Budgetary shortfall for health funds expected

Maccabi director-general warns of erosion of compensation in expenditures.

By JUDY SIEGEL
litzman 311 (photo credit: Ariel Jerozolimski )
litzman 311
(photo credit: Ariel Jerozolimski )
The erosion of compensation for their expenditures that the four health funds receive from the state will probably put them into deficit for the first time in years, Dr. Ehud Kokia, director-general of Maccabi Healthcare Services, the second- largest public health insurer, said on Wednesday.
Kokia was among the speakers at a meeting of the Knesset Health Caucus that periodically meets in the parliament building and is chaired by Meretz MK Haim Oron. The event was attended by representatives of dozens of patient groups but only a handful of MKs.
The two-hour session was scheduled before the Health Ministry concludes its deliberations with the Finance Ministry on the health budget for 2011 and 2012.
Kokia noted that the insurers get increases in state funding according to the rise in the cost-of-living index, but that this index rises much more slowly than the unofficial cost-of-health-services index. This shortfall is likely to put the insurers, who are very efficient, into deficit and cause financing problems in the hospitals as well, he said.
Kokia demanded that the Treasury allocate more funding for health services in the new budget.
Deputy Health Minister Ya’acov Litzman, who made a short appearance at the meeting, said that for years, the health and education budgets have been neglected.
“Health and education are more important [in the long term] that defense budgets,” he said. “We are close to ending our budget negotiations with the Treasury. While it has not been easy, I can offer praise to the Finance Ministry for accepting some of our viewpoints. I can’t say I will be happy with the result, but there will be some good news.”
Litzman said that his director-general, Dr. Ronni Gamzu, has put matters on the table “that had not been stressed before, such as the need for more hospital beds, compensation for demographic changes [the ageing and growth of the population] and improving services in the periphery. We have a good health system, but it needs improvements.”
One of the deputy minister’s priorities is eliminating or further reducing the copayments of the elderly for subsidized prescription medications, as many of them can’t afford to buy them because they don’t have the money for out-ofpocket fees, he said.
Litzman also said he hopes in the next couple of years to expand subsidized dental care for children beyond the current seven years to 12, he said.
He insisted that the wages of doctors working outside the center of the country be “drastically increased” to encourage more physicians to move there, and that there be incentives to specialists to work in hospitals on weekends and holidays.
Gamzu added that he aimed at “slowing down the private health system,” which has been expanding rapidly in recent years due to the contraction of public medical services.
“The private hospitals are less efficient and have higher costs,” he said, “and they expand the gap” between the rich and the poor.
Kadima MK Rachel Adatto wondered what would be left of the expansion in the basket of subsidized medications for next year if subsidized dental coverage is to be expanded to more children – as this year, dental care came at the expense of the basket.
In addition, the much-needed reform in psychiatric care – whose responsibility is to move from the Health Ministry to the health funds – will also need hundreds of millions of shekels to carry out.
Much money is needed to train additional doctors and expand the number of hospital beds.
“It is not realistic that there will be money for all of these things,” said Adatto, a physician and lawyer by training.
Israel Medical Association chairman Dr. Leonid Eidelman expressed his concern about the Treasury’s annual arrangements bill, which – while not as drastic as previous ones – would still cause a lot of mischief.
“Nothing in the bill is aimed at solving our problems, including narrowing socioeconomic gaps. Instead of providing solutions to real problems, the Treasury proposes politicization of the system. Instead of adding money, it cuts.”
Voluntary hospitals that do not get state money, said Shaare Zedek Medical Center director-general Prof. Jonathan Halevy, have to raise tens of millions of shekels from donations each year for ongoing expenses, not to mention development. This is because they are forced by the government to give discounts to the health funds, he said.
Oron called on the Health Caucus to focus on the most important issues and put pressure on the two ministries to significantly expand funding of health services, expand the medication basket, reduce copayments and shrink the gap between the periphery and the center of the country.
He also demanded that the Treasury avoid its tactic of proposing horrible and extreme measures in its arrangements bill, only to pull them out to show that it is “generous” while making more cuts.