Israel has established one of the most enviable health care systems among OECD countries in the 15 years since it legislated mandatory health insurance. While most OECD countries have been grappling with rapidly rising health costs, Israel has contained growth in health care costs to less than half the average for OECD countries over the past decade. Health care spending in Israel absorbed 7.9% of GDP in 2009 – the eighth lowest among OECD countries. While low levels of health spending are likely to reflect successive years of tight control over spending and the lesser demands of a younger and healthier population, Israel has also made the most of tight budgetary circumstances to build a health care system with high-quality primary health care.