(photo credit: Marc Israel Sellem)
No matter how the current doctor labor dispute is resolved, an agreement is
unlikely to fix fundamental problems that the Israel Medical Association insists
on solving before halting sanctions, suggests Prof. Dov Chernichovsky, a
senior health economist at Ben-Gurion University and researcher at the Taub
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He wrote a chapter on the country’s medical system as part of a
wider report the Jerusalem institute is issuing on Wednesday that also takes in
economic and social problems in Israel.
Chernichovsky identified a
reduction in efficiency in the health system, as expressed through relative
inflation for medical services and reduced access to healthcare for certain
parts of the population. In addition, a change in the capitation formula
instituted by the government to strengthen medical services in the periphery has
not worked, increasing gaps between outlying areas and the center of the country
rather than shrinking them, the health economist wrote.
As an example, he
cited evidence of increasing levels of infant mortality among Beduin in the
Negev, countering a trend in recent years of lower infant mortality among this
Chernichovsky said that the Israeli health system is “at a
crossroads” between rejoining leading Western countries with better healthcare,
or becoming “Americanized” – a process that the US is now trying to escape –
with health systems that offer less-developed healthcare.
recent years Israelis – especially haredim and Arabs – have expressed high
satisfaction with their medical care, signs of cracks have begun to show in
satisfaction levels due to the shortage of doctors, dearth of specialists and
overcrowded facilities, he wrote. A government policy encouraging higher demand
for health services resulted from a serious decline in state spending on health
and a major increase in out-of-pocket expenditures.
The 6% increase the
government proposed for the funding of doctors in the periphery will not be
effective, he charged, suggesting that unless changes are made, the “pull” to
the center of the country will make the periphery even weaker.
medical facilities manned by physicians who also work at public medical
facilities has caused much harm by reducing the quality and amount of medical
services in public hospitals, Chernichovsky contended.
He urged that the
national expenditure on medical care be increased by around 9.5% by 2020, with
state spending returning to the level the country enjoyed in 1995. He also
called for giving everyone the right to choose hospital specialists and receive
a second opinion by an expert of his choice, and for improving the wages and
conditions of medical residents.