Maccabi Healthcare Services
The Maccabi Institute for
Health Services Research
Department of Public Health
In the
School of Public Health
Tel Aviv University
January 2007
Department of Public Health
Maccabi’s Vision
Israel's leading and most advanced healthcare
organization aims to achieve Total Health for its
members, providing integrative and personallytailored health care to each and every member, and
encourages excellence in the quality of medical
care, knowledge and service.
Department of Public Health
Maccabi Statistics - 2007
 1,700,000 members (24% Market Share)
 3,560 physicians (independent contract and salaried)
 797 nurses
 429 physical therapists
 97 social workers
 168 dieticians
 197 occupational therapists
 177 speech therapists
 207 psychologists
 5 regions with 152 branches and clinics
 Income budget (capitation) $1.28 Billion
 Total income $1.65 Billion
Department of Public Health
Director General
Assistant to Director
General
Maccabi
Institute for
Health
Services
Research
Quality
Promotion
Marketing
Media
Relations &
Public Affairs
Internal
Auditor
Ombudsman
Legal
Department
Operations and
Hospital Relations
Section
Real Estate
and Logistics
Division
Information
Technology
Division
Human
Resources
Division
Purchasing
Division
Central
Services
Medical Section
Insurance
Division
Finance &
Planning
Division
Secondary
Healthcare
Division
Primary
Healthcare
Division
Supplementary
Healthcare Services
North
Region
Sharon
Region
Department of Public Health
Center
Region
Medical
Technology
Shfela & Jerusalem
Region
Negev
Region
Pharmacy &
Pharmacolog
y
Objective
The Institute provides
an organizational framework
for encouraging and supporting
health services research
which is aimed at
promoting community health
for Maccabi members
and for the health sector at large
Department of Public Health
Purpose and Goals
Promoting research activities at Maccabi
This is accomplished by:
1. Encouraging research in relevant areas according to
priorities set by the Institute’s Steering Committee
and Advisory Board.
2. Developing and expanding research potential via
collaborative activities with researchers from
academic institutions and/or external research
organizations.
3. Providing the necessary means to implement research
projects.
Department of Public Health
The Maccabi Institute for
Health Services Research
Advisory
Board
Director
Steering Committee
Institute Director
Dr. Rachelle Kaye
Maccabi Research
Committee
Research Fund
Department of
Research and
Evaluation
Department of Public Health
Medical
Section
Department of
Public Health
The Department of Public Health
Director
Dr. Rachelle Kaye
Clinical
Appointments
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Epidemiology
Dr. Gabriel Hodick
Dr. Nurit Friedman
Dr. Ayalla Blau
Dr. Anthony Heymann
Dr. Yossi Lomnicky
Dr. Yoram Sandhaus
Dr. Yoav Yechezkeli
Dr. Yosef Cohen
Dr. Rachel Miron
Dr. Miki Nobel
Dr. Barbara Silverman
Dr. Galit Fusman
Dr. Ehud Kokia
Dr. Yitzchak Katzir
Dr. Meir Raz
Dr. Eduardo Scejter
Dr. Varda Shalev
Prof. Yair Shapiro
Department of Public Health
Preventive Med
Mrs. Leora Valinsky
Dr. Shelley Sternberg
Environmental
Health
Dr. Shlomo Moshe
Mentors and
Advisors
Prof Manfred Green
Prof Joshua Shemer
Department of Public Health
 The goal is to integrate academic activity with implementation
in healthcare facilities.
 Department activities focus on: Research, lecturing, mentoring
and collaboration with academic institutions.
 Members of the Department form a bridge between academia
and the community.
 Department members are full time employees, they each hold a
half time position in the School of Public Health and half time
position at a senior post in Maccabi.
 16 Clinical appointees are on the staff, each one holds a quarter
time position.
 16 more Clinical appointments will be added in the future (4
positions).
Department of Public Health
Research Infrastructure
 Members
 Physicians and other care givers
 Integrated administrative Data Base
 Facilities (e.g. mega lab)
 Knowledge and research capability
 Connections with academic intuitions
Department of Public Health
Maccabi offers an ideal framework for
health services research
 Defined and stable population.
 Integrated health care system dedicated to finding solutions to
unknown problems.
 Full access to health status and treatment to all members.
 System is characterized by mutual dynamic interaction between
health care and research.
Department of Public Health
Information System
Maccabi’s fully computerized health system includes
 ID numbers and demographic information for each member.
 Physician visits including diagnoses and treatments.
 Medications prescriptions and purchases at Maccabi
pharmacies.
 Diagnostic procedures and results: laboratory, pathology.
 Visits to expert consultation clinics and para- medical centers.
 Visits to out patient hospital clinics.
 Hospitalization.
 Visits and treatment by supportive and para medical services.
Department of Public Health
Integrated Information System
Information Sources
Doc. Clinic
Members
Members
Members
Members
Internet
Doc. Clinic
Medical
Control
Pharmacy
Main Computer
Intranet
Specialist
Clinic
Extranet
Firewall
Backup
Computer
Consultant
CMR
Admin
Control
Payment
Control
ERP
IDC
Paramedic
Diagnostic
Center
IDC
Drug
consumptio
n control
Department of Public Health
Labs
control
Tele
radiology
Web
Services
Mgmt. of
Service
Providers
IDC
Mgmt. of
the Fund
Mgmt. of
Insured
People
Reimburse-ment
Control
Department of Public Health
Information : Type and Scope
 Administrative and medical data bases on over 2 million people
collected over a 16 year time span.
 Integrated data base includes clinical, financial and
demographic data.
 Medical data includes information from all physicians and other
care givers, clinics, laboratories and etc.
 Recently the centralized electronic health record (EHR) program
, further improved data by Physicians.
 Data Base is easily accessible to researchers.
Department of Public Health
Publications in Professional Journals
Heymann AD, Tarashansky I, Kokia E, Chodick G. The use of organizational data for
the evaluation of mass prevention programs. Prev Med. 2004 Dec;39(6):1143-7.
Heymann AD, Shapiro Y, Chodick G, Shalev V, Kokia E, Kramer E, Shemer J. Reduced
hospitalizations and death associated with influenza vaccination among patients
with and without diabetes. Diabetes Care. 2004 Nov;27(11):2581-4.
Heymann AD, Hoch I, Valinsky L, Shalev V, Silber H, Kokia E. Mandatory Computer
Field for Blood Pressure Measurement Improves Screening. Family Practice 2005;
22(2):168-9.
Heymann A, Hodick G, Halkin H, Shalev V , Kokia E, Shemer J. The implementation
of country-wide managed care for diabetes using medical informatics in a large
Preferred Provider Organization. Diabetes research and clinical practice. 2006;
71:290-8.
Lerman Y, Chodick G, Tepper S, Livni g, Ashkenazi S. Seroepidemiology of varicellazoster virus antibodies among health-care workers and day-care-centre workers.
Epidemiol Infect. 2004 Dec;132(6):1135-8.
Department of Public Health
Publications in Professional Journals
Heymann AD, Chodick G, Reichman B, Kokia E, Laufer J. Influence of school closure on
the incidence of viral respiratory diseases among children and on health care
utilization. Pediatr Infect Dis J. 2004 Jul;23(7):675-7.
Hoch I, Heymann AD, Kurman I, Valinsky LJ, Chodick G, Shalev V. Countrywide
computer alerts to community physicians improve potassium testing in patients
receiving diuretics. J Am Med Inform Assoc. 2003 Nov-Dec;10(6):541-6. Epub 2003 Aug
4.
Huerta M, Chodick G, Balicer RD, Davidovitch N, Grotto I. Reliability of self-reported
smoking history and age at initial tobacco use. Prev Med. 2005 Aug;41(2):646-50.
Kaye R. Long Term Care – The Next Revolution? Accepted for publication in proceedings
from The Third International Jerusalem Conference on Health Policy, Dec 2006.
Moshe S. Levin M. occupational aspects of low back pain. Harefua 2005:144;492-496.
Department of Public Health
Publications in Professional Journals
Chodick G, Heymann AD, Wood F, Kokia E. The direct medical cost of diabetes
in Israel. Eur J Health Econ. 2005 Feb 3.
Shalev V, Chodick G, Bialik M, Heymann AD. Predictors of mortality in people
with diabetes in a population based five years follow-up. Journal of
Clinical Epidemiology accepted 3.06.
Shapiro J, Cohen AD, David M, Chodik G, Viner A, Kremer E, Heymann AD
The association between Psoriasis, Diabetes Mellitus and Atherosclerosis in
Israel.Journal of the American Academy of Dermatology accepted 8.06
Shmuely H, Samra Z, Ashkenazi S, Dinari G, Chodick G, Yahav J. Association
of Helicobacter pylori infection with Shigella gastroenteritis in young
children. Am J Gastroenterol. 2004 Oct;99(10):2041-5.
Sikron R, Wilf-Miron R, Israeli A. Adolescent pregnancy in Israel: a
methodology for rate estimation and analysis of characteristics and
trends. Harefuah. 2003 Feb;142(2):131-6, 158, 157. Review. Hebrew.
Department of Public Health
Sample Research Grants
Research Subject
Funding Organization
Grant (NIS)
A study to examine the differences
between different primary physician’s
specialty on patient’s health and health
utilization
The Israel National Institute
for Health Policy and Health
Services Research
98,000
Implementing Clinical Guidelines in Primary
Care Medicine in Israel: Changing
Physicians’ Behavior.
The Israel National Institute
for Health Policy and Health
Services Research
200,000
What are the factors the encourage and
obstruct the delivery of preventive care to
the elderly in primary care
The Israel National Institute
for Health Policy and Health
Services Research
100,000
Financial Thinking for Physicians and
Healthcare Consumers
The Israel National Institute
for Health Policy and Health
Services Research
500,000
The Content of Pediatric Practice in the
Community and Training for the Task.
The Israel National Institute
for Health Policy and Health
Services Research
500,000
Complementary Health Insurance in Europe
and the West: Dilemmas and Directions
The Israel National Institute
for Health Policy and Health
Services Research
65,000
Department of Public Health
Teaching Experience
Dr. Ayala Blau, Lecturer, Wolfson School of Nursing, School of Nursing, Tel Hashomer
Hospital
Dr. Anthony Heymann- Lecturer, Tel Aviv University, Faculty of Medicine, Department of
Family Medicine
Leora Valinsky – Lecturer, School of Nursing and Public Health, Edith Cowan
University, Perth, Western Australia, School of Medicine, Univ Of Western Australia
Dr. Gabriel Chodick- Lecturer, Department of Epidemiology, Tel Aviv University
Dr. Sandhaus-Lecturer, Tel Aviv University, School of Medicine, pediatrics
Dr. Shlomo Moshe- Lecturer, Tel Aviv University, School of Medicine
Dr. Joseph Cohen-Lecturer, Technion, School of Medicine, Wolfson Hospital, diabetes
Dr. Miki Nobel- Lecturer, Tel Aviv University, School of Medicine, surgery
Dr. Galit Fussman- Lecturer, Tel Aviv University, School of Medicine, family medicine
Dr. Ehud Kokia- Lecturer, Ben Gurion University, health administration
Dr. Rachelle Kaye- Lecturer, University of Denver, Guest Lecturer, School of Public
Health, Hadassah University Hospital, lecturer, Kiryat Ono College, Health Insurance
and long term care
Dr. Shelley Sternberg – Lecturer, University of Toronto, Assistant Prof, Department of
Medicine, University of Chicago
Prof. Yair Shapiro-Prof, Ben Gurion University, Tel Aviv University, faculty of health
sciences, Judea & Samria College, department of physiology and pharmacology,
School of Public Health.
Department of Public Health
Types of Support and Mentoring
for Students
 Research planning and Methodology.
 Data Extraction.
 Data Analysis consultation.
 Reporting Consultation.
Department of Public Health
Examples of projects supported by the
Department of Public Health
BA Students: Degree in Health Administration
at the Ben-Gurion University and Emek- Jezrael College
 Intervention Program by Nurses in Patients to Improve Mammography.
 Performance Measurement to Gauge Improvement of Mammography
Screening.
 Effectiveness of Group Therapy Sessions on Health and Compliance in
Diabetic Patients.
 Predictors of Beta blocker Use for Post MI Patients in a Preferred
Provider Organization.
Department of Public Health
Department of Public Health
LONG TERM CARE – THE NEXT REVOLUTION?
__________________________________________________________
Rachelle Kaye, PhD
Maccabi Healthcare Services, Israel
_____________________________________________________________________
The issue of Long Term Care, particularly for the dependent elderly, has been of increasing
concern in all of the countries of the Western world, and is even beginning to demand
attention in developing countries. One of the obvious reasons for this growing concern is
demography. Life expectancy is increasing and is expected to continue increasing,
particularly in the elderly population. From 1960 to 2000, the life expectancy of males aged
65 in OECD countries increased by almost 3 years – an increase of 22%, while the life
expectancy of women aged 65 increased by almost 5 years – an increase of more than
30%.[1]
As a result of increasing life expectancy as well as the trend in decreasing birth rates, the
share of older people in the population has increased dramatically and the prediction is that
it will continue to increase. In 1960 the OECD average for the share of persons aged 65
and over was 8.7% of the population. In 2000 it had increased to 13.8% and the projection
for 2040 is 25.6%. It should be noted that the average share of persons aged 65+ for
Western Europe in 2000 was even higher than the OECD average – about 15%. The
increase in the share of persons over 80 in the population is no less dramatic. In 1960 it
was 1.3%, in 2000 it was 3.1% and the projection for 2040 is almost 8% - similar to the
average for the over 65s in 1960.[2]
Accepted for publication in The Proceedings of the Third International Jerusalem Conference on Health Policy.
Department of Public Health
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Department of Public Health