Giora Kaplan | The Gertner Institute (original) (raw)
Papers by Giora Kaplan
Israel Journal of Health Policy Research, Jan 8, 2024
Background End-of-life (EoL) care practices (EoLCP) are procedures carried out at the EoL and bea... more Background End-of-life (EoL) care practices (EoLCP) are procedures carried out at the EoL and bear directly on this stage in the patient's life. Public support of these practices in Israel is far from uniform. Previous studies show that while ∼30% of participants support artificial respiration or feeding of terminally ill patients, 66% support analgesic treatment, even at the risk of shortening life. This study aimed to create a typology of six end-of-life care practices in Israel and assess the association of medical, social, and normative factors with the implementation of those practices. These practices included mechanical ventilation, artificial feeding, deep sedation, providing information to the patient and family caregivers, including family caregivers in EoL decision-making, and opting for death at home. Methods This cross-sectional study was performed as an online survey of 605 adults aged 50 or more in Israel, of which ~ 50% (n = 297) reported supporting a dying terminally ill relative in the last 3 years. Participants were requested to provide their account of the EoL process of their relative dying from a terminal illness in several aspects, as well as the EoL care practices utilized by them. Results The accounts of the 297 interviewees who supported a dying relative reveal a varied EoL typology. The utilization of end-of-life care practices was associated with the socio-normative beliefs of family caregivers but not with their socioeconomic status. Strong correlations were found between family caregiver support for three key practices (mechanical ventilation, artificial feeding, and family involvement in EoL) and the actual utilization of these practices in the care of dying patients. Conclusions The findings portray an important image of equity in the utilization of EoLCP in Israel, as the use of these practices was not associated with socioeconomic status. At the same time, the study found substantial diversity in family caregivers' preferences regarding EoL care practices use not related to socioeconomic status. We believe that differences in preferences that do not lead to problems with equity or other important societal values should be respected. Accordingly, policymakers and health system leaders should resist calls for legislation that would impose uniform EoL practices for all Israelis. Instead, they should take concrete steps to preserve and enhance the widespread current practice of practitioners to adapt EoL care to the varied needs and preferences of Israeli families and cultural, social, and religious subgroups. These steps should include providing frameworks and tools for family caregivers to support their loved ones close to their deaths, such as educational programs, seminars, supportive care before and during the end of life of their loved ones, etc.
Health policy, Jun 1, 2017
The majority of Israelis voluntarily purchased supplemental health insurance The public shows l... more The majority of Israelis voluntarily purchased supplemental health insurance The public shows low level of knowledge about the insurance Three different measurements were used to evaluate knowledge Knowledge is a basic condition to an intelligent use of insurance's benefits Abstract: Background: The National Health Insurance Law in Israel ensures basic health basket eligibility for all its citizens. A supplemental health insurance plan (SHIP) is offered for an additional fee. Over the years, the percentage of supplemental insurance's holders has risen considerably, ranking among the highest in OECD countries. The assumption that consumers implement an informed rational choice based on relevant information is doubtful. Are consumers sufficiently well informed to make market processes work well? Objectives: To examine perspectives, preferences and knowledge of Israelis in relation to SHIP. Methodology: A telephone survey was conducted with a representative sample of the Israeli adult population. 703 interviews were completed. The response rate was 50.3%. Findings: 85% of the sample reported possessing SHIP. This survey found that most of the Israeli public parched additional insurance coverage however did not show a significant knowledge about the benefits provided by the supplementary insurance, at least in the three measurements used in this study. Conclusions, policy implications and recommendations: The scope of SHIP acquisition is very broad and cannot be explained in economic terms alone. Acquiring SHIP became a default option rather than an active decision. It is time to review the goals, achievements and side effects of SHIP and to create new policy for the future.
PubMed, Jun 1, 2007
Background: The relationship between immigration and health has unique aspects during adolescence... more Background: The relationship between immigration and health has unique aspects during adolescence because of the psychosocial aspects of health status at this age. Aims: To provide data on the physical and emotional health, risk behavior and services utilization of the new immigrant youth from the Former Soviet Union, compared with long-term Israeli residents and Israeli-born youth. Methods: A survey was performed among Israeli-born and former Soviet Union-born pupils from middle and high schools living in Rishon-le-Zion. A self-reported anonymous questionnaire was completed by 861 adolescents, 29% of them new immigrants. Results: No relationship was found between the immigration status or the number of years in Israel and physical or emotional health. Overall, 82% of the entire sample reported at least one health symptom such as pain or fatigue; 5% reported a chronic disease (mostly asthma) and 9% were overweight; 80% reported to have at least one emotional problem; however the immigration status had no influence on this situation. A total of 11% of the new immigrants reported smoking (5% of the Israeli-born), but in the multivariable analysis the immigration status was not significant. Furthermore, 40% of the new immigrants reported consuming alcoholic beverages compared to 25% of the Israeli-born. One quarter of the sample stated that they know someone who uses narcotic drugs. The percent of girls reporting they were involved in fights was higher among the new immigrants (21% compared to 12%). New immigrants report less visits to dentists even when controlling for other variables. Conclusions: In general, the authors found many health problems among the youth but no significant differences between the two groups were found. New immigrants reported higher rates of risk behavior.
Cancer Nursing, Mar 1, 2008
The dual adjustment to being a cancer patient and an immigrant involves major changes in life and... more The dual adjustment to being a cancer patient and an immigrant involves major changes in life and might be a severe experience. This study set out to describe the experience of women who have come to Israel from the former Soviet Union and are coping with ovarian cancer. It focused on illness narratives as presented by 8 patients with cancer at stage III. Our findings indicated that the dual process might have different implications according to the meaning attributed by the patient to the illness situation. Viewing the illness as one more burden among other difficulties, such as language barrier, was a prism through which patients experienced their vulnerability in coping with the illness. Alongside a helplessness pattern, we found indications of interviewees' perceiving advantages in their status as immigrant cancer patients, by dealing with that problem alongside other difficulties. They showed a "fighting spirit" in coping with the illness. Immigration can have a moderating effect on patients' experiences, and the 2 stressors do not necessarily accumulate. Our findings indicate that patients' meaning to the illness experience was a "litmus test," which indicated the way patients would describe their coping stages. This may have potential as a clinical marker of psychological vulnerability.
BMC Public Health, May 27, 2010
Background: Studies have shown that perceived discrimination may be associated with impaired heal... more Background: Studies have shown that perceived discrimination may be associated with impaired health. The aim of this study was to assess the levels of perceived discrimination on the basis of origin and ethnicity and measure the association with health in three population groups in Israel: non-immigrant Jews, immigrants from the former Soviet Union, and Arabs. Methods: A cross sectional random telephone survey was performed in 2006 covering 1,004 Israelis aged 35-65; of these, 404 were non-immigrant Jews, 200 were immigrants from the former Soviet Union and 400 were Arabs, the final number for regression analysis was 952. Respondents were asked about their perceived experiences with discrimination in seven different areas. Quality of life, both physical and mental were measured by the Short Form 12. Results: Perceived discrimination on the basis of origin was highest among immigrants. About 30% of immigrants and 20% of Arabs reported feeling discriminated against in areas such as education and employment. After adjusting for socioeconomic variables, discrimination was associated with poor physical health among non-immigrant Jews (OR = 0.42, CI = 0.19, 0.91) and immigrants (OR = 0.51, CI = 0.27, 0.94), but not among Arabs. Poor mental health was significantly associated with discrimination only among non-immigrant Jews (OR = 0.42, CI = 0.18, 0.96). Conclusions: Perceived discrimination seemed high in both minority populations in Israel (Arabs and immigrants) and needs to be addressed as such. However, discrimination was associated with physical health only among Jews (nonimmigrants and immigrants), and not among Arabs. These results may be due to measurement artifacts or may be a true phenomenon, further research is needed to ascertain the results.
New Media & Society
eHEALS is one of the most prevalent scales used to measure eHealth literacy. However, significant... more eHEALS is one of the most prevalent scales used to measure eHealth literacy. However, significant criticism toward its conceptualization had raised. This study tests the effects of eHEALS alongside constructs from the elaboration likelihood model and information seeking processes, within a multidimensional model to predict medical decision-making quality. We test this model using a sample of 56 participants who completed a 45-minute online simulation task, requiring them to offer recommendation for a hypothetical medical scenario. Findings revealed that neither eHealth literacy nor elaboration likelihood independently predicted decision quality. However, eHEALS was positively associated with higher decision quality, but only among participants who had greater motivation and ability to process health information, and who used more complex information seeking strategies. Findings suggest that the eHEALS measure can be examined using a multidimensional theoretical approach to illustrat...
European journal of public health, May 3, 2010
Background: Extreme and acquiescence biases are the tendency to give a positive or extreme answer... more Background: Extreme and acquiescence biases are the tendency to give a positive or extreme answer regardless of the 'true' answer. These biases may compromise comparisons of attitudes regarding health between population groups. The aim of the study was to measure the extent of extreme and acquiescence biases and identify factors associated with them in two ethnic groups: Jews and Arabs in Israel. Methods: A random telephone survey was conducted during 2006, interviewing 2322 Jews and 809 Arabs. Three attitude questions were presented twice with opposite wording to measure extreme and acquiescence biases in these two groups. Results: Extreme bias ranged from 2 to 14% among Jews and from 6 to 29% among Arabs, depending on the question. Acquiescence bias ranged from 2 to 10% among Jews and 5-19% among Arabs. The less educated respondents gave more extreme biased responses for all items. The older respondents gave more extreme answers for two out of the three questions tested. After adjusting for age and education the odds ratio (OR) of giving more extreme biased answers was higher among Arabs compared with Jews for all three questions [OR = 2.49, confidence interval (CI) = 1.87, 3.31; OR = 2.33, CI = 1.75, 3.10; and OR = 2.94, CI = 1.83-4.71, respectively, for each question]. Conclusions: Levels of response biases are higher in the Arab minority population compared with the majority Jewish population and depended on the subject, age and education.
PubMed, Dec 1, 2001
Background: A mass influx of immigrants from the former Soviet Union to western countries and Isr... more Background: A mass influx of immigrants from the former Soviet Union to western countries and Israel followed the demise of the Soviet Bloc at the beginning of the 1990s. It was expected that these immigrants would have a higher morbidity and mortality rate similar to that in the former USSR. Objectives: To measure and compare self-reported diseases, subjective health and health services utilization of a representative sample of veteran Israeli Jews and immigrants from the former USSR. Methods: A cross-sectional survey of Israeli adults was performed by telephone interviews. The survey included 793 Israeli Jews, of whom 124 were immigrants from the former USSR who arrived in Israel after 1989 (response rate 52%). Results: The immigrants reported a higher rate of diseases and sub-optimal health after adjustment for other variables. However, no excess in health services utilization was reported. A time trend of reporting sub-optimal subjective health was observed: the longer the immigrants spent in Israel the more their reporting patterns resembled those of immigrants who arrived in Israel before 1970. Those who arrived after 1994 more frequently reported having a chronic disease. Conclusions: Acculturation seems to have been the main effect on the immigrants' health, together with a healthy migrant effect at the beginning of the 1990s. The immigrants' health was worse in the later years of the immigration wave, partially reflecting the poor state of health in the former Soviet Union compared to Israel.
Israel Journal of Health Policy Research, Jun 28, 2016
Background: Decision makers often assume they know the public's standpoints and see themselves as... more Background: Decision makers often assume they know the public's standpoints and see themselves as capable of representing them. The aim of this study is to assess the level of acquaintance that senior decision-makers in the Israeli health system have concerning the priorities of the public in whose name they act. Methods: A phone survey was conducted with a representative population sample and face-to-face interviews were conducted with senior decision-makers. Results: The decision-makers did predict correctly the public's desired level of government involvement in health care; but only some of them correctly predicted the public's preferences on allocation of funds-to health versus other areas. They had difficulty foreseeing public priorities for allocating additional monies to health, and even greater difficulty ascertaining preferences of the public for their own health insurance. Conclusions: Government decision-making processes should include evidence about public preferences. The findings of this study indicate that decision makers need to be provided with reliable, systematic information on public preferences.
Quality of Life Research, May 2, 2016
PurposeLow self-rated health (SRH) has been found to be associated with increased risk of type 2 ... more PurposeLow self-rated health (SRH) has been found to be associated with increased risk of type 2 diabetes (T2D) and with mortality. We examined the possible interaction between SRH and diabetic state on all-cause mortality in a large cohort of elderly subjects, followed for 14 years.MethodsDuring the years 2000–2004, survivors of the nationwide longitudinal Israel Study of Glucose Intolerance, Obesity and Hypertension were interviewed and examined for the third follow-up. The 1037 participants (mean age 72.4 ± 7.2 years) were asked to rate their health as: excellent, good, fair, poor, or very poor. Glucose categories were as follows: Normoglycemic, Prediabetes, T2D and Undiagnoseddiabetes. Survival time was defined as the time from interview to date of death or date of last vital status follow-up (August 1, 2013). Multivariate Cox proportional hazards models were performed in order to assess whether SRH interacts with glycemic state in the association with mortality.ResultsA better SRH was reported by those with undiagnosed than known diabetes, and best for normoglycemic and prediabetic individuals. While all individuals with fair or poor/very poor SRH were at increased risk of mortality compared to those with excellent/good SRH, in the known diabetic individuals a greater hazard was observed in the excellent/good SRH (HR 3.32, 95 % CI 1.71–6.47) than in those with fair or poor/very poor SRH (HR 2.19, 95 % CI 1.25–3.86), after adjusting for age, sex, ethnic origin, marital status, education, BMI, physical activity, CVD, tumors, and creatinine level (p for interaction = 0.01).ConclusionsSelf-rated health is not a sensitive tool for predicting mortality in elderly men and women with known T2D.
Social Science & Medicine, Nov 1, 2009
Disparities in health exist between the three main population groups in Israel, non-immigrant Jew... more Disparities in health exist between the three main population groups in Israel, non-immigrant Jews, immigrants from the former Soviet Union (arriving in Israel since 1990) and Arabs. This study examines the relationship between health and socioeconomic status in this multicultural population and assesses to what extent subjective and objective socioeconomic measures may explain the disparities in health. A random cross sectional telephone survey of 1004 Israelis aged 35-65 was performed. The questionnaire measured physical and mental health-related quality of life using the Short Form 12. Information regarding subjective socioeconomic status (SSS) and objective socioeconomic status (SES) was collected. Arabs and immigrant women from the former Soviet Union had worse physical health compared to non-immigrant Jews. Immigrant and Arab men and women had worse mental health compared to non-immigrant Jews. Multivariable log-linear regression analysis adjusting for age, SSS or SES explained the disparities in physical health between Arab and non-immigrant Jewish men. However, SSS and SES did not explain the disparities in physical health between the three groups of women. The disparities in mental health between immigrants and non-immigrant Jews can be explained by SSS for both men and women, whereas the disparities between Arabs and Jews can be explained by objective SES only among women. Employed men reported better physical and mental health. Part of the disparities in mental health in Israel can be attributed to differences in SSS and SES in the different groups. However, there is a need to identify additional factors that may add to the disparities in both physical and mental health. The disparities due to socioeconomic status vary by health measure and population group.
Social Science & Medicine, Nov 1, 2001
This study examines the agreement between two subjective health measures, a general question on s... more This study examines the agreement between two subjective health measures, a general question on subjective health and an age-related question on subjective health. The study identifies specific groups differing in their answer to the two questions. These measures are used frequently in health-related studies where a short measure is needed to estimate health. Therefore, it is important to understand how the population estimates its health. The study based on 793 telephone interviews shows that among respondents aged 65-75 with no reported diseases and those with less than 12 years of education with no reported diseases, the agreement between the two questions was poor. These two groups reported better health when they were asked to compare their health to people of their age and sex. Excellent agreement between the two questions was reported in those aged 55-64 with no diseases. The respondents having more years of education reported better health than the less educated but only when using the age-related subjective health measure. These findings demand caution when using different wordings in questions on subjective health in non-homogeneous populations.
International Journal of Environmental Research and Public Health, Nov 10, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
American Journal of Health Behavior, Sep 1, 2016
Objectives: Social support is associated with improved adherence to treatment recommendations amo... more Objectives: Social support is associated with improved adherence to treatment recommendations among patients with diabetes. This research examines negative dimensions of social support such as interference and insensitivity which may interfere with appropriate lifestyle choices. Methods: A telephone survey in Israel of 764 patients with type 1 and type 2 diabetes was conducted to assess social support and unsupportive social interactions, and correlate them with self-reported current health status. Results: Patients with higher levels of interference reported poorer health after adjusting for other factors including positive social support. Interference, which is a negative dimension of social support, was higher among Arabs than Jews (OR=2.12; 95% CI: 1.44, 3.10) after adjusting for factors, including positive social support, in a logistic regression model. Among Jews, the less educated, those not performing physical activity, and those with lower levels of social support reported significantly higher levels of interference. Insensitivity was lower among Arabs compared to Jews (OR=0.64, 95%CI: 0.44, 0.94) after adjusting for the variables in the regression model. Conclusions: Unsupportive social interactions can hamper adoption of a lifestyle needed for diabetes management, negatively influencing self-reported health.
Patient Preference and Adherence, Jul 1, 2015
Objectives: The positive aspects of social support and its impact on health have been studied ext... more Objectives: The positive aspects of social support and its impact on health have been studied extensively. However, there may also be negative effects of social environments on the diabetic patient. This study developed and validated a new diabetic unsupportive social interaction scale (USIS), including two subscales: interference and insensitivity. Methods: A list of 22 items depicting unsupportive interactions associated with management of diabetes was developed. A telephone survey was administered to 764 Israelis with diabetes. The questionnaire included the USIS and questions about social networks, social support, health behaviors, and health. The characteristics, validity, and reliability of the scale were tested. Results: A principal component analysis was performed for extraction of two factors describing unsupportive social interaction concepts: interference and insensitivity. Cronbach's alpha for the full 15-item scale was 0.84, indicating internal consistency. The two subscales were calculated to have Cronbach's alphas of 0.85 and 0.73, respectively. The USIS showed construct validity as it was associated with social support, some measures of social networks, subjective measures of health, and health behaviors. Arabs, older respondents, those defining themselves as more religious, and the less educated reported higher rates of unsupportive interactions. Conclusion: This study suggests a new concept of unsupportive interactions including interference and insensitivity. These unsupportive interactions may adversely affect patients' ability to adhere to treatment and may undermine their health in various ways. Identifying these problems may enable clinicians to help patients cope with their unsupportive environments.
Health Expectations, Apr 3, 2013
Background Rationing in health services cannot be solved only by cost-effective analysis because ... more Background Rationing in health services cannot be solved only by cost-effective analysis because social values play a central role in the difficult trade-off dilemma of prioritizing some service over others. Objective To examine the relative importance ascribed by the public to selected components of health services, in the national allocation of resources as well as in their personal insurance. Methods A telephone survey of a representative sample of the Israeli adult population (N = 1225). Two versions of the questionnaire were used. At the national level, interviewees were asked to assume they were the Minister of Health. At the personal level, interviewees were asked to choose items to be included in their personal complementary health insurance. Results Checkups for early disease detection and nursing care for the frail elderly got the highest support for extra budget as well as to be included in personal insurance. Other items presented were fertility treatments, cardiac rehabilitation, mental health, dental health, programmes for preventive medicine and health promotion, subsidizing supplemental insurance for the poor, additional staff for primary clinics and building a new hospital. The lowest support was for alternative medicine and for cosmetic surgery. No subgroup in the Israeli society presented a different first priority. Conclusion The Israeli public does not give high priority to 'nice to have' services but their selections are 'mature' and responsible. Rationing in health care requires listening to the public even if there are still many methodological limitations on how to reflect the public's opinion.
Palliative and Supportive Care
Objectives End-of-life (EoL) processes are a complex socio-normative and ethical phenomenon. This... more Objectives End-of-life (EoL) processes are a complex socio-normative and ethical phenomenon. This study aimed to generate a database of public opinion in Israel concerning EoL processes and decisions and to identify differences in attitudes across subgroups in the population, particularly based on experience as a family caregiver of a dying patient. Methods This cross-sectional study was performed in late March 2022. The study utilized an online sample of 605 adults over the age of 50 including those who accompanied a loved one to their death in the last 3 years. Participants were requested to provide their opinions and attitudes on several aspects of EoL decisions, including truth-telling, medically assisted dying, EoL procedures, pre-death actions, and family caregivers’ engagement. Results While only 27% and ∼30% of participants support artificial respiration or feeding (respectively) of terminally ill patients, 66% support analgesic treatment, even at the risk of shortening life...
Omega - Journal Of Death And Dying, Mar 29, 2023
Journal of Perinatology, 2016
Objective:Premature delivery and prolonged hospitalization of infants in the neonatal intensive c... more Objective:Premature delivery and prolonged hospitalization of infants in the neonatal intensive care unit (NICU) are very stressful for parents. As technology has advanced, short message services (SMS) have been used increasingly in the medical disciplines. To date, the use of SMS for updating patients and families regarding medical information has not been reported. We implemented the SMS technique to daily update the parents regarding the health status of their preterm infant. The objective of this study was to evaluate the use of SMS technology and to assess its impact on the parents and the nursing staff.Study Design:Parents and nurses completed questionnaires at two time periods: pre-SMS implementation (pre-SMSi) and post-SMS implementation (post-SMSi). The parent questionnaires included statements about medical information delivery, communication and trust between parents and medical staff, parental anxiety and overall satisfaction. The nurse questionnaires included statements about the expected and actual impact on their workload.Results:Comparison of the parents' responses at the two time periods indicated that in the post-SMSi time period, they felt that the physician was more available when needed (P=0.002), they were more comfortable about approaching the physician (P=0.001) and more satisfied with the medical information provided by the staff (P=0.03). In the post-SMSi period, 78.1% of the nurses noted that the SMS communication is a convenient and user-friendly method.Conclusions:SMS updating is an easy and user-friendly technology that enriches the modalities of information delivery to parents of hospitalized preterm infants. It is a complementary and useful tool for encouraging and improving personal communication between parents and medical staff and should be considered part of quality improvement in health care.
Israel Journal of Health Policy Research, Jan 8, 2024
Background End-of-life (EoL) care practices (EoLCP) are procedures carried out at the EoL and bea... more Background End-of-life (EoL) care practices (EoLCP) are procedures carried out at the EoL and bear directly on this stage in the patient's life. Public support of these practices in Israel is far from uniform. Previous studies show that while ∼30% of participants support artificial respiration or feeding of terminally ill patients, 66% support analgesic treatment, even at the risk of shortening life. This study aimed to create a typology of six end-of-life care practices in Israel and assess the association of medical, social, and normative factors with the implementation of those practices. These practices included mechanical ventilation, artificial feeding, deep sedation, providing information to the patient and family caregivers, including family caregivers in EoL decision-making, and opting for death at home. Methods This cross-sectional study was performed as an online survey of 605 adults aged 50 or more in Israel, of which ~ 50% (n = 297) reported supporting a dying terminally ill relative in the last 3 years. Participants were requested to provide their account of the EoL process of their relative dying from a terminal illness in several aspects, as well as the EoL care practices utilized by them. Results The accounts of the 297 interviewees who supported a dying relative reveal a varied EoL typology. The utilization of end-of-life care practices was associated with the socio-normative beliefs of family caregivers but not with their socioeconomic status. Strong correlations were found between family caregiver support for three key practices (mechanical ventilation, artificial feeding, and family involvement in EoL) and the actual utilization of these practices in the care of dying patients. Conclusions The findings portray an important image of equity in the utilization of EoLCP in Israel, as the use of these practices was not associated with socioeconomic status. At the same time, the study found substantial diversity in family caregivers' preferences regarding EoL care practices use not related to socioeconomic status. We believe that differences in preferences that do not lead to problems with equity or other important societal values should be respected. Accordingly, policymakers and health system leaders should resist calls for legislation that would impose uniform EoL practices for all Israelis. Instead, they should take concrete steps to preserve and enhance the widespread current practice of practitioners to adapt EoL care to the varied needs and preferences of Israeli families and cultural, social, and religious subgroups. These steps should include providing frameworks and tools for family caregivers to support their loved ones close to their deaths, such as educational programs, seminars, supportive care before and during the end of life of their loved ones, etc.
Health policy, Jun 1, 2017
The majority of Israelis voluntarily purchased supplemental health insurance The public shows l... more The majority of Israelis voluntarily purchased supplemental health insurance The public shows low level of knowledge about the insurance Three different measurements were used to evaluate knowledge Knowledge is a basic condition to an intelligent use of insurance's benefits Abstract: Background: The National Health Insurance Law in Israel ensures basic health basket eligibility for all its citizens. A supplemental health insurance plan (SHIP) is offered for an additional fee. Over the years, the percentage of supplemental insurance's holders has risen considerably, ranking among the highest in OECD countries. The assumption that consumers implement an informed rational choice based on relevant information is doubtful. Are consumers sufficiently well informed to make market processes work well? Objectives: To examine perspectives, preferences and knowledge of Israelis in relation to SHIP. Methodology: A telephone survey was conducted with a representative sample of the Israeli adult population. 703 interviews were completed. The response rate was 50.3%. Findings: 85% of the sample reported possessing SHIP. This survey found that most of the Israeli public parched additional insurance coverage however did not show a significant knowledge about the benefits provided by the supplementary insurance, at least in the three measurements used in this study. Conclusions, policy implications and recommendations: The scope of SHIP acquisition is very broad and cannot be explained in economic terms alone. Acquiring SHIP became a default option rather than an active decision. It is time to review the goals, achievements and side effects of SHIP and to create new policy for the future.
PubMed, Jun 1, 2007
Background: The relationship between immigration and health has unique aspects during adolescence... more Background: The relationship between immigration and health has unique aspects during adolescence because of the psychosocial aspects of health status at this age. Aims: To provide data on the physical and emotional health, risk behavior and services utilization of the new immigrant youth from the Former Soviet Union, compared with long-term Israeli residents and Israeli-born youth. Methods: A survey was performed among Israeli-born and former Soviet Union-born pupils from middle and high schools living in Rishon-le-Zion. A self-reported anonymous questionnaire was completed by 861 adolescents, 29% of them new immigrants. Results: No relationship was found between the immigration status or the number of years in Israel and physical or emotional health. Overall, 82% of the entire sample reported at least one health symptom such as pain or fatigue; 5% reported a chronic disease (mostly asthma) and 9% were overweight; 80% reported to have at least one emotional problem; however the immigration status had no influence on this situation. A total of 11% of the new immigrants reported smoking (5% of the Israeli-born), but in the multivariable analysis the immigration status was not significant. Furthermore, 40% of the new immigrants reported consuming alcoholic beverages compared to 25% of the Israeli-born. One quarter of the sample stated that they know someone who uses narcotic drugs. The percent of girls reporting they were involved in fights was higher among the new immigrants (21% compared to 12%). New immigrants report less visits to dentists even when controlling for other variables. Conclusions: In general, the authors found many health problems among the youth but no significant differences between the two groups were found. New immigrants reported higher rates of risk behavior.
Cancer Nursing, Mar 1, 2008
The dual adjustment to being a cancer patient and an immigrant involves major changes in life and... more The dual adjustment to being a cancer patient and an immigrant involves major changes in life and might be a severe experience. This study set out to describe the experience of women who have come to Israel from the former Soviet Union and are coping with ovarian cancer. It focused on illness narratives as presented by 8 patients with cancer at stage III. Our findings indicated that the dual process might have different implications according to the meaning attributed by the patient to the illness situation. Viewing the illness as one more burden among other difficulties, such as language barrier, was a prism through which patients experienced their vulnerability in coping with the illness. Alongside a helplessness pattern, we found indications of interviewees' perceiving advantages in their status as immigrant cancer patients, by dealing with that problem alongside other difficulties. They showed a "fighting spirit" in coping with the illness. Immigration can have a moderating effect on patients' experiences, and the 2 stressors do not necessarily accumulate. Our findings indicate that patients' meaning to the illness experience was a "litmus test," which indicated the way patients would describe their coping stages. This may have potential as a clinical marker of psychological vulnerability.
BMC Public Health, May 27, 2010
Background: Studies have shown that perceived discrimination may be associated with impaired heal... more Background: Studies have shown that perceived discrimination may be associated with impaired health. The aim of this study was to assess the levels of perceived discrimination on the basis of origin and ethnicity and measure the association with health in three population groups in Israel: non-immigrant Jews, immigrants from the former Soviet Union, and Arabs. Methods: A cross sectional random telephone survey was performed in 2006 covering 1,004 Israelis aged 35-65; of these, 404 were non-immigrant Jews, 200 were immigrants from the former Soviet Union and 400 were Arabs, the final number for regression analysis was 952. Respondents were asked about their perceived experiences with discrimination in seven different areas. Quality of life, both physical and mental were measured by the Short Form 12. Results: Perceived discrimination on the basis of origin was highest among immigrants. About 30% of immigrants and 20% of Arabs reported feeling discriminated against in areas such as education and employment. After adjusting for socioeconomic variables, discrimination was associated with poor physical health among non-immigrant Jews (OR = 0.42, CI = 0.19, 0.91) and immigrants (OR = 0.51, CI = 0.27, 0.94), but not among Arabs. Poor mental health was significantly associated with discrimination only among non-immigrant Jews (OR = 0.42, CI = 0.18, 0.96). Conclusions: Perceived discrimination seemed high in both minority populations in Israel (Arabs and immigrants) and needs to be addressed as such. However, discrimination was associated with physical health only among Jews (nonimmigrants and immigrants), and not among Arabs. These results may be due to measurement artifacts or may be a true phenomenon, further research is needed to ascertain the results.
New Media & Society
eHEALS is one of the most prevalent scales used to measure eHealth literacy. However, significant... more eHEALS is one of the most prevalent scales used to measure eHealth literacy. However, significant criticism toward its conceptualization had raised. This study tests the effects of eHEALS alongside constructs from the elaboration likelihood model and information seeking processes, within a multidimensional model to predict medical decision-making quality. We test this model using a sample of 56 participants who completed a 45-minute online simulation task, requiring them to offer recommendation for a hypothetical medical scenario. Findings revealed that neither eHealth literacy nor elaboration likelihood independently predicted decision quality. However, eHEALS was positively associated with higher decision quality, but only among participants who had greater motivation and ability to process health information, and who used more complex information seeking strategies. Findings suggest that the eHEALS measure can be examined using a multidimensional theoretical approach to illustrat...
European journal of public health, May 3, 2010
Background: Extreme and acquiescence biases are the tendency to give a positive or extreme answer... more Background: Extreme and acquiescence biases are the tendency to give a positive or extreme answer regardless of the 'true' answer. These biases may compromise comparisons of attitudes regarding health between population groups. The aim of the study was to measure the extent of extreme and acquiescence biases and identify factors associated with them in two ethnic groups: Jews and Arabs in Israel. Methods: A random telephone survey was conducted during 2006, interviewing 2322 Jews and 809 Arabs. Three attitude questions were presented twice with opposite wording to measure extreme and acquiescence biases in these two groups. Results: Extreme bias ranged from 2 to 14% among Jews and from 6 to 29% among Arabs, depending on the question. Acquiescence bias ranged from 2 to 10% among Jews and 5-19% among Arabs. The less educated respondents gave more extreme biased responses for all items. The older respondents gave more extreme answers for two out of the three questions tested. After adjusting for age and education the odds ratio (OR) of giving more extreme biased answers was higher among Arabs compared with Jews for all three questions [OR = 2.49, confidence interval (CI) = 1.87, 3.31; OR = 2.33, CI = 1.75, 3.10; and OR = 2.94, CI = 1.83-4.71, respectively, for each question]. Conclusions: Levels of response biases are higher in the Arab minority population compared with the majority Jewish population and depended on the subject, age and education.
PubMed, Dec 1, 2001
Background: A mass influx of immigrants from the former Soviet Union to western countries and Isr... more Background: A mass influx of immigrants from the former Soviet Union to western countries and Israel followed the demise of the Soviet Bloc at the beginning of the 1990s. It was expected that these immigrants would have a higher morbidity and mortality rate similar to that in the former USSR. Objectives: To measure and compare self-reported diseases, subjective health and health services utilization of a representative sample of veteran Israeli Jews and immigrants from the former USSR. Methods: A cross-sectional survey of Israeli adults was performed by telephone interviews. The survey included 793 Israeli Jews, of whom 124 were immigrants from the former USSR who arrived in Israel after 1989 (response rate 52%). Results: The immigrants reported a higher rate of diseases and sub-optimal health after adjustment for other variables. However, no excess in health services utilization was reported. A time trend of reporting sub-optimal subjective health was observed: the longer the immigrants spent in Israel the more their reporting patterns resembled those of immigrants who arrived in Israel before 1970. Those who arrived after 1994 more frequently reported having a chronic disease. Conclusions: Acculturation seems to have been the main effect on the immigrants' health, together with a healthy migrant effect at the beginning of the 1990s. The immigrants' health was worse in the later years of the immigration wave, partially reflecting the poor state of health in the former Soviet Union compared to Israel.
Israel Journal of Health Policy Research, Jun 28, 2016
Background: Decision makers often assume they know the public's standpoints and see themselves as... more Background: Decision makers often assume they know the public's standpoints and see themselves as capable of representing them. The aim of this study is to assess the level of acquaintance that senior decision-makers in the Israeli health system have concerning the priorities of the public in whose name they act. Methods: A phone survey was conducted with a representative population sample and face-to-face interviews were conducted with senior decision-makers. Results: The decision-makers did predict correctly the public's desired level of government involvement in health care; but only some of them correctly predicted the public's preferences on allocation of funds-to health versus other areas. They had difficulty foreseeing public priorities for allocating additional monies to health, and even greater difficulty ascertaining preferences of the public for their own health insurance. Conclusions: Government decision-making processes should include evidence about public preferences. The findings of this study indicate that decision makers need to be provided with reliable, systematic information on public preferences.
Quality of Life Research, May 2, 2016
PurposeLow self-rated health (SRH) has been found to be associated with increased risk of type 2 ... more PurposeLow self-rated health (SRH) has been found to be associated with increased risk of type 2 diabetes (T2D) and with mortality. We examined the possible interaction between SRH and diabetic state on all-cause mortality in a large cohort of elderly subjects, followed for 14 years.MethodsDuring the years 2000–2004, survivors of the nationwide longitudinal Israel Study of Glucose Intolerance, Obesity and Hypertension were interviewed and examined for the third follow-up. The 1037 participants (mean age 72.4 ± 7.2 years) were asked to rate their health as: excellent, good, fair, poor, or very poor. Glucose categories were as follows: Normoglycemic, Prediabetes, T2D and Undiagnoseddiabetes. Survival time was defined as the time from interview to date of death or date of last vital status follow-up (August 1, 2013). Multivariate Cox proportional hazards models were performed in order to assess whether SRH interacts with glycemic state in the association with mortality.ResultsA better SRH was reported by those with undiagnosed than known diabetes, and best for normoglycemic and prediabetic individuals. While all individuals with fair or poor/very poor SRH were at increased risk of mortality compared to those with excellent/good SRH, in the known diabetic individuals a greater hazard was observed in the excellent/good SRH (HR 3.32, 95 % CI 1.71–6.47) than in those with fair or poor/very poor SRH (HR 2.19, 95 % CI 1.25–3.86), after adjusting for age, sex, ethnic origin, marital status, education, BMI, physical activity, CVD, tumors, and creatinine level (p for interaction = 0.01).ConclusionsSelf-rated health is not a sensitive tool for predicting mortality in elderly men and women with known T2D.
Social Science & Medicine, Nov 1, 2009
Disparities in health exist between the three main population groups in Israel, non-immigrant Jew... more Disparities in health exist between the three main population groups in Israel, non-immigrant Jews, immigrants from the former Soviet Union (arriving in Israel since 1990) and Arabs. This study examines the relationship between health and socioeconomic status in this multicultural population and assesses to what extent subjective and objective socioeconomic measures may explain the disparities in health. A random cross sectional telephone survey of 1004 Israelis aged 35-65 was performed. The questionnaire measured physical and mental health-related quality of life using the Short Form 12. Information regarding subjective socioeconomic status (SSS) and objective socioeconomic status (SES) was collected. Arabs and immigrant women from the former Soviet Union had worse physical health compared to non-immigrant Jews. Immigrant and Arab men and women had worse mental health compared to non-immigrant Jews. Multivariable log-linear regression analysis adjusting for age, SSS or SES explained the disparities in physical health between Arab and non-immigrant Jewish men. However, SSS and SES did not explain the disparities in physical health between the three groups of women. The disparities in mental health between immigrants and non-immigrant Jews can be explained by SSS for both men and women, whereas the disparities between Arabs and Jews can be explained by objective SES only among women. Employed men reported better physical and mental health. Part of the disparities in mental health in Israel can be attributed to differences in SSS and SES in the different groups. However, there is a need to identify additional factors that may add to the disparities in both physical and mental health. The disparities due to socioeconomic status vary by health measure and population group.
Social Science & Medicine, Nov 1, 2001
This study examines the agreement between two subjective health measures, a general question on s... more This study examines the agreement between two subjective health measures, a general question on subjective health and an age-related question on subjective health. The study identifies specific groups differing in their answer to the two questions. These measures are used frequently in health-related studies where a short measure is needed to estimate health. Therefore, it is important to understand how the population estimates its health. The study based on 793 telephone interviews shows that among respondents aged 65-75 with no reported diseases and those with less than 12 years of education with no reported diseases, the agreement between the two questions was poor. These two groups reported better health when they were asked to compare their health to people of their age and sex. Excellent agreement between the two questions was reported in those aged 55-64 with no diseases. The respondents having more years of education reported better health than the less educated but only when using the age-related subjective health measure. These findings demand caution when using different wordings in questions on subjective health in non-homogeneous populations.
International Journal of Environmental Research and Public Health, Nov 10, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
American Journal of Health Behavior, Sep 1, 2016
Objectives: Social support is associated with improved adherence to treatment recommendations amo... more Objectives: Social support is associated with improved adherence to treatment recommendations among patients with diabetes. This research examines negative dimensions of social support such as interference and insensitivity which may interfere with appropriate lifestyle choices. Methods: A telephone survey in Israel of 764 patients with type 1 and type 2 diabetes was conducted to assess social support and unsupportive social interactions, and correlate them with self-reported current health status. Results: Patients with higher levels of interference reported poorer health after adjusting for other factors including positive social support. Interference, which is a negative dimension of social support, was higher among Arabs than Jews (OR=2.12; 95% CI: 1.44, 3.10) after adjusting for factors, including positive social support, in a logistic regression model. Among Jews, the less educated, those not performing physical activity, and those with lower levels of social support reported significantly higher levels of interference. Insensitivity was lower among Arabs compared to Jews (OR=0.64, 95%CI: 0.44, 0.94) after adjusting for the variables in the regression model. Conclusions: Unsupportive social interactions can hamper adoption of a lifestyle needed for diabetes management, negatively influencing self-reported health.
Patient Preference and Adherence, Jul 1, 2015
Objectives: The positive aspects of social support and its impact on health have been studied ext... more Objectives: The positive aspects of social support and its impact on health have been studied extensively. However, there may also be negative effects of social environments on the diabetic patient. This study developed and validated a new diabetic unsupportive social interaction scale (USIS), including two subscales: interference and insensitivity. Methods: A list of 22 items depicting unsupportive interactions associated with management of diabetes was developed. A telephone survey was administered to 764 Israelis with diabetes. The questionnaire included the USIS and questions about social networks, social support, health behaviors, and health. The characteristics, validity, and reliability of the scale were tested. Results: A principal component analysis was performed for extraction of two factors describing unsupportive social interaction concepts: interference and insensitivity. Cronbach's alpha for the full 15-item scale was 0.84, indicating internal consistency. The two subscales were calculated to have Cronbach's alphas of 0.85 and 0.73, respectively. The USIS showed construct validity as it was associated with social support, some measures of social networks, subjective measures of health, and health behaviors. Arabs, older respondents, those defining themselves as more religious, and the less educated reported higher rates of unsupportive interactions. Conclusion: This study suggests a new concept of unsupportive interactions including interference and insensitivity. These unsupportive interactions may adversely affect patients' ability to adhere to treatment and may undermine their health in various ways. Identifying these problems may enable clinicians to help patients cope with their unsupportive environments.
Health Expectations, Apr 3, 2013
Background Rationing in health services cannot be solved only by cost-effective analysis because ... more Background Rationing in health services cannot be solved only by cost-effective analysis because social values play a central role in the difficult trade-off dilemma of prioritizing some service over others. Objective To examine the relative importance ascribed by the public to selected components of health services, in the national allocation of resources as well as in their personal insurance. Methods A telephone survey of a representative sample of the Israeli adult population (N = 1225). Two versions of the questionnaire were used. At the national level, interviewees were asked to assume they were the Minister of Health. At the personal level, interviewees were asked to choose items to be included in their personal complementary health insurance. Results Checkups for early disease detection and nursing care for the frail elderly got the highest support for extra budget as well as to be included in personal insurance. Other items presented were fertility treatments, cardiac rehabilitation, mental health, dental health, programmes for preventive medicine and health promotion, subsidizing supplemental insurance for the poor, additional staff for primary clinics and building a new hospital. The lowest support was for alternative medicine and for cosmetic surgery. No subgroup in the Israeli society presented a different first priority. Conclusion The Israeli public does not give high priority to 'nice to have' services but their selections are 'mature' and responsible. Rationing in health care requires listening to the public even if there are still many methodological limitations on how to reflect the public's opinion.
Palliative and Supportive Care
Objectives End-of-life (EoL) processes are a complex socio-normative and ethical phenomenon. This... more Objectives End-of-life (EoL) processes are a complex socio-normative and ethical phenomenon. This study aimed to generate a database of public opinion in Israel concerning EoL processes and decisions and to identify differences in attitudes across subgroups in the population, particularly based on experience as a family caregiver of a dying patient. Methods This cross-sectional study was performed in late March 2022. The study utilized an online sample of 605 adults over the age of 50 including those who accompanied a loved one to their death in the last 3 years. Participants were requested to provide their opinions and attitudes on several aspects of EoL decisions, including truth-telling, medically assisted dying, EoL procedures, pre-death actions, and family caregivers’ engagement. Results While only 27% and ∼30% of participants support artificial respiration or feeding (respectively) of terminally ill patients, 66% support analgesic treatment, even at the risk of shortening life...
Omega - Journal Of Death And Dying, Mar 29, 2023
Journal of Perinatology, 2016
Objective:Premature delivery and prolonged hospitalization of infants in the neonatal intensive c... more Objective:Premature delivery and prolonged hospitalization of infants in the neonatal intensive care unit (NICU) are very stressful for parents. As technology has advanced, short message services (SMS) have been used increasingly in the medical disciplines. To date, the use of SMS for updating patients and families regarding medical information has not been reported. We implemented the SMS technique to daily update the parents regarding the health status of their preterm infant. The objective of this study was to evaluate the use of SMS technology and to assess its impact on the parents and the nursing staff.Study Design:Parents and nurses completed questionnaires at two time periods: pre-SMS implementation (pre-SMSi) and post-SMS implementation (post-SMSi). The parent questionnaires included statements about medical information delivery, communication and trust between parents and medical staff, parental anxiety and overall satisfaction. The nurse questionnaires included statements about the expected and actual impact on their workload.Results:Comparison of the parents' responses at the two time periods indicated that in the post-SMSi time period, they felt that the physician was more available when needed (P=0.002), they were more comfortable about approaching the physician (P=0.001) and more satisfied with the medical information provided by the staff (P=0.03). In the post-SMSi period, 78.1% of the nurses noted that the SMS communication is a convenient and user-friendly method.Conclusions:SMS updating is an easy and user-friendly technology that enriches the modalities of information delivery to parents of hospitalized preterm infants. It is a complementary and useful tool for encouraging and improving personal communication between parents and medical staff and should be considered part of quality improvement in health care.