Health and Zionism: The Israeli Health Care System, 1948-1960 (review)

Shifra Shvarts's book, Health and Zionism: The Israeli Health Care System, 1948-1960 is a follow-up to Shvarts's Workers' Health Fund in Eretz Israel: Kupat Holim 1911-1937, published in 1997. The book details the development of the Israeli health care system, particularly the story of Kupat Holim (Sick Fund of the Histadrut), in the years slightly before and mostly after the establishment of the state of Israel in 1948. The book consists of six chapters, plus introduction and conclusion, and explores the stages of Kupat Holim's internal politics alongside its role in national politics. Established in 1920, Kupat Holim remains a major medical provider/ insurer in the state of Israel. Although the book is titled Health and Zionism, the ideology of Zionism is not featured as prominently here as is the history of the Workers' Health Fund. This is not a book about the place of health in the Zionist movement but rather one about constructing, strengthening, and facing the challenges of a health care institution and health care delivery within the larger context of building a new state.

Like Shvarts's earlier work, this book fits squarely within the scholarly literature on Israeli politics and society investigating the development of state and civil society institutions (and their relationship) alongside the various challenges the state faced in its early years. Although it can also be utilized by health care management and organization scholars, some of the book is written at a level of detail that most likely would be most appreciated by specialists working on particular issues in the history of medicine in Israel. Meticulous accounts of meetings and physician character conflicts could seem at times onerous to a nonspecialist.

One of the most interesting parts of the book—for both scholars of Israel and of the Middle East at large—is Shvarts's discussion of the medical delivery plans made by Ben Gurion, Chaim Sheba, and others before 1948 in anticipation of an all-out war and the building of a state thereafter. Although Shvarts doesn't analyze it as such, this section shows the reader that the Zionist leadership understood well before May 1948 that an extensive war would occur (not just the one characterized by domestic strife that started in 1947) with the pronouncement of a Jewish state, involving neighboring Arab countries. Shvarts shows that Ben Gurion and others understood that in all likelihood, a state would ensue (i.e., inferences are made that the Jews would win, although the boundaries of the state remained unknown) and that the state would need sophisticated and well-coordinated health services and institutions throughout the country. This concern spawned the establishment of a Military Medical Service, a service that was "created primarily in order to meet the needs of the Yishuv in wartime" but also "fueled by the vision of health services for the army and the State's citizenry at the end of the war" (p. 263).

Shvarts's book also contributes to our understanding of the dynamics of immigration and health care delivery after the establishment of the State of Israel. During the late 1940s and 1950s, Israel experienced massive immigration from Middle Eastern countries (Yemen, Morocco, Iraq, etc.) as well as from refugee camps that had housed Holocaust survivors. Shvarts details the debate about medical selection of immigrants—stating that though the topic was seriously considered, it was rarely implemented or carried out in practice. She looks at health care in the transit camps (Shaar HaAliyah), and at how Kupat Holim made a deal with the government to serve all immigrants for the first three months of residency. This initial service ultimately allowed Kupat Holim to attract more recruits into their system and into the Labor Federation (Histadrut) at large. As a long-term consequence, Kupat Holim was able to expand...