For a real health reform

The Health Ministry got off to a bad start when it released an erroneous report of Sunday’s cabinet vote on what is being touted by Prime Minister Binyamin Netanyahu as a “new program” to cure our understaffed and overcrowded hospitals. The ministry claimed cabinet support was unanimous. In reality, Vice Premier Silvan Shalom, who is minister for developing the Galilee and the Negev, abstained. Nitpicking? Perhaps, but it was an ominous sign of a disconnect between appearance and reality, a sign confirmed by a close look at the approved program that has the unmistakable smack of populism.

A Health Ministry report back in 2005 predicted that by 2015, there would be about a 4,000-hospital-bed deficit nationwide. Yet not a single bed has been added over the past six years. In fact, the total number of beds has actually decreased as a dearth of specialty doctors has led to the closing of some sub-specialty departments.

In response, Netanyahu’s new plan proposes adding just 960 beds in the next six years. This will do little to alleviate an unbearable situation in which during the winter months, hospital occupancy levels commonly climb to 150 percent and even 200%, meaning that dozens of sick people are forced to wait for hours in corridors or in makeshift arrangements while a skeleton staff of doctors, nurses and auxiliary workers, spread far too thin, struggles to provide basic health care. This situation can also be life-threatening.

OBVIOUSLY THERE are no “quick-fix” solutions. Adding beds entails more than a physical expansion of existing hospitals or the building of new ones. It also necessitates an increase in the number of doctors and nurses, which translates into years of study and training.

The dearth of doctors is due in part to larger immigration and demographic trends. The waves of immigrants from the former Soviet Union brought hundreds of doctors. For years, Israel had the privilege of having one of the highest doctors-per-capita rates in the world. But in recent years, these immigrants have begun retiring, and women, who constitute half of medical students, often want to work less than full time. Years of oversupply coupled with skimpy university budgets have pushed universities that host the nation’s four medical schools to adopt highly demanding acceptance criteria. Israelis who fail to meet these demands go abroad to Italy, Romania or elsewhere to become doctors. Many never come back.

A step in the right direction is the approval of a fifth medical school, to be established by Bar-Ilan University in Safed. But as Health Ministry director-general Dr. Ronni Gamzu said when the new school, slated to open in October, received accreditation, the Treasury needs to provide funding to the universities so they can expand the number of students in medical schools.

Netanyahu, who holds the health portfolio (though deputy minister Ya’acov Litzman is the acting minister), also promised to increase the number of nursing students from 100 to 180. However, he did not say how he would accomplish this.

Nor was it immediately clear what was new about the “program” besides the packaging. Litzman has been bandying about the plan to add another 960 beds for a few months now. The idea of building an additional hospital in Ashdod goes back a decade. The new IVF unit in Nahariya’s Western Galilee Hospital, another part of the program, is obligatory according to Health Ministry directives for a minimum of one IVF unit per 300,000 people. Currently, the whole Western Galilee – with its 650,000 residents – lacks a single unit. And approval to increase the number of magnetic resonance imaging (MRI) instruments from 10 to 21 was not accompanied by a budget that would enable hospitals to actually finance their purchase.

No surprise, then, that the Israel Medical Association’s response was lukewarm. While it “welcomed the prime minister’s statement on the importance of the society’s ability to treat its patients,” it also noted that the approved plan “failed to bring a new and significant” boost to the public health system.”

Kadima MK Rachel Adatto, a former deputy directorgeneral of Shaare Zedek Medical Center and a member of the Public Advisory Committee on the Health Basket, put it more bluntly, calling the plan “recycled Bibibluff.” The Treasury and the prime minister, proponents of a decidedly neoconservative world view, have a deep-seated aversion to social welfare spending and big government. But they would do well to internalize the fact that maintaining one of the world’s finest health systems will pay off in the long run by reducing the devastating costs to society of less than adequate health care.