EFERENCES History and Purpose of the Hospital British Journal of Clinical Practice 1956 Vol. 10. P. 739 W. Gissane. Accidents and Road Injuries British Journal of Clinical Practice 1956 Vol. 10 Several articles by W. Gissane, J.P. Bull, Clarke & Fisher, Wolfson, Davios and Flear. "The Care of Injured" Gissene. Ruscoc-Clarke Memorial Lecture 1966. "Some Observations on the Course of Events after Severe Injury of the Head". Public Health. Edited by W. Hobson, 1965 Oxford University Press. "Human Factors and Road Accidents". J.P. Bull, Proceedings of the Conference on Vehicle Crash and Injury Prevention. Royal College of Surgeons 1967. P.113. "A Study of Motorway Fatalities". Gissane and Bull. British Medical Journal. January 11th, 1964 Vol. i. p.p. 75 - 80. "The Nature and Causation of Fatal Road Injuries to Car Occupants on Various Types of British Roads." Gissene and Bull. Reprint of Proceedings of the 7th Stapp Car Crash Conference, pub. Charles C. Thomas, Springfield, Illanois. 1965. "The Causes and Prevention of Car Occupant Neck Injuries". Gissane. "Prevention of Highway Injury", Highway Safety Research Institute, University of Michigan 1967. "International Comparisons of Road Accident Statistics". Bull. Journal of the Institute of Highway Engineers, England. March, 1968. "Research Evidence of the Nature and Causes of Road Accidents with Particular Reference to Car Occupants." Gissane. New Zealand Medical Journal. July, 19 67. Vol. 66 No. 419. p.p. 427 431. "A Study of 183 Road Deaths in and Around Birminghan in 1960". Gissane and Bull. (1961), British Medical Journal. Vol. (i) 1716. "Modern Trends in Accident Surgery and Medicine". Edrs. Clarke, Badger and Sevitt (1959) Butterworth, London. "Principles of First Aid for the Injured". H. Proctor and P.S. London. (1962) Butterworth, London. "Multiple Injuries". P. S. London (1964) in "Clinical Surgery", edited by C. G. Rob and R. Smith, Butterworth, Londen. "Abdominal Injuries". P. S. London (1964) in "Accident Surgery 2". H. F. Moseley Appleton, Century Crofts. "Early Treatment of Multiple Injuries" Proceedings of the Royal Society of Medicine. October 1967. Vol. 60. No. 10 p.p. 945 - 952. Also, section on Orthopaedics, p.p. 31 - 38. "A Practical Guide to the Care of the Injured". P. S. London 1967. Edinburgh and London. E. S. Livingstone. "Traffic Injury in Brisbane Report of a General Survey". K. G. Jamieson and I. A. Tait. National Health and Medical Research Council 71-413 073-19 HEALTH CARE IN ISRAEL In considering how comprehensive health services are made availble to the people of Israel, through three major health services prorams (Ministry of Health, Hadassah Medical Organization, and he Kupat Holim (sick fund) of the General Federation of Labor, ereinafter referred to as Kupat Holim) the Subcommittee believes t most important that cognizance be taken of the roles of these agenies in the context of their historical perspective. The Ministry of Health is the supreme authority in all matters elating to health and the licensing body for the medical and othr professions and was created as an administrative organ to superise the functioning of already existing health organizations. Howver, Hadassah Medical Organization, a private organization, pioeered health services in Palestine long before the establishment of he State of Israel, beginning in 1913 when its nurses distributed fresh milk in the Old City of Jerusalem, to its present day operation of Israel's largest university hospital. Moreover, Kupat Holim; the argest provider of services (over 70% of Israel's population is covred) and was also founded before Israel reached statehood [founded n 1911 to provide assistance to agricultural workers]. Kupat Holim Health Insurance, a voluntary health organization embraces workers in urban and rural areas, in industry, commerce, and public services; self-employed and members of the collective and Cooperative Kibbutz and Moshan communities and render comprehensive medical services mainly in its own institutions staffed by its own personnel or where it becomes necessary to render treatment in other institutions, the Kupat Holim directly covers the cost. Accordingly, these two organizations Hadassah and Kupat Holim-have had great influence in the ultimate determination of coordinated health care and in the provision of curative services. A detailed description of the development of health services is included in the Subcommittee's report as Appendix A. ITINERARY The Subcommittee examined the structure of medical and health services in Israel with a view toward determining what features of the mosaic of different organizations health services and health manpower training in Israel could be effectively implemented and utilized to improve the crisis in America's health care, though the Subcommittee was limited in that it was only able to spend two days in Israel. The Subcommittee did not intend its trip to be a critique of Israel's progress in medical science, technology and research. Although the Subcommittee only had a limited period of time available for its visit to Israel the Subcommittee elected, rather than have Israel's health care leadership brought together for discussions with the Subcommittee, to have the Subcommittee personally inspect various health care facilities (which exemplified typical rural and urban health care settings) and during such on-site inspections, often of remote facilities, conduct meetings and discussions with not only the medical personnel in charge or in training, but also, where possible with the consumer of health care, the patient, whether Arab or Jew. Included in the facilities visited by the Subcommittee were hospital emergency clinics, first aid stations, university medical schools, family health care centers, maternal and child health clinics in urban centers and remote Bedouin villages, geriatric hospitals, medical facilities at a kibbutz, convalescent and rest homes, large city hospitals and medical centers in remote desert areas, all of which were operated and maintained by either the Ministry of Health, Hadassah Medical Orga nization or Kupat Holim. Although it appeared to the Subcommittee that Israel's health services were not operated within or by a welldefined national health authority, which would be responsible for medical policy and personnel and the financial resources to operate such program, there was a demonstrated deep concern by the Ministry of Health, the Hadassah Medical Organization and Kuput Holim to provide a comprehensive range of health services, preventive and curative, to all the people of Israel without regard to their ability to pay for health care; with a definite view toward assuring that health services were equally available to the people; that nurses and paraprofessional health personnel were utilized to their maximum capacity and efficiency; that medical education was provided without regard to ability to pay; and that health services were expanded to immigrant and frontier areas as a matter of social policy, although it is precisely there that it would have an adverse impact on budget. A detailed schedule of the health facilities and personnel visited in Israel is included in the Subcommittee's report as Appendix B. SUMMARY OF HEALTH INSTITUTIONS I. MINISTRY OF HEALTH The Ministry of Health is the supreme authority in all matters relating to health and serves as the licensing body for the medical and allied professions. It ensures the provision of health services for the population and is the principal public health agency of the country. It administers Government hospitals and supervises others. Fifteen subdistrict health departments organized in six districts are responsi ble for personal preventive services (which include 462 mother and child health stations, health centers, mental health and child guidance clinics) and for environmental health services. Eight laboratories in the main cities, with an academic staff of 67, provide all public health laboratory services for the Ministry and its health departments. In addition the Ministry maintains seven and supervises the curriculum of nine schools of nursing. These functions are coordinated through the various divisions under Assistant Directors-General who are responsible for medical administration of the Ministry's services. In Jerusalem, preventive health services, originally established by the Hadassah Medical Organization in 1913, were transferred to the municipality in 1963, and are now operated by the Department of Public Health in the fields of mother and child health, school health and school dental health. The Department also collaborates in epi emiological field studies. In Haifa, the Department of Public Health perates the public health services of the city providing free curaive services for the needy, home visits by doctors and nurses, and home-care rehabilitation service. In the field of preventive services runs mother and child care centers, day nurseries for underweight nd neglected infants, and school health services, including a school ental services (administered, historically, by the Department of Education). It also operates two homes for rehabilitation and cusodial care: The Abrahams Home in Tel Aviv, a combined day-hospial and school for crippled children maintained jointly with the Alyn Organization, and the Givat Hashlosha Municipal Home for the Disbled in Petah Tikva with 195 beds. The Department is attached to he Tel Aviv University Medical School. A detailed description of the activities of the Ministry of Health s included in the Subcommittee's report as Appendix C. II. HADASSAH MEDICAL ORGANIZATION Sponsored by Hadassah, the Women's Zionist Organization of America, Hadassah has created a country-wide network of diagnostic, preventive and public health services and teaching and research nstitutions, and has set up hospitals and mother and child care ceners since transferred to the Ministry of Health and local authorities. Partnership with the Hebrew University dates from 1939 with the establishment of a Medical Center on Mount Scopus, the organization of a pre-faculty of medicine and the granting of university status o Hadassah's hospital. The Hebrew University-Hadassah Medical School was established in 1949 and the Medical Center in Ein Karem opened in 1961 to provide a framework for major teaching and research activities. In addition to its departments and outpatient clinics, Hadassah operates more than 40 clinical research laboratories and institutes which carry out studies, among others, in the field of biophysics and radioactive isotopes; cardiovascular and pulmonary research; the experimental fields of dematology and mycology, neurology, orthopedics, pediatrics and surgery; gastroenterology and endocrinology; hemaology; isotopes; lipids; metabolism; microcirculation; neurophysiology and psychophysiology; renal research, vision research, etc. Other voluntary medical agencies include JDC-Malben services in Israel. JDC-Malben was established in 1949 by the American Joint Distribution Committee (AJDC), the Government of Israel and the Jewish Agency, as an organization for the care of handicapped needy immigrants. The AJDC has undertaken complete responsibility for its activities since 1950. JDC-Malben has developed services for the care of tubercular patients, the chronically sick, the aged, handicapped children and youth and has pioneered in the field of rehabilitation and long-term care. JDC-Malben cooperates with and advises government and local authorities on the development of national and community projects in the fields of public health, welfare, rehabilitation and mental health. It provides preventive medical services for the aged in its rehabilitation hospital, a program for long-term care of the chronically |