If you live in Jerusalem, Tel Aviv or Haifa, the lines for medical treatment are significantly shorter than if you reside and seek help at hospitals in the North or South, according to a new study released on Monday morning by Jerusalem’s Taub Center for Social Policy Studies. This highlights the feeling in the country that the “haves” are better off in medical care than the “have-nots.”The independent, nonpartisan institution for socioeconomic research found that there is a negative correlation between the number of hospital beds and waiting times for elective (non-emergency) surgery. In Jerusalem, Tel Aviv and Haifa, the number of beds is the highest in the country (2.2 to 2.5 beds per 1,000 residents) on average. However, in the southern district, there are only 1.3 beds per 1,000 people, and waiting times are about 44 percent longer than the average.The study was conducted by Liora Bowers, Taub Center policy director, and Prof. Dov Chernichovsky, the chairman of its health policy program.Between 1999 and 2012, the share of Israelis holding both types of private health insurance (supplementary through a public health fund and commercial) nearly quadrupled and stood at about 40% in 2012. This phenomenon may, the authors wrote, come from the feeling among Israelis that they do not receive effective care in the public healthcare system. Since the public and private systems rely on the same healthcare workforce, the existence of supplementary insurance leads to longer lines in the public system and thus further proliferation of private care.When measuring waiting times in 27 general hospitals, it was found that there is large variation between institutions.For example, there is a difference of nearly a year in waiting times for knee replacement, tonsillectomy and deviated septum (nose) procedures between the hospitals with the longest and shortest waiting times. At hospitals owned by Clalit Health Services, the median wait time is the longest – about 15% higher than the national average. In hospitals that function as non-profits, wait times are the shortest – 32% less than the national average.The 23 developed countries, including Israel, in the Organization of Economic Cooperation and Development (OECD) have stated that waiting times are an important policy issue, and 15 of the nations have strategic plans to deal with the challenge. But, said the Taub researchers, there is still no such plan here.The National Health Insurance Law established that every resident is entitled to receive healthcare within a reasonable time and at a reasonable distance from his/her place of residence.To date, no guidelines have been set regarding “reasonable time or distance,” and this remains one of the main challenges facing policy makers in the field of healthcare in Israel. This is one of the first studies in Israel that looks at waiting times for elective surgeries from an international comparison perspective, they added.Out-of-pocket payment for medical care is becoming more and more common among the Israeli public, the researchers continued. The share of those with supplementary insurance increased by about 60% between 1999 and 2012. It has reached the point where almost four out of five Israelis (80%) hold this type of insurance.In parallel, the share of those with commercial health insurance has risen by about 80%, with about 40% of the population holding private commercial health insurance in 2012.Patients are apparently concerned that they won’t get satisfactory healthcare through the public system; their fears are intensified by the fact that patients at public hospitals cannot choose their treating doctor, as well as due to the lack of transparency and the lack of information regarding expected waiting times.Patients are also encouraged by the system to shorten waiting times by choosing to activate their private insurance.While waiting times are a mechanism for rationing care in a system in which patients are not deterred by the cost of care because they do not pay a significant portion of the cost, there is evidence that lengthy wait times are a burden on society since they increase the likelihood of more complex hospitalizations and poorer outcomes, potentially leading to increased healthcare costs, they continued. In addition, long waits are likely to reduce the patient’s ability to work and the quality of their leisure time and increase dissatisfaction levels with the overall healthcare system. The Taub Center study also looked at waiting times for elective medical procedures by location of residence and found that the median waiting time for surgery in the large metropolitan areas (Jerusalem, Tel Aviv and Haifa) are substantially shorter than waiting times in hospitals in the North and South of the country. In Jerusalem, waiting times are about 28% shorter than the national average, while in the South, waiting times are the longest in the country – about 44% longer than the national average. The long waiting times in the periphery parallel the limited healthcare resources allocated to these areas, and particularly the number of inpatient beds.In 2013, the supply of doctors per 1,000 people in the North was only two-thirds as high as in other parts of the country (2.2 versus 3.2 or more, respectively), while the supply of other healthcare professionals (such as pharmacists, physiotherapists, occupational therapists, etc.) in the North and South was half that of other regions (2.1 and 2.2 versus 4.0 or more, respectively).It should be noted that there are efforts underway to narrow these gaps, including the opening of a medical school in Safed and additional pay for doctors who work in the periphery, but it is still too early to assess the result of these actions, said Chernichovsky and Bowers.The study found that wait times for elective surgeries are shorter in Israel than in other OECD countries, although in most developed countries, waiting times are measured from the point when the patient is referred for treatment until surgery is performed while here, the waiting time is only measured from the date when the surgery in the hospital is set.The Health Ministry declared in 2014 that the measurement of waiting times for elective procedures from the time of referral as well as real-time data accessibility was on its agenda, although it’s unclear if there has been progress on these issues, wrote the researchers.Nonetheless, the ministry’s initiative to collect data on waiting times for elective procedures at the various institutions and publish these figures regularly is a “significant step,” they wrote.An OECD study examining 13 countries showed that all of them provide patients with guaranteed waiting times so that patient knows what to expect. Some of the countries use a model of negative enforcement. In England, for example, a medical department that does not meet the waiting time targets could lose 5% of its monthly funding.There are also examples of positive enforcement such as Sweden, which gives a generous bonus to municipalities that provide medical treatment or surgery within 90 days of the referral; this technique has proven to be very effective.Another option is to give the patient the right to choose between public and private care; in Portugal, the patient can turn to the private system – at the state’s expense – once the waiting time in the public system has reached 75% of the pre-established waiting time.