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The supply of lifesaving and palliative radiotherapy to more than 12,000 patients a year will collapse if the Finance and Health ministries are allowed to cut the amount per treatment that the health funds pay hospitals for the therapy, according to cancer experts.
The Jerusalem Post has learned that the Treasury - in its Economics Arrangements Bill attached to the 2008 state budget - intends to reduce the payment from the current NIS 355 to NIS 266 per treatment.
Prof. Rafael Beyar, director-general of Haifa's Rambam Medical Center, told the Post that cutting the price paid to oncology departments would be "a fatal blow" for radiotherapy and that hospitals would no longer to able to supply the treatments. "Not only did the government not allow increased manpower slots at a time when we have many fewer radiotherapists per capita than Europe, but we are way behind those of the major centers in the US," said Beyar, a senior interventional cardiologist whose hospital is government owned.
Israel Cancer Association director-general Miri Ziv said she was "very worried" about the implications of the government decision, as radiotherapy was much more sophisticated and complicated than in the past, requiring a great deal of expertise. There was a severe shortage of oncologists and radiation technicians trained to perform radiotherapy, which could cure many patients, and in cases where it could not cure, it could reduce pain and slow the growth of tumors, she said.
Ziv said that if the hospitals were reimbursed by the health
funds for only NIS 266 per treatment, hospitals wouldn't offer it or buy new equipment. "More patients per radiotherapy expert mean that they can't spend the amount of time on each patient as they should. There is more pressure, so they can make mistakes," she said.
Four years ago, the Cancer Association raised the issue of the lack of nuclear accelerators for performing radiotherapy and of trained manpower. The Encol Committee, headed by Dr. Omer Encol (who was lent by the Israel Defense Forces to the Health Ministry's technology assessment department) was established by the ministry, and in 2005, the committee released unanimous recommendations calling for the allocation of more funds to increase manpower in the field and to purchase more equipment. Prime Minister Ehud Olmert was finance minister at the time.
The committee members also advocated the expansion of existing hospital radiotherapy institutes instead of building new ones in other hospitals, and an expert brought in from Europe endorsed all the recommendations. The absolute minimum amount said to be required to upgrade radiotherapy facilities was NIS 120 million over five years. But since then, the Treasury has allocated few funds, and little has been done. Instead, the Post learned, the government insisted on the establishment of yet another committee to look into the problems.
The Finance Ministry spokesman said that its and the Health Ministry's policy was to "suit the prices of services to their costs. It was decided to reduce the costs of radiotherapy treatments and transfer the rest of the money to other hospital services whose prices are lower than their costs."
The Health Ministry spokeswoman added that this transfer of funds "will make it possible to continue giving radiotherapy treatments without harming the quality of service given today."
The new committee, she continued, was appointed to take a look at radiotherapy services over the next 10 to 15 years. The Health Ministry disputes the contention of radiotherapists that most of the Encol Committee's recommendations have gone unimplemented, saying 10 manpower slots were added in 2007 and that more will follow; a new training center for radiotherapy technicians and physicists (but not oncologists) has been developed at the Technion-Israel Institute of Technology in Haifa; and additional radiotherapy devices have been added to bolster existing centers. But she conceded that "it would take another several years to implement all the recommendations."
Half of the 24,000 new cancer patients each year need radiotherapy to kill cancer cells, while thousands more chronic cancer patients who have little chance of being cured need the treatment to shrink their tumors and reduce pressure on organs and pain. Each accelerator costs about $1m., plus $800,000 for a structure to encase the radioactive equipment. Numerous hospitals, both state and those owned by Clalit Health Services and voluntary organizations, purchased radiotherapy equipment without state help, but more money is needed to train physicians and technicians to do the work.
Due to the severe shortage of manpower, many work double shifts. Beyar, along with Dr. Rafael Pfeffer, chief of radiotherapy at Sheba Medical Center at Tel Hashomer, said Sunday that the NIS 266-per-treatment price described by the Treasury as "realistic" was anything but, as staffers were exhausted by being forced to work double shifts and the price did not include equipment costs. Many experts have left to work abroad, at least temporarily, and few doctors wanted to go into the specialty because of the relatively low pay, difficult conditions and inability to do private work, Beyar and Pfeffer said.
Pfeffer said the growing need for radiology centers was due to improvements in cancer-fighting technology. Tumors can now be radiated with more accurate focus, so less of the healthy tissue is harmed and side effects are minimized. Today, a radiation session takes six hours instead of 90 minutes as in the past, because the greater accuracy requires more effort by the specialist. He added that radiotherapy was not expensive, accounting for only 5.6 percent of all costs for cancer treatment.
His department at Sheba had only 3.5 radiology manpower slots, instead of the eight needed to function properly, Pfeffer said. "We have less than half the manpower of European centers. The whole system will collapse. Instead of the government adding job slots, they cut them. I personally know of colleagues who went to the US to work."
The average Israeli radiologist treated 630 patients, as compared to 200 in Europe, the doctors said.