WHO director-general: Keep up the good work

Top health official Dr. Margaret Chan scans the Israeli system and offers suggestions.

By JUDY SIEGEL-ITZKOVICH
WHO director Dr. Margaret Chan_311 (photo credit: WHO)
WHO director Dr. Margaret Chan_311
(photo credit: WHO)
After rapidly firing questions at local senior Health Ministry officials about hospital occupancy rates, physician and nurse ratios per 1,000 residents and the level of private expenditure on healthcare, World Health Organization secretary-general Dr. Margaret Chan concluded on Monday: “Keep up the good work.”
Chan, an expert in infectious diseases, displayed a high level of expertise in the quantitative measurement of health systems during her 90-minute visit to the ministry – and considerably higher English-language proficiency than many of the Israeli experts she met.
A native of the People’s Republic of China, she studied medicine at Canada’s University of Western Ontario before joining the Hong Kong health department in 1978 and the UN organization in 2003.
Chan is the first WHO secretary- general ever to visit Israel, which is now part of its European Region rather than its Eastern Mediterranean Region – due to the hostility of its neighbors.
Ministry director-general Prof. Ronni Gamzu specified that, “We consider ourselves in-between regions. We [have much in common with the Europeans, but we are locally and geographically in the Middle East, so we do our best to contribute to the health of this region.”
Gamzu and associate director- general Dr. Boaz Lev, who presented a recent film on the history of the country’s health system since the mid-19th century, appeared both surprised and pleased by Chan’s in-depth queries and her constant notetaking.
The WHO chief was taken aback by Israel’s figures of 98 percent to 130% hospital occupancy – which increases in winter.
“This is not good – a revolving door,” she said.
“The number of beds is controlled by the government, both public and private,” Gamzu – a former hospital director – explained. The average hospital stay here is less than four days – a record low for the OECD of which Israel is a member.
“It’s an efficient, but deficient, system,” said Lev, a former ministry director-general himself.
“We never have enough,” he said, nodding his head when Chan said she was sure that the Israeli population had high expectations and demands for top-notch healthcare.
“Every patient aspires to Rolls Royce treatment, but it’s not sustainable,” she said.
When Chan suggested more community healthcare to reduce the burden on the hospitals, Lev said that was “exactly what we are aiming at – more community care and emedicine, but we still need more infrastructure and hospital beds, we think nurses can be specialists dealing with chronic diseases in community.”
Chan congratulated the health system for controlling expenses and planning an increase in physicians and nurses, after learning that many medical professionals who arrived during the 1990s immigrant wave from the former Soviet Union union were reaching retirement age.
The ministry officials said they are looking at ways of stretching professional care by recognizing that physician’s assistants and nurse practitioners can take over some of the tasks of doctors and nurses without lowering medical standards.
When the ministry official hinted that the Treasury is the main force that limits the health system, Chan noted: “It is true all over the world.
Health and finance ministers really don’t talk to each other.
There is a disconnect. The health minister asks for more money and the finance minister says there is no more. You live in two worlds. But the WHO organized four meetings of national health and finance ministers and after they started talking, I could see that the Treasury people realized that health is not a bottomless hole, but an investment.”
When Chan noted that in Africa, the average health minister “lasts for a year or two because their political systems do not have stability” and that it was good that Israeli health ministers last longer and are able to promote long-term planning, the Israelis smiled.
They did not tell her that except for the four-year-term of the previous (deputy) health minister, Israel has had 16 health ministers in the past 28 years.
After hearing that 38% of medical costs are paid for outof- pocket by the taxpayer and that the state’s contribution to healthcare has been declining over the last two decades, Chan said this could not continue “Almost 40% of Israelis buy private insurance, in addition to the 75% who buy supplementary health insurance through their public health fund. It’s a challenge to us to combat that,” said the official.
“Make sure you don’t go the way of the US,” suggested the WHO chief.