that this organization serves as the first responders in a medical emergency, they do not receive any government funding. Thus as Israel’s sole EMS system, they are entirely reliant on donors for funding as well as the 10,000 volunteers who make up their staff. These volunteers are trained through a 60-hour rigorous course and serve as assistant medics and dispatch center employees, among other roles. The donors and volunteers have created a qualified and effective emergency service system in Israel that successfully operates without government funding.

Another identifying aspect of the Israeli healthcare system is the way in which it cares for senior citizens. Since Israel is a developed country, characterized by a less intact community structure in which family members often live far way from the aging, the country’s health system is forced to handle disabled elderly citizens. Further complicating the issue, in Israeli culture, sending elderly persons to retirement homes is considered immoral and disrespectful. Hence, the majority of elderly people are taken cared for at home. Currently, community health organizations provide many necessary services for the elderly, including preserving at home independence, providing financial assistance for in-home caretakers, ensuring safety at home, and providing meals-on-wheels, medical equipment, and transportation.

However, the healthcare system is not without flaws and it presents a number of challenges to the public health status of the country.  Many politicians assert that the immense military spending budget has undermined the need for budget allocation to health care (Reeves & Stuckler, 2013). The inadequate funding has led to high copayments and a turn towards privatized medicine, placing low socioeconomic individuals at risk. Many Israelis also complain about the wait times to see specialized physicians and the fact that many life saving medications are not approved because of the cost-benefit ratio (“Overview of Israeli Healthcare System,” 2016).

Overall, however, the Israeli healthcare system is considered efficient because the health status levels of the population are relatively similar to that of other developed countries, even though a lower proportion of GDP is spent on health care. Israel’s healthcare expenditure comprises 7.5% of its Gross Domestic Product (GDP), which ranks 10.4 % lower than the United States’ share of GDP spent on healthcare, and 1.4 % lower than the OECD country average. (Chintz, 2014). While still considered a form of socialized medicine, the competition amongst healthcare insurance plans provides fair market pricing and physician choice for the patient.

This past summer I spent two months living in Tel Aviv and working in Israel’s health sector. I chatted with young professional Israelis who appreciated having the ability to chose their own health insurance plan. I met children who had been waiting over a year to see a specialized physician for their rare condition. I encountered economically disadvantaged patients receiving similar treatment as their economically advantaged counterparts. I worked alongside health care providers who were not only multi-lingual, but were able to provide culturally and religiously competent care to all patients they treated. As Israel is a mecca of religions, cultures, languages, and ethnicities, I personally witnessed a healthcare system which is responsive to the needs of the community. While of course no system is perfect, as American leaders work to create a healthcare system that provides quality, culturally competent, and affordable healthcare to all citizens, I believe that we could learn a thing or two from the Israeli healthcare system.

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Working at the Intersection of Human-Centered Design and Healthcare Technology: An Alumna Interview with Eleanor Burgess (SoC 2015)

Eleanor Burgess has been passionate about the intersection between human-centered design and healthcare technology since her days as a global health student here at Northwestern. After graduation, she received a Fulbright scholarship to obtain her Master of Science in Technology Entrepreneurship at University College London (UCL).

During her time in London, she completed a Fulbright research project in which she worked to create an online health community for chronic kidney disease patients in the UK. In addition to her research Ellie and three of her colleagues co-founded the company drfocused to provide clinician-focused digital solutions for the medical community. Currently Ellie is working toward her PhD in human-computer interaction at Northwestern.

Techstars London Headshots - Image ©Dan Taylor/Heisenberg Media.

Techstars London Headshots – Image ©Dan Taylor/Heisenberg Media.

What did you learn from your Fulbright project?

“Ever since I was a global health minor at Northwestern, I have been excited about the intersection between technology and health. While working toward my masters degree at UCL, I started a research project to build an online health community for chronic kidney disease patients. However, after conducting interviews with patients, I learned a key insight: many patients actually did not want to use an online health community. This experience emphasized the importance of talking to the people who will use the technology to accurately address their needs when developing healthcare tech.”

How did you create the idea for your company drfocused?

“After learning the importance of user-centered design, I went on to co-found my own company, drfocused. One of my classmates at UCL was a physician who pointed out the many issues doctors face when completing their arduous yearly mandatory appraisal, essential to maintaining their license to practice medicine. This appraisal is a yearly compilation of a doctor’s educational learning. Using my software design experience and my colleague’s experience as an Accident & Emergency doctor, we agreed to work together to create a solution for this problem.

Initially, we wanted to help doctors with their appraisals, but ultimately our vision is to improve the working lives of doctors. Until recently, many companies have created healthcare technologies and sold them to hospitals without much design input from health professionals. This method of tech design often fails to involve the clinician – the end-user – in the creation of tools to support medical practice.”

Tell us a little bit about the company you co-founded, drfocused.

Drfocused involves doctors at every design stage of our healthcare technology. My company has created an online community of doctors, called the Doctor’s Digital Collective (DDC), which provides opportunities for collaboration between physicians to design, build, and disseminate technology solutions. In collaboration with this community, we created an innovative app, and our first features support education and safety reporting for doctors in the . The drfocused app helps to streamline these processes, while simultaneously reducing the burden these reports inflict on doctors. Our future aim is to support all non-clinical administration tasks for doctors worldwide.”

Techstars London Headshots - Image ©Dan Taylor/Heisenberg Media.

The co-founders of drfocused

Can you explain how human computer interaction research supports global health?

“From my studies in the field of global health I have learned that many health interventions which had good intentions were often unsuccessful and had unintended consequences. Human-Computer Interaction (HCI) research works to prevent these unintended consequences in technology interventions. One major question is: how do we make a technology practical for those who use it? Many HCI scholars focus on improving access, personalizing, and reducing the complexity of technology. If we can accomplish these goals, we can ensure that our health technology works effectively for those who use it. Most importantly, global health and human computer interaction urge me to remain self-critical in my work as a technology designer and to be aware of the possible consequences of new technologies.”

As you are probably well aware, many global health scholars warn against “quick fix” healthcare technology solutions. How do you address this concern in your work?

“I always remember that every decision I make as an innovator has repercussions. Through my PhD work here at Northwestern, I have investigated how technology fits into a society and how that society changes as a result of implemented technology. I think critically about the effects of technology so that it can be accessible and beneficial to as many people as possible.

The recent , a new, evidence-based approach for addressing many of the complex and serious problems facing the world today, talks about the continued failed attempts to design and implement large, multi-stakeholder projects to revolutionize health systems. This is exactly the kind of “quick fix” we need to avoid. Instead we must focus our work on smaller projects that address specific problems. By addressing acute problems, we can better design systems and ensure that updates to the system happen quickly. We must also ensure long term adaptability of the technology. By asking user-centered questions and continually critiquing our own work, we can avoid failed ‘quick fix’ solutions.”

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New Faculty Spotlight: Beatriz Oralia Reyes

Beatriz O. Reyes is a new professor in the Department of Global Health who will be teaching Community-Based Participatory Research in the Winter 2017 and 301: Intro to International Health in the Spring 2017. She is a member of the Native American Indigenous Studies Steering Group and researcher at the Foundations of Health Research Center at Northwestern.

img_3208Reyes, who is Tepehuán and a citizen of the Navajo Nation, earned her bachelor’s degree in Zoology from the University of Oklahoma. As a recipient of the Gates Millennium Scholarship and a first-generation student, Reyes initially thought being a medical doctor best suited her interests. Growing up, her experience with the U.S. health system—in particular the Indian Health Services—was less than ideal. She dreaded becoming sick because she would have to wait at the hospital for hours to be seen, which also meant her mom would have to take time off work. For her, health care was an inefficient system, and only at college did she realize that this was not an experience shared with many of her peers.

While she enjoyed studying Zoology at OU, it was connecting science to sociology and history that sent her on a path to realizing she was more interested in health policy and health disparities. As an indigenous person, she was cognizant of the ways policy shapes society’s view of her existence and the ways her experiences in the world are shaped by policy-makers. Everything from the types of foods you have access to, what land you live on, everything about your identity is shaped by these systems. Further, Dr. Heather Ketchum’s courses on Parasitology and Entomology highlighted for Reyes how human health is heavily impacted by the life cycle of insects and parasites. Reyes realized she had multiple interests but still struggled to determine where they intersected.

Reyes’s multiple experiences as an intern in the federal government provided her with a roadmap to public health. She was accepted into the Washington Internship for Native Students, a summer internship where students work for an agency in the federal government and take two classes at American University, one course being Federal Indian Law.

After this experience, she enrolled at East Carolina University to earn a master’s degree in public health. This was the first time she was exposed to public and community health, and was drawn in by its complexity. Her research project looked at the policy and implementation of recommendations for Division 1 NCAA athletes with sickle cell trait. While it was an interesting project, she wanted to further gain experience and knowledge in qualitative research methods and community-based participatory research. She then decided to pursue a doctorate in Health Policy and Social Justice at the Dornsife School of Public Health at Drexel University in Philadelphia, Pennsylvania. Her doctorate research focused on evaluating a faith-based 16-week prediabetes prevention program. This larger study was conducted by her advisor, Dr. Nicole A. Vaughn and was an adaptation of the National Diabetes Prevention Program (DPP). Reyes’s dissertation study was a qualitative analysis of the ways lay health educators adapted and utilized program materials to fit the needs and concerns of their specific communities.

Reyes hopes to provide Northwestern undergraduates with an introduction to the benefits and challenges of collaborations between researchers and communities, in her Winter 2017 course on Community-Based Participatory Research (CBPR). She told me, “The thing about CBPR is that it’s not a method, it is a paradigm, it’s an approach to research.” It begins with asking yourself questions like: where does the community fit into developing the research question, decision-making process and resulting intervention? Does the community find value in the research and intervention? Is there joint ownership of the data, its presentation, and implementation? While there is no standard way to do CBPR, it is so important to remove the barriers that prevent researchers from working with communities, and one of the most powerful ways of doing this is by coming together with a shared vision of improving health in a socially just manner with the intent to eliminate health disparities.

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Meet Sera Young: anthropologist studying undernutrition in low-resource settings

sera-young

 

Dr. Young joined the Northwestern Department of Anthropology and Program in Global Health Studies this year. Her work focuses on maternal and child undernutrition in low-resource settings, particularly sub-Saharan Africa. “Everything I do focuses on what you call ‘the first thousand days,’ which is the year before delivery and the two years after. The people who struggle the most in that time are those with insufficient resources,” she said. “Some of the research I do involves people who are experiencing food insecurity, mothers who are micronutrient deficient, the implications of water insecurity and those who crave consumption of non-foods–known as pica.”

She received her bachelor’s degree in Anthropology from the University of Michigan. She then studied medical anthropology (MA, University of Amsterdam), international nutrition (PhD, Cornell University) and HIV (Fellowship, University of California – San Francisco).  

 

What inspired your research?

When I was an undergraduate at the University of Michigan, I went to West Africa as a field assistant doing anthropometry, measuring height, weight and upper arm circumference. There, I studied anthropology of religion, and how people make meaning of what the world is. When I got there, there were health problems I couldn’t have even imagined, and the high infant mortality rate caught my attention.

 

What is the intersection of Anthropology and Global Health?

We often think that we can fix health problems when we understand the virus, the cell or the toxin–all the physiological causes of poor health. Although these are the actual causes of health outcomes, something happens before a virus is transmitted or before a toxin is ingested. That’s what’s really interesting to me. You can make a distinction between pre-dental and post-dental nutrition. There’s everything that happens with food before it crosses our teeth, and then there’s everything that happens after you swallow it–the biochemical side of things. In my opinion, the biochemical side is necessary but not sufficient for understanding the major global health problems we see in the world. You could say that my research group’s focus is on pre-dental nutrition.

 

What were your most meaningful international research experiences?

My heart was captured by my time in West Africa. A few years after, I went to Zanzibar in East Africa, which was a vastly different world, and lived with several different Swahili families. This experience led me to my master’s project on maternal anemia, which led me to complete a doctorate in nutrition. These experiences were important to me professionally, but they also shaped my worldview, for example the importance of cross-cultural understanding and embrace of different ideas.

 

What is the most pressing factor we should address in regard to maternal and child health?

Undernutrition is a huge problem. There are a lot of causes of poor health, and illnesses kill millions every year. But there’s this concept called “potentiating effect of undernutrition” which is a fancy way of saying that poor nutrition is the underlying cause of death in cases that don’t seem nutrition related, like pneumonia. If a well-nourished child contracts a virus, they’ll become sick, but then they’ll get better. If a poorly-nourished child contracts the same virus, they’ll be much less likely to recover.

Another issue related to undernutrition is breastfeeding. If more babies got more breastmilk for long periods of time, there would be economic benefits, cognitive development benefits and so much more.

Lastly, food insecurity among women and children is really high, even right here in the United States. It is associated with many bad outcomes in terms physical and mental health, cognitive development, and economic productivity.

 

What is the leading contributor to food insecurity?

There’s plenty of food in the world, and if that was evenly distributed, problem solved. But the issue at hand is equitable distribution.

I also want to bring up the topic of water insecurity. We often think of water insecurity being in drought-ridden nations, but it’s right here as well. The consequences haven’t really been studied, so that’s something I’d like to explore with undergraduates.

 

Dr. Young will be teaching a course in Winter 2017 called “Ecology of Infant Feeding: A global perspective on the best ways to feed babies.” The course will introduce students to the health and social consequences of practices such as breastfeeding, bottle feeding and complementary (non-milk) foods.

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The Power of Patient Narrative

“The whole world, all human life, is one story.” We as humans are hard wired for the lynn-kelsolistening and telling of stories. Our stories define who we are as individuals, and as a community. If we wish to have meaningful and strong relationships in our lives, we must be able to listen effectively. We can choose what we hear and what we do not hear, what we listen to and what we do not listen to. While one can hear without any specific purpose, listening takes purposeful self-awareness, focus, and unselfconsciousness. Northwestern professor Lynn Kelso, who has devoted her life to the art of storytelling, says it best: “Hearing is a sense. Listening is an art.”

Northwestern Community Health Corps is a student organization focused on empowering community members to take charge of their own health through the implementation of informational health desks located in libraries. As volunteers at the health desk, we sought the advice of Professor Kelso in order to improve our ability to be empathetic and active listeners when hearing health narratives from desk patrons. Storytelling or patient narrative plays a central role in the health care provider-patient relationship. As Kelso illuminated, the ability of any healthcare professional to actively listen to the stories of patients will define their capacity to treat their patients effectively. Patients must believe that they can truthfully and comfortably share their story with someone who will listen in a non-judgmental way. They must not feel that they have to say what the healthcare provider wants to hear, nor feel that they must align with the healthcare provider’s religious, cultural, or social beliefs about the practice of medicine.

In order to be effective and empathetic listeners of narrative, Kelso emphasized that healthcare providers must take the “I” out of the conversation. In other words, the listener must not talk about his or herself and rather focus intently on the speaker. More so, Professor Kelso contends that 90 percent of communication between the teller and the listener occurs through non-verbal body language. Your eye contact, posture, voice tone and responses reveal if you are truly listening. This emphasizes why active listening cannot occur through non-in person communication methods, such as texting.

Health care providers must learn to be attentive, active, and engaged listeners in order to provide patient centered and culturally competent care. In order for healthcare professionals to receive this listening training, a multi-disciplinary collaborative approach is necessary. The healthcare sector must seek advice from those who specialize in speaking and body language, such as Kelso who hails from the theatre department here at Northwestern.

This push for multisector collaboration in developing listening skills of health care providers, has been reflected in the newly developed Feinberg curriculum which places an emphasis on medical humanities and communication training. Medical students, both here at Feinberg as well as other medical institutions across the country, are now required to take courses in the medical humanities, in order to aid in their ability to decipher narratives and communicate effectively with their patients. Even this quarter in Weinberg, Hosanna Krienke has been leading an English course focused on the medical humanities. I am a student in the course, and she has encouraged us as future healthcare providers to pay close attention to narrative, the way in which we listen, and most importantly the language we use to communicate. Words have the power to shape the physician-patient relationship, and thus should be used only with specific purpose and acute awareness of language’s ramifications. In order to understand what language will define our vernacular as future healthcare providers, we must start with listening to every patient’s narrative. As Kelso says, “listen to your world and the stories they tell. They are all a part of your story.”

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