Although last summer, Deputy Health Minister Ya’acov Litzman (UTJ) did an
about-face and reluctantly decided to support the proposed reform of the mental
health system, the Finance Ministry has still not announced how much budget it
will add to transfer state responsibility for psychiatric care to the four
health funds.
The Knesset Labor, Social Affairs and Health Committee
chaired by Likud MK Haim Katz declared on Wednesday that if the Treasury does
not allocate the full sum needed for the reform, “there will be no reform of the
mental health system.”
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the necessary funding for the change must be allocated or we will not approve
this sensitive step,” he said.
In 1990, the Shoshana Netanyahu Judicial
Commission to Reform the Health System recommended that the insurers take over
responsibility for providing psychiatric care so that mental illness would be
regarded as just another illness, without stigma. In recent years, funds for the
state system have been reduced, thus reducing services and lengthening queues
for care, especially for children and for residents of the
periphery.
Litzman had opposed the reform when he chaired the Knesset
Finance Committee, but said last year that the situation is so bad that
something had to be done.
Labor MK Shelly Yacimovich said that “this
reform is forced and not from free choice. The government dried up public funds
for psychiatric services and beat it up, leaving a system empty of
content.
That intentional policy does not have to be. Psychiatric
services should remain under state supervision and must receive additional
funds. But the Treasury refuses to give it, even for advancing the
reform. And what will 1,500 state employees do? God knows what will
happen to them.”
When Katz called on Yair Zilberstein, the Treasury’s
budgets division liaison for health matters, to declare how much money he would
be willing to invest in the reform, Zilberstein refused to give exact
numbers.
“Sums such as NIS 450 million a year or even NIS 500m. or double
that were raised. I stress that the health funds have their own money, too,
including from their supplementary health insurance policies,” the Treasury
official said.
On this, Yacimovich commented cynically: “Maybe it’s time
for people to take out private mental health insurance...”
Health
Ministry director-general Dr. Ronni Gamzu said that “at present, we need between
NIS 400m. and NIS 500m. annually. We are still busy with
calculations. In any case, we will not present the reform without an
agreement on budgets.”
Without enough funding, said Prof. Shlomo Winker,
chairman of the Israel Family Physician Society, “the burden will fall on family
doctors. Even now, the load is insufferable. If they close or privatize the
little that exists, we doctors will be able to devote only five minutes to each
patient. The multidisciplinary clinics that exist should be developed
rather than be closed.”
Israel Beiteinu MK Orly Levy said she supports
the reform, as “75 percent of those needed treatment who live in the periphery
have to wait half a year to get it. Without outpatient care, there will be
unnecessary hospitalization.”
The Israel Medical Association issued a
position paper, saying that it wanted reform, but the way it has been proposed,
patients and medical staffers would be harmed.
It demanded changes in the
proposals, including eliminating psychiatrists’ quotas for the number of
sessions they could have with each patient (today, it is determined by
need).
The reform would close down mental health clinics in five years
without ensuring that they would continue to give service when the health funds
take over.
The IMA charged that to reduce demand for services, patients
will face bureaucratic and administrative hurdles to lengthen queues for care.
The result will be worse than the current problematic system, it
said.
Meanwhile, the Knesset Science and Technology Committee chaired by
Kadima MK Meir Sheetrit convened to discuss the unification of the health
system’s computer systems and the use of “data capsules” composed of medical
files. This would make the Health Ministry’s and the health funds’ computers
able to “speak” to each other in a synchronized way, including the transfer of
test results each way.
Clalit Health Services already has a system called
Ofek that allows data from its community clinics to be used in its hospitals.
Data could also be transferred between health funds for patients who change
membership.
Health Ministry director-general Gamzu said this coordination
would reduce medical errors and save hospitalization days, as well as minimize
unnecessary scans and other medical tests. Litzman said at the meeting that he
has “for a long time” been demanding the advancement of a national medical file
project, but the Justice Ministry has been holding it back because of privacy
considerations.
It was suggested that legislation was needed to set
standards for the transmission of medical data, but Litzman said he thought it
could be accomplished without any new legislation.
Sheetrit said he felt
there was a positive atmosphere all around regarding the unification of medical
data. What was needed now, he concluded, was discussions and the use of existing
funding. “It’s preferable to unify systems than to invest in the development of
a new system,” he said, adding that his committee would follow up on the matter.