Twenty years minus one day after the Knesset passed the law that instituted National Health Insurance in 1994, the German Committee to Strengthen the Public Health System presented a report that claims it will constitute the most important reform since then.
Health Minister Yael German and the 12 other members of the committee, along with the Health Ministry’s new director-general, Prof. Arnon Afek, stated at a press conference at the ministry’s Jerusalem headquarters on Wednesday that some of the changes will be instituted immediately and some implemented gradually in the next few years.
The Treasury will inject NIS 1 billion into improvement in healthcare and additional manpower, they said. There will be no “sharap” [private medical services] in hospitals owned by the government and Clalit Health Services, but they will be allowed to continue in Jerusalem medical centers. Residents will have a choice of being referred by their health fund to three hospitals rather than one, in hope of shorter queues for treatment and operations and higher-quality care. Steps will be taken to eliminate superfluous health insurance coverage.
Senior physicians in government and Clalit hospitals will be encouraged to become “full timers,” meaning that instead of leaving the institutions in early afternoon to go to private clinics, they will be paid more to treat patients and perform surgery in the public hospitals after their regular shifts, German said.
State websites are set to be established to increase public information and choice about healthcare, the committee said.
Profits from medical tourism will go toward improving the treatment and services for residents, the committee said, but did not explain how this would happen.
For the first time, health budgets will be linked to a demographic index, meaning they will get bigger as the population grows and ages. Israelis who want additional health insurance beyond the basic policy guaranteed to every resident by National Health Insurance will be able to pick and choose among “layers” of benefits from healthfunds supplementary health insurance.
Most people will not need private medical insurance, the authors of the 25-page report contended, as queues for procedures and consultations will be reduced.
The plans for the general hospital being built in Ashdod by Assuta Medical Centers, whose contract includes a significant percentage of medical procedures carried out as private medical services, will be amended so there will be no “sharap” there.
The hospital is due to open in two-and-a-half years’ time, and Assuta has already invested NIS 200m. in infrastructure and construction.
The committee, which includes representatives from the Health Ministry, the Finance Ministry, hospitals, the Israel Medical Association, universities and from the general public, held 100 meetings totaling 800 hours over the course of more than a year.
It was appointed by German soon after she took office in March 2013, and was originally supposed to present its recommendations within a few months. But deliberations, disagreements, lobbying and leakage of inaccurate information to the press caused the deliberations to drag on.
“The residents will pay less, get more healthcare and have shorter waits for medical services,” German said at the outset.
“From the beginning, we put the focus on the citizen and improving his healthcare,” she said, adding that the system will be transparent to the public.
Afek, who previously was a senior administrator at Sheba Medical Center and more recently the head of the medical branch at the ministry, said that a hospitalization authority will be established to replace the current situation, in which the ministry owns government hospitals.
“This will give us more time to be regulators of healthcare instead of owning hospitals and supervising them,” he said, crediting the ministry’s former director- general, Prof. Ronni Gamzu, for his work with the German Committee.
Israelis will be able to compare online the various public and private health-insurance policies available, and choose the ones they want, as well as canceling superfluous policies that many people are paying for necessarily, Afek said.
“We will promote the continuity of care between the community health-fund clinics and the hospitals and promote home hospitalization services when patients do not need to go to medical centers, he said.
Startup companies whose services supply monitoring of patients from home will be used.
The general practitioner status as each patient’s case manager will be promoted, the director-general said.
The committee recommended an annual 0.8 percent updating for the health basket supplied by the four public health funds – not the 2% automatic increase recommended for years by experts in health economics – but which the Treasury has not yet approved. Using non-physicians, such as physicians’ assistants, nurse practitioners, as well as upgrading the training of paramedics, to increase the number of medical professionals will help fill the gap as more medical students graduate, it said.
The recommendations were generally greeted in a positive manner among some medical professionals and MKs from both sides of the aisles in the Knesset, but there were some dissenting voices.
Prof. Jonathan Halevy, longtime director-general of Jerusalem’s Shaare Zedek Medical Center and chairman of the public advisory committee on the health basket told The Jerusalem Post that he thought the committee did “good work.”
The plan, he said, is to strengthen healthcare in the community and connections with the hospitals, keep senior doctors in the hospitals and provide more public funding. The committee’s work will be tested by whether and how their recommendations are applied, but the emphases they made are correct.
However, Prof. Yehoshua Shemer, chairman of Assuta Medical Centers that is building the Ashdod hospital, was deeply dissatisfied with the committee.
As a former Health Ministry director-general and Maccabi Health Services director-general who says he still cares deeply about the public health system, Shemer told the Post that “there is nothing new here for the public.
Sharap was not approved for the government and Clalit hospitals because German knew that Likud MK Haim Katz, who heads the Knesset Labor, Welfare and Health Committee would not allow it,and because public opinion runs against it.”
The committee “missed an historic opportunity to change the system,” he said.
“The committee did not produce an organized working program with milestones and timetables.
It is only populism. There is not really NIS 1b. shekels in new money but already existing money. There is a NIS 5b. annual deficit in the system, including NIS 2b. of annual debts in the health funds. Nothing will be done about shortening queues for care in the community clinics.
If I had been the one to decide, I would have restored the parallel tax that was canceled by the Treasury in the 1990s, in which employers contributed significant sums for their employees’ healthcare; this would have been new money,” he added.
Asked about the Ashdod hospital that his company was building, Shemer said that implementing German’s decision to cancel “sharap” is “impossible and illegal.
Even in a totalitarian country it wouldn’t happen. We won the public tender. They can’t change the conditions. It’s like buying a car, after which the dealer says he wants the tires back. Before we won the tender, the government said the Ashdod hospital couldn’t be built without private medical services. I have recently held many talks with German and other ministry officials, and nobody ever mentioned to me the intention to cancel sharap in the Ashdod hospital we are building for the government.
“One can’t study the recommendations and say “Wow! The health system will change next year,’ because it won’t. It won’t look better in five years,” he said.
Yet, instant analyses and comments by others in the health system were generally favorable.
Clalit director-general Elil Depes said he welcomed the decision against introducing “sharap” and that he was in favor of increasing supervision of medical tourism.
But he had a negative opinion about the health-insurance reforms, and said that having three layers would “only confuse the public and lead to increased premiums.”
He also complained that no health fund officials were on the committee.
Labor MK Shelly Yacimovich welcomed the decision not to allow “sharap,” which she said ”is immoral, a nightmare and crashes to pieces every remnant of modern Western medicine.”
Meretz MK Ilan Gilon also congratulated the committee for its recommendations, but said he would “give seven times as many blessings when I see its implementation.
I am glad the health minister has sensed the views of the public, the Knesset and the Knesset’s health lobby.”
Meretz chairman MK Zehava Gal-On also cheered the decision not to allow private medical services.
The Association of Civil Rights in Israel and the Adva Center for Information on Equality and Social Justice in Israel said that while they welcomed the decision against “sharap” and for the full-timer program to boost utilization of medical facilities in the afternoons and evenings, “too little money is being added” to the system.
They added that the proposed solutions are far from what is needed to revitalize public health institutions.
“The decision to regulate medical tourism without the ministry’s having a genuine ability to supervise it will necessarily lead to harm to Israeli patients and more hospital crowding, which is also very high,” the voluntary organizations maintained, “but there is more positive than negative in the recommendations.”
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