New health-basket c'tee receives demands

Prof. Jonathan Halevy, the longtime director-general of Jerusalem’s Shaare Zedek Medical Center, will be chairman of the public committee that recommends to the government what medical technologies to add to the basket of health services in 2013.

The almost completely new committee was appointed by Deputy Health Minister Ya’acov Litzman on Tuesday.

The previous chairman, for several years, was Prof. Rafael Beyar, a senior interventional cardiologist and director-general of the state-owned Rambam Medical Center in Haifa.

The committee has to make life-and-death decisions because many patients needing expensive drugs cannot purchase them if they are not subsidized by health funds. Committee members will have NIS 300 million worth of Treasury allocations to expand the 2012 budget, the same as in the past few years but smaller than in some previous years.

The recommendations are due to be formally approved by the government before the end of December, and implemented at the beginning of 2013.

The medical technology expansion budget is the funding with which the four public health funds provide their members with new mediations, medical devices and services.

Public health advocates have for years demanded that the allocation be increased automatically by two percent annually, thus reducing the power of Finance Ministry budget officials over the health system and eliminating the Health Ministry’s need to negotiate (or beg) for higher allocations each year. The Treasury has always thwarted such initiatives, which also come from Knesset members.

The committee’s coordinator will again be Dr. Osnat Luxenburg, who heads the Health Ministry’s department for medical technologies and infrastructure, which prepares background on each proposed technology and a rating system to be used by committee members.

So far, importers and manufacturers have presented 600 different lifesaving, -extending and -improving technologies for inclusion in the basket whose total cost would require a state allocation of several billion shekels. Only a few dozen new medications, services and types of equipment are approved each year within budgetary limitations. Thus, setting priorities and making decisions is always very difficult.

The committee consists of of Health and Finance ministry professionals, as well as doctors, public and health fund representatives, economists and rabbis. Its members also include Prof. Dina Ben-Yehuda, Prof. Nir Giladi, Eyal Gabai, Shira Greenberg, Prof. Ya’acov Neparstek, Noam Hoizlich, Rabbi Avraham Menale, Revital Topper, Prof. Haim Bitterman, Prof. Avi Porath, Dr. David Mossinsohn, Prof. Daniel Vardi, Yair Assraf, Iris Ginsburg, Prof. Riad Agabaria and Prof.

Noam Zohar.

Meanwhile, Kadima MK Rachel Adatto, a gynecologist by training and (ironically) Halevy’s deputy at Shaare Zedek years ago, criticized the choice of committee members.

“Again we witness the committee representing most hospitals but not family practitioners – those physicians who serve on the frontlines of patient care,” Adatto said.

“It would have been preferable out of concern for patients’ interests that their voices be heard [directly], and not through hospitals or health funds,” she continued. “An additional worrisome fact is that the committee is made up of a large number of administrators and financial people, whose role is to worry about patients medically, socially and ethically.”

Financial and administrative representatives naturally want to cut costs.

Adatto also pointed out that only four are women.

“The fact that women did not get equal representation on this important committee raises the question of what message the ministry is sending women in the health system, and Israeli women in general,” she concluded.

A coalition of health rights groups sent a letter to Halevy congratulating him on his appointment. But it noted that the Finance and Health ministries “do not supply you with the full tools needed to carry out your national mission, and send you to battle over patients lives with a low budget.”

The coalition, which includes Israel Cancer Association director-general Miri Ziv and Patients Rights Association head Shmuel Ben Ya’acov, said this is the third year the Treasury has allocated “only half of the necessary budget for updating the basket with vital drugs, not only for economically disadvantaged patients but also in the middle class.”

The coalition’s members called on Halevy, who as a physician and hospital director deals daily with problems resulting from the lack of medical technologies in the basket, to demand that “the allocations reflect the professional recommendations of the committee and not the policy of Treasury officials.”

Copies of the letter to Halevy were sent to Prime Minister Binyamin Netanyahu, who holds the portfolio for health affairs, and to Finance Minister Yuval Steinitz.