'Coronavirus highlights urgency to fix Israel’s broken healthcare system'

Comptroller: ‘It is recommended that the various offices work to simplify unnecessary bureaucratic procedures’

An empty hospital bed at Hasharon Hospital (photo credit: Courtesy)
An empty hospital bed at Hasharon Hospital
(photo credit: Courtesy)
The country must simplify its bureaucratic procedures and streamline its administrative rules in order to be more effective, said new State Comptroller Matanyahu Englman in the introduction to his latest report, which highlighted inefficiencies in the health system and the working of the Health Ministry.
“It is recommended that the various offices work to simplify unnecessary bureaucratic procedures,” Englman said. “Keep it simple. This is true in routine and easy times and even more relevant in times of emergency, such as the coronavirus crisis.”
He highlighted the challenge of the Health Ministry serving as both regulator and owner of the state’s hospitals and recommended that the ministry separate its institutional functions and the management and supervision of the medical centers. 
“The Health Ministry serves as regulator of the health system – including economic regulation – while also owning 24 [out of 27] government hospitals (general, geriatric and psychiatric),” the report noted. “Hence, the ministry works as a regulator, operator and owner and even as an insurer in various health fields. This issue has been previously examined and it was determined that the ministry wearing these multiple hats has a negative effect on care.”
The comptroller said this tension affects pricing for services and hospital revenue. He pointed out that the price committee does not meet often enough to evaluate the cost for services. There is a concern that this is due to fundamental disagreements on the need for price adjustments between the Finance and Health ministries.
For example, the price of cardiac catheterization according to the Health Ministry's price list is twice as high as the price for the same service through the Health Fund. The pricing committee has not discussed the need to update the catheter prices, nor those in areas such as eating disorder treatments or other therapies.
Moreover, in 2017, the government hospital debt stood at NIS 1.5 billion, despite budgetary assistance it received, because the Finance and Health ministries did not require the hospitals to run more efficiently. The comptroller recommended that the High Court formulate a decision-making mechanism between them, whether bringing the issue to the government or otherwise.
Professor Dan Ben-David, president and founder of the Shoresh Institution for Socioeconomic Research, has written about similar issues many times in the past. He said that the government “has an obsession with micromanaging everything. You cannot have a government body that is setting down regulations and running the show and doing oversight: deciding what needs to be done, actually running it in much of the cases and doing oversight of itself. It is dysfunctional.”
He said that the severity of the measures that were taken by Israel at the outbreak of the coronavirus pandemic were because the country had let its medical system deteriorate for decades, leaving it unprepared.
He said that the coronavirus crisis offers an opportunity to take a hard look at the country’s health system and make changes.
“This crisis should be a wake-up call for more serious, strategic long-term policies that won’t require Israel to implement such severe measures in the future,” Ben-David said.
“I intend to update the audit program to include a review of how the various bodies handled the coronavirus crisis,” the comptroller concluded.