Geriatric nursing coverage in Israel ranks among the lowest of OECD countries even as the rate of elderly people needing nursing care – at more than 20% – is among the highest, according to a report embargoed for release until Monday.
The report, which represents the first international quantification and comparison of levels of social protection for long-term care in 14 OECD countries, found that Israel is one of the few that does not give communal assistance to elderly with relatively low nursing needs, and that those who are not totally dependent on help get no public assistance – the situation is the same only in the US, Croatia and the Czech Republic.
Israel, according to the report, also has some of the strictest means (income) tests, including assets, for nursing care.
Although almost 80% of the cost of treatment in full-time geriatric nursing hospitals in Israel is covered by the public purse, because the means tests are so strict, the patient and his family have to pay significant amounts each month.
Relative to other groups and their income, the Israeli poor must spend the most for geriatric nursing among all the OECD countries, the report found.
“The cost of care varies widely between countries, but it is always high relative to typical incomes, meaning that long-term care is often unaffordable in the absence of social protection,” the report said. “All countries studied have some form of social protection for long-term care, but even where coverage is comprehensive, people pay some of the cost out of pocket.
Coverage for home care for moderate or severe needs is often insufficient, leaving people with large out-of-pocket costs.
“In contrast, all countries studied ensure that institutional care is affordable. Unless family and friends can provide informal care, many people will be unable to afford care in their own home, leaving them with unmet needs or at risk of early institutionalization,” it continued.
Health Minister Ya’acov Litzman reacted to the report, saying: “The lack of state preparation for the aging of the population has created a ticking time bomb.”
“It is urgent that there be a systemic change in the country for the aging population,” he said.
“We must bring about social correction for those in the previous generation who need nursing care, and today there are not enough answers to the red tape needed for nursing services. I call on Prime Minister Benjamin Netanyahu and Finance Minister Moshe Kahlon to complete the discussion and bring about an immediate implementation for the benefit of Israeli citizens.”
The Finance Ministry would prefer to transition long-term care insurance, which is based on group premium payments through pensioner associations and workplaces, to a system that revolves around individual premium payments. However, the Health Ministry wants universal long-term care insurance by raising the health tax by 0.6% and transferring the full responsibility of long-term care to the health funds, thus reducing the burden on families.
A study undertaken a month ago at Jerusalem’s independent Taub Center by health economist Prof. Dov Chernichovsky, Prof.
Avigdor Kaplan, Eitan Regev and Prof. Yochanan Shtessman called for serious and urgent handling of the problem, but was not really satisfied with either Litzman’s program or that of the Finance Ministry.
The Taub researchers argued that the two proposals failed to address the fundamental issue in the area of long-term care – the selective entitlement to institutional care and the split among the various agencies involved in organizing and providing long-term care.
The Finance Ministry’s approach, the researchers said, “has not proven effective in other parts of the world. The funding available through a private insurance system is relatively limited, as low-income earners cannot afford the premiums and high-income earners often prefer to make other arrangements, such as paying for in-home care.”
The Health Ministry’s approach, they wrote, “is compatible with international trends and suitable in terms of public finance, but it lacks certain basic elements. It focuses on the medical aspects of long-term care without meeting other needs such as social support.
In nearly all other OECD countries, long-term care is managed separately within the welfare system, not in the healthcare system, so it doesn’t sufficiently address fragmentation in the Israeli system and the funding sources that are required in order to expand long-term care.”
The Taub Center study found that Israel’s total national expenditure on long-term care, including community care, institutional care and premiums on long-term care insurance, was NIS 15.3 billion in 2014, and the government covers only about half of this expenditure.
On Sunday, Health Ministry director-general Moshe Bar Siman Tov said, “Only a systemic solution with a major infusion of money and adding high-quality manpower to the system will provide an answer. The public expects from us a better health and nursing system that will save them many private expenses, and this demands a moderate increase in health taxes.”
The population, he added, “is getting older in giant steps and we are not prepared for it nationally.
Only a significant reform will put us in the right place.”