After an Israel Medical Association (IMA) committee documented "growing inequity" between the wealthy and poor in access to health services and medications and in life expectancy and disease rates, the organization urged the Health Ministry to establish a special branch or national authority to minimize the gaps. The inequity, members said, was increasing despite the 13-year-old National Health Insurance Law that was meant to offer a "universal health care" system. The committee, headed by Prof. Leon Epstein - former head of the Hebrew University-Hadassah Braun School of Public Health and Community Medicine and a vigorous fighter against inequalities in health - said on Wednesday that those with inadequate financial means and cultural differences from the better-off populations who reside mostly in the center of the country lived shorter lives, had a higher rate of chronic disease and disability. The differences show up even in infants, as infant mortality rates were considerably higher among the disadvantaged, especially the Arab sector, said Epstein. The committee report also said there were significantly fewer hospital beds for residents of the North and South and in development areas than in the center of the country and the big cities. Plus, the waits for treatment were longer where there were fewer specialists and less sophisticated medical facilities. The IMA called on the government, especially the Health and Finance ministries, to arouse institutional awareness of the social gaps and change national priorities to reduce the gaps. The committee also pushed for giving preferential treatment to peripheral areas by expanding the medical infrastructure for the disadvantaged and others with less access to health care. The IMA body called for minimizing out-of-pocket copayments for medical services that made it difficult or impossible for the poor - including the elderly - who often cannot afford to buy medications they have been prescribed or pay for supplementary health insurance. The committee demanded an increase in "cultural competency" of medical staffers and bureaucrats in clinics and hospitals so that they could better understand the sensitivities and needs - from providing interpreters to meeting religious needs - of patients. Medical students should be trained in cultural competency, too, as an integral part of the curriculum, Epstein said. IMA chairman Dr. Yoram Blachar said its member doctors encountered the implications of inequity in the health system "on a daily basis, and sometimes too late" to help the patient, thus it decided to establish the committee and fight for the reduction of the gaps. The IMA's Scientific Council is now investigating the possibility of including a test of cultural competency in exams for medical students, interns and doctors training for specialties, he added. The forum of medical school deans has already agreed to investigate the possibility of including these subjects in their curricula. In addition, the IMA released a public survey in which 79 percent of the public said the government did not do enough to expand the basket of health services provided by the health funds and that over 40% of those polled feared they would not be able to afford medications and treatments not included in the basket. As a result, those who can afford to purchase supplementary health insurance from their public health fund do so, but about 20% cannot afford even this. In reaction to the survey, Physicians for Human Rights-Israel confirmed the view that many residents had to forgo treatment because they could not afford it. The group called for the cancellation of copayments and has initiated a bill regarding this matter. The ministry commented that it has "long been aware" of inequities in the health system and given the topic "high priority." The spokeswoman said that many of the statistics presented by the committee come from surveys and studies carried out by the ministry. It has already taken action to reduce infant mortality levels in the South (especially Bediun) and deaths from home accidents in the North and South, the spokeswoman added. Copayments for the very elderly and poor have been reduced, she said, and an ongoing program to monitor health fund performance keeps tabs on how well the insurers provide health care to people in outlying areas and to the poor. The ministry has asked the Treasury to allocate extra funds in next year's budget to minimize the gaps, she concluded.