Exclusive: Health basket should finance pre-detection program

IDA said it officially applied to the Health Min.'s medical technologies unit for programs to be included.

For the first time ever, a screening program and media campaign intended to facilitate early detection of a disease and the identification of those at high risk of developing it have been proposed for inclusion in the basket of health services provided by the health funds and subsidized by the government. The Israel Diabetes Association (IDA) said that on June 15 it officially applied to the Health Ministry's medical technologies unit for these programs to be included in the basket. The unit processes requests for annual consideration of drugs and other medical technologies via a public committee. Last year, the Treasury allocated NIS 350 million to expand the basket of health services, and the Health Ministry approved those drugs and technologies recommended by the public committee. But, since the health funds are not required to screen seemingly healthy members for chronic diseases or for being at high risk for these diseases, insurers currently very hard-pressed financially are reluctant to volunteer, even though health funds would benefit in the longer term because they would save the heavy financial costs of treating diabetics. There are some 200,000 diagnosed Type II diabetes patients in Israel, but at least an equal number of people don't know they have the disease or a possible precursor, metabolic syndrome, both of whose symptoms include high cholesterol, overweight, hypertension and a higher-than-normal blood glucose level when fasting. IDA head and diabetes expert Dr. Julio Wainstein said at the opening session of the Second Russell Berrie International Symposium on Diabetes and Atherosclerosis at Jerusalem's Renaissance Hotel on Monday that the intended screening and publicity programs were vital for the early detection of people with Type II diabetes and for the hundreds of thousands of people of all ages with undiagnosed metabolic syndrome, which almost inevitably leads to full-blown diabetes. Israel would become the first country in the world to establish such a mass screening program, he said, as other countries have tried but failed. Those discovered to have the syndrome should be sent immediately to lifestyle-change programs to head off diabetes, Wainstein said. He told The Jerusalem Post of recent research proving that 58 percent of those with the syndrome who learn of it and change their lifestyles with weight reduction, diet and exercise can prevent or delay the onset of diabetes. A health fund's average annual cost of treating one diabetic patient is NIS 10,000, said Wainstein, and preventing the disease will save the health funds a great deal of money. The health funds are being encouraged by the Health Ministry to monitor their members by promoting mammograms to detect breast cancer, high blood pressure monitoring and other key indicators of possible future disease, but they are not required to pay for screening of conditions that lead to chronic diseases. Wainstein's idea has been endorsed by Prof. Itamar Raz, former IDA president and current head of D-Cure, the sponsor of the symposium. Prof. Yehoshua Shemer, the director-general of Maccabi Health Services (the second largest health fund) and a diabetes researcher who attended the symposium, said the Health Ministry should finance a publicity campaign and screening for metabolic syndrome and diabetes. "There is nothing more important in public health," he said, as diabetes is rapidly reaching epidemic proportions. However, Shemer who when he was Health Ministry director-general founded the system for updating the basket of services said screening and a publicity campaign were not appropriate for adding as a "medical technology" to the basket. Maccabi, he said, already does a lot to diagnose diabetes and metabolic syndrome, but other health funds do not do as much. Asked to comment, the Health Ministry's acting spokeswoman said it "did not receive a request for mass screening for metabolic syndrome or a publicity campaign," but only for various sugar-testing equipment and workshops for patients who already have diabetes. The ministry did not publicly react to the IDA's proposal, whether the programs are to be conducted at the ministry's or the insurers' expense. Meanwhile, 60 of the world's leading diabetes researchers who arrived to attend the symposium and hundreds of their Israeli counterparts learned about a Technion researcher's major discovery of a key enzyme's involvement not only in cancer but also in kidney damage, heart disease and Alzheimer's disease. In the opening lecture, Prof. Israel Vlodavsky discussed his lab work on heparanase, a multifaceted enzyme in cells that has major implications in a variety of serious and potentially fatal chronic diseases. Heparanase in excessive quantities promotes not only blood-vessel proliferation, which causes cancer to spread, but also the clogging of coronary arteries and protein damage to kidneys in diabetics. D-Cure, just a year old, is an umbrella organization that raises funds and coordinates diabetes research in institutions throughout Israel. Thirty-one separate research projects are already being conducted with nearly $5 million in D-Cure funds obtained from the Russell Berrie Foundation in the US, Pfizer pharmaceuticals and others, Raz said.