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The current growth of the Israeli economy is impressive enough to allow a significant increase in the state-subsidized basket of health services beyond the NIS 275 million allocated by the Treasury, according to one of the country's leading health economists.
Ben-Gurion University Prof. Dov Chernichovsky, a member of the new public forum for recommending medical technologies to be included in the basket, said Sunday that failure to do so would actually cause harm to the economy.
The forum, founded by the Israel Medical Association (IMA), is chaired by retired Supreme Court justice Dalia Dorner and comprised of leading figures in medicine, academia, the rabbinate, ethics and other fields. It held its first meeting Sunday at Beit Belgia on the Hebrew University of Jerusalem's Givat Ram campus.
Although the forum was regarded by the Health and Finance ministries - which appointed the official "basket committee" that will recommend priorities for expanding the basket by the end of December - as "a provocation" and a "shadow committee," the forum's prestigious members said they wanted to use their expertise to help the official committee in making its decisions.
Chernichovsky said that while he did not advocate an annual 2 percent increase to the basket because it would constitute putting the system on "automatic pilot," he felt the economic boom justified a significant expansion - more than 2% (some NIS 500 million) for 2008, rather than what the Treasury allocated, which is close to a 1% increase. An increase was merited, he said, as state financing of the basket has eroded in recent years, and some years there was no expansion at all.
Less and less public money is being spent on health, with a third paid for by individuals as out of pocket expenses, compared to only a quarter in 1995, when the National Health Insurance Law went into effect, Chernichovsky said. Having to allocate a growing part of their income on health services is pushing many families below the poverty line, he said.
Public suppliers of health services can save money with central purchasing of drugs and technologies that reduces costs, while individuals have to spend more because they can't purchase them collectively, Chernichovsky said. The erosion of the basket led to more private insurance, some through employers, and this did not promote economic growth, he added, and in fact contributed to inflation in the cost of services.
Chernichovsky also suggested that the state clearly declare exactly what medical technologies it cannot afford to provide the public and that the decision-making process on the health basket be carried out all year long.
Dorner said her self-appointed group wants to influence the health authorities. She said she had expected Health Minister Ya'acov Ben-Yizri would welcome this voluntary body of high-ranking experts rather than being hostile to it.
The forum, which is open to the press and has not yet taken decisions except procedural ones, has already influenced the official basket committee, which decided for the first time since it began eight years ago to open sessions to the media at its session on Monday.
The forum heard from six patients and their representatives, who described the torture of knowing their lives could be saved or extended or their quality of life improved with new drugs not included in the basket of health services. One man with colon cancer said he was taking Avastin, a drug that reputedly extends life by an average of five months, but said it has kept him going for three years after he participated in a hunger strike that got it added to the basket. But Erbitux, another cancer drug needed by 1,000 colon cancer patients, remains outside the basket.
Another man said a drug already approved by the US Food and Drug Administration for multiple myeloma has not even been registered by the Health Ministry and cannot even be considered for the basket.
A young man said his 74-year-old grandmother suffered from a pathological surplus of iron in her blood that threatened to damage her heart and liver. While an old-fashioned treatment that required hospital care was in the basket, a new pill that need be taken at home only once a day was not, even though the old drug and hospital care cost at least as much, he said.
The father of an eight-year-old girl with neuroblastoma, a pediatric cancer, said she was doing very well with a drug supplied free by the company. But he feared that would end and her condition would decline because the drug is not in the basket.
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