A prominent health economist has urged the new government to significantly
increase its funding of public medicine. Favoring private health insurance has
increased residents out-of-pocket expenditures and “altered Israel’s health care
system for the worse,” wrote Prof. Dov Chernichovsky, who teaches and researches
health economics and policy at Ben-Gurion University of the Negev, in the
journal Health Affairs.
The BGU economist noted Tuesday in his article
that Israel has a better doctor/patient ratio than in other Organization for
Economic Cooperation and Development (OECD) countries.
However, it is
declining rapidly due to physician emigration; career switches to private
medical institutions; and higher demands on the system due to the rapid aging of
The state’s per-capita contribution to the health care of
the aging population in recent years has increased by just 4.3 percent while
private funding rose by 43.7%.
He said the government could increase the
number of doctors by increasing the number of medical students or by introducing
the profession of physician assistants.
The Health Ministry recently
voiced support for this idea in theory, but it has not yet taken any action to
He noted that the reduction of state contributions for
health care was triggered by the section in the Treasury-instigated Arrangements
Law Encouraging Economic Growth and Employment in 1998. In that year, the
government’s share of total health spending was 68.4%, but in 2009 it had
declined to only 58.9%, with the remainder paid for by citizens, who should have
more of a say in choosing what publicsystem doctors will treat them, he
More residents get less health care in public hospitals and health
fund clinics, and many publicly paid physicians moonlight at “less efficient and
increasingly unaffordable” private facilities to earn more
Inequities in access to care by lower socioeconomic sectors have
been the result, Chernichovsky wrote.
While Israel still has a relatively
young population, the share of older people who need more medical care is
growing. The number of people aged 75 and older is growing at an annual rate of
4.6% – about twice the growth rate of the whole population.
recommended that the government hike the share of gross domestic product that it
spends on health care from 8% to 9%. This is closer to the average of the OECD
and the level can return to the 1998 figure.
Less money would be wasted
on private medicine, he said, and the publicly supported system would be more
responsive to changing circumstances by adopting care practices and technology
to alleviate the impact of the declining physician-to-population ratio, he
Chernichovsky also recommended that in addition to accepting
physician assistants, doctors in specialties with too little manpower would be
able to get higher wages through a personal contract than those set down by the
Israel Medical Association union contract with the government.
changes would come at the expense of private pay to physicians who are already
paid by the public and the investment and use of privately funded infrastructure
and technology that are already available in publicly funded facilities... This
arrangement would also give hospital managers the autonomy – and the public
funds – they need to manage their physician workforce more effectively than they
do now,” Chernichovsky explained.
Doctors in the periphery are given
bonuses for leaving the Center of the country, a benefit that came out of the
2011 doctors’ strike.
Chernichovsky suggested that advocating reform
would stop the government from running state hospitals, including psychiatric
institution. Instead, handing them over to competing, nonprofit hospital
corporations – stymied by Treasury opposition – would eliminate the Health
Ministry’s conflict of interest in owning, running and supervising health care
institutions, he said.
He concluded that Israel has a high-performing
health care system and the population has one of the best life expectancies in
the world. These accomplishments have resulted mostly from “a relatively high
ratio of very qualified physicians to population, coupled with equitable and
efficient funding and operations.”
But times and conditions have changed,
Chernichovsky said, and they can “create great inequities and must be handled
He urged the state to “resume its leading role in financing
health care while relinquishing its relatively sizable roles as a manager and
provider of care.”