Health Minister Yael German and Director-General Prof. Ronni Gamzu conceded on Monday that most of the complaints about a continuing decline in the health system and its severe underfunding are accurate. However, German told the National Health Council that no real solutions are likely to be proposed until the “end of May or June,” when the German Committee to Improve the Public Health System presents its recommendations.
The council – established by the National Health Insurance Law nearly 20 years ago and comprising health system leaders – was summoned to the ministry’s Jerusalem headquarters to discuss severe deficits in the four public health funds: Clalit Health Services, Maccabi Health Services, Kupat Holim Meuhedet, and Kupat Holim Leumit.
Clalit director Eli Depes said that the queues for care in the clinic and in hospital diagnostic institutes, surgical theaters, and outpatient clinics have lengthened, and care is less accessible to the average patient.
“Every once in a while, the state gives us some money to close the deficit, and then it returns. The health system needs realistic funding,” he said.
Israel Medical Association chairman Dr. Leonid Eidelman said that, “Medical care here is getting more expensive all the time. Patients everywhere feel it. We’re all on he same side. Money, a lot of money, has to be injected into the system. If not, the situation will explode in our faces.”
Health fund representatives argued that a manpower freeze as an “efficiency measure” is hurting the system. There are more chronic diseases, and we are not treating them well enough. One woman from Clalit said that in her area, the number of diabetics has increased by 50% in only a few years, and that many of the patients can’t afford the copayments to buy the necessary drugs for their condition. As a result, they will develop dangerous complications that will be even more expensive to treat.
Soroka University Medical Center director Dr. Ehud Davidson, whose Beersheba hospital is owned by Clalit and has a NIS 70 million deficit, noted that the Israel Defense Forces will soon begin to move training bases to the Negev.
However, no one is helping Soroka – the only hospital in the area – to build needed medical facilities.
The health fund managers said that the wage agreements with the doctors and nurses in recent years put an extra financial burden on them, causing hospitals and clinics to delay the replacement of outdated equipment. In addition, there are fewer doctors on duty, and doctors studying specialties have less chance of finding hospital jobs because of hiring freezes.
All the health fund directors said that they have been “living in uncertainty” for the last three years, “without having a clue” what their annual budgets will be. They remain in deficit, waiting for the Treasury to bail them out, and are unable to do proper planning.
“Nobody speaks to us about what will be,” was a general complaint. When Maccabi director Ran Sa’ar used a PowerPoint presentation to show how low spending rates for healthcare in Israel compared to other countries, he said: “It’s lucky we have Chile and Turkey below us.” German scolded him for being “cynical.”
Sa’ar continued that while he is an optimistic sort, the “big hole in the budget is depressing. Now I am pessimistic. As minister, you make take control and lead.”
Naomi Caspi, representing the nurses, said the average of community nurses is 55, with a third going on pension in the coming years. “It’s normal now for the patient to ask the nurse how she feels than the opposite, Caspi said ironically.
“The shortage in manpower is now killing patients. The new Generation Y wants to make money, and they will get up and leave for other countries. If we had the same rates of nurses in our population as in the OECD, we would need 36,000 more,” she declared.
Former Health Ministry director-general Prof. Yehoshua Shemer, who now heads the private hospital chain of Assuta Medical Centers, said that members of the council are responsible for overseeing the national health insurance system and that if they do nothing to prevent further erosion, they can be held responsible.
“It is getting worse from day to day,” Shemer said. “There are devoted staffers, but when it takes two or three months for a cancer patient to have an MRI scan, we are in trouble.”
Shemer asked whether Israel is ready to adopt the British practice of halting the supply of certain drugs to old people, because the health system cannot afford them.
German summarized by saying that, “I know you expect me to bring in more money. I agree. But it isn’t enough; there have to be more efficiency measures. There are other ways to bring in more money from additional sources, and for that we have the German committee. We are at a stage in the ministry when we are not yet ripe to make decisions on funding, because things could be changed by the German committee.”
Gamzu noted that he had identified the budgetary difficulties some three years ago.
“We noted all these trends. You put your finger on them. We measured queues for medical care. We know there is not enough money in the system. We have put it on the table during our discussions with the finance minister.”
The Treasury’s liaison on health services remained silent throughout.