I am an American expat. As a pregnant woman in Israel it is challenging to navigate a new health system when most of my information resources are geared to another system. This is especially true for pregnancy, where there are many decisions to make regarding symptom management, prenatal testing, and giving birth. However, on comparing the US and Israeli health care systems from my perspective, I find that the latter has notable advantages.
Unlike the semi-private system in the US, Israel has a nationalized, single-payer health system. This difference reveals itself in terms of spending priorities. For example, in the US, obstetricians are responsible for all prenatal care and deliveries, both low- and high-risk. In Israel, the default is for gynecologists to manage pregnant women’s health and for registered nurse midwives to deliver babies. Special facilities and obstetricians are available in the event of complications. This approach is less costly, yet results in similar or better health outcomes.
In a private system, doctors and hospitals may try to attract patients with perks such as more attractive facilities and more attentive staff. In Israel, the law prohibits private midwives; many hospitals will not accept private OBs or doulas in order to ensure that care is not stratified by economic status. Furthermore, the women I’ve spoken with report somewhat spartan conditions in the regular birth wards, but are overwhelmingly satisfied with the level of care for women and neonates who experience complications. In other words, money goes towards medical necessities rather than pleasing the patients.
Another major difference between the US and Israel is the attitude of medical professionals towards the women in their care. US practitioners are more proactive in providing guidelines to pregnant women regarding food and medication safety and symptom management. Israeli practitioners rely on women to do their own basic research and to ask specific questions. Further, in the Israeli system, women have unlimited, no-cost visits to family doctors and gynecologists, whereas cost of prenatal care and testing are greater concerns to women in the US.
Critics of nationalized health care in the US argue that such systems reduce patient choice and reduce quality of care. In my experience, it is true that patient options are more limited. However, outcomes are comparable on average. Furthermore, the limited out-of-pocket expenses and the clear information on costs faced by patients contribute to peace of mind.