Experts want 2% auto updating of health basket

Eighty-eight medical technologies – prescription drugs, screening tests, medical nutrition products and devices – will be added to the 2013 basket that the four public health funds provide their members, following a NIS 300 million allocation from the Finance Ministry.

The public “basket committee” of health experts and public representatives – which Shaare Zedek Medical Center director-general Prof. Jonathan Halevy chaired for the first time on Tuesday – announced its recommendations for inclusion in the basket. The list, which the committee chose out of hundreds of technologies that would have cost NIS 2 billion were they all to go in the basket, will be presented to the Israel Health Council for formal approval on Wednesday, and then to the cabinet on Sunday.

Halevy said that chairing the committee during the past two months had been “the most fascinating and challenging task in my career.” He has been given the job for next year as well.

Halevy, who has run the Jerusalem hospital since 1988, worked as an internal medicine and liver expert at the Rabin Medical Center-Beilinson Campus before joining Shaare Zedek, and in recent years also headed Israel Transplant as a volunteer.

He told The Jerusalem Post that the 88 technologies, some of which replaced less-successful medications and thus did not cost any additional money, made for an admirable balance between life-saving and lifeextending drugs and disease prevention, based on medical, social and compassion considerations.

In the preventive category will be free vaccination for eighth-grade girls against human papilloma virus (HPV), to prevent them from contracting cervical and other cancers via sexual contact when they get older. The School Health Service will carry the three-part vaccination at NIS 244 per girl.

Though some countries that have more funding for their health systems administer the shots to boys as well so they don’t infect girls, boys here will not receive the shots.

Another preventive item is screening for carriers of diseases with a 1:60 risk in the population.

These include Fragile X, SMA, Canavan, MLD, ICCA, Costeff, PCCA, ICCA and mutations common in the Arab population. As the health funds do not include such screening even in supplementary health insurance packages, and people with low incomes often cannot afford to pay privately for these services, the items’ inclusion in the basket will especially help the socioeconomically disadvantaged.

As for life-saving and lifeimproving drugs, the list includes medications for respiratory, kidney and gastroenterological diseases; diabetes; psychiatric disorders; AIDS; hematological, neurological, endocrinological, cardiovascular and endocrinological disorders; and dental treatment for people under the age of 30 with specific syndromes and cancers.

Although reactions to the decisions were positive (except from some pharmaceutical companies whose entries were not accepted), many agreed that the annual NIS 300m.

increment over the past three years was not enough. But this is the purview of the Treasury, which prefers to decide the size of the allocation alone.

Halevy said he was sure that for 2014, the budget for the next increment would be “at least NIS 300m.,” but he hoped for more.

Israel Cancer Association director-general Miri Ziv, Kadima MK Dr. Rachel Adatto and Meretz MK Ilan Gilon all called for an annual automatic update of the basket by 2 percent – or around NIS 600m. – rather than having the Treasury approve the amount each year, but the Health Ministry has been unable to persuade the Treasury to give up some of its decision-making powers.

Halevy said that if the budget were doubled, he would add more drugs and technologies for psychiatric, cardiovascular and respiratory diseases.

Adatto, a former deputy director- general at Shaare Zedek, said that the Treasury’s refusal to allow automatic updating was serious, considering the aging and natural growth of the population – factors that would make more funding necessary.

But she praised the members of the committee for their excellent work.

As a gynecologist by training, Adatto said the HPV vaccine was very important, but that it should have been financed as part of the Health Ministry’s special budget for vaccines and not as part of the NIS 300m. for expanding the basket.

She added that the government had “fought every attempt in the Knesset to set down the activities of the basket committee and updating of the basket through primary legislation, which was the original intention of the Knesset with the passage of the National Health Law in 1994, and not the way the government runs it today.”