MKs: Psychiatric reform still held back by lack of funds

Chairman of the Israel Family Physician Society warns: The burden will fall on family doctors.

Litzman 311 (photo credit: JUDY SIEGEL-ITZKOVICH)
Litzman 311
Although last summer, Deputy Health Minister Ya’acov Litzman (UTJ) did an about-face and reluctantly decided to support the proposed reform of the mental health system, the Finance Ministry has still not announced how much budget it will add to transfer state responsibility for psychiatric care to the four health funds.
The Knesset Labor, Social Affairs and Health Committee chaired by Likud MK Haim Katz declared on Wednesday that if the Treasury does not allocate the full sum needed for the reform, “there will be no reform of the mental health system.”
The Treasury thinks it can “get free reform, but the necessary funding for the change must be allocated or we will not approve this sensitive step,” he said.
In 1990, the Shoshana Netanyahu Judicial Commission to Reform the Health System recommended that the insurers take over responsibility for providing psychiatric care so that mental illness would be regarded as just another illness, without stigma. In recent years, funds for the state system have been reduced, thus reducing services and lengthening queues for care, especially for children and for residents of the periphery.
Litzman had opposed the reform when he chaired the Knesset Finance Committee, but said last year that the situation is so bad that something had to be done.
Labor MK Shelly Yacimovich said that “this reform is forced and not from free choice. The government dried up public funds for psychiatric services and beat it up, leaving a system empty of content.
That intentional policy does not have to be. Psychiatric services should remain under state supervision and must receive additional funds. But the Treasury refuses to give it, even for advancing the reform. And what will 1,500 state employees do? God knows what will happen to them.”
When Katz called on Yair Zilberstein, the Treasury’s budgets division liaison for health matters, to declare how much money he would be willing to invest in the reform, Zilberstein refused to give exact numbers.
“Sums such as NIS 450 million a year or even NIS 500m. or double that were raised. I stress that the health funds have their own money, too, including from their supplementary health insurance policies,” the Treasury official said.
On this, Yacimovich commented cynically: “Maybe it’s time for people to take out private mental health insurance...”
Health Ministry director-general Dr. Ronni Gamzu said that “at present, we need between NIS 400m. and NIS 500m. annually. We are still busy with calculations. In any case, we will not present the reform without an agreement on budgets.”
Without enough funding, said Prof. Shlomo Winker, chairman of the Israel Family Physician Society, “the burden will fall on family doctors. Even now, the load is insufferable. If they close or privatize the little that exists, we doctors will be able to devote only five minutes to each patient. The multidisciplinary clinics that exist should be developed rather than be closed.”
Israel Beiteinu MK Orly Levy said she supports the reform, as “75 percent of those needed treatment who live in the periphery have to wait half a year to get it. Without outpatient care, there will be unnecessary hospitalization.”
The Israel Medical Association issued a position paper, saying that it wanted reform, but the way it has been proposed, patients and medical staffers would be harmed.
It demanded changes in the proposals, including eliminating psychiatrists’ quotas for the number of sessions they could have with each patient (today, it is determined by need).
The reform would close down mental health clinics in five years without ensuring that they would continue to give service when the health funds take over.
The IMA charged that to reduce demand for services, patients will face bureaucratic and administrative hurdles to lengthen queues for care. The result will be worse than the current problematic system, it said.
Meanwhile, the Knesset Science and Technology Committee chaired by Kadima MK Meir Sheetrit convened to discuss the unification of the health system’s computer systems and the use of “data capsules” composed of medical files. This would make the Health Ministry’s and the health funds’ computers able to “speak” to each other in a synchronized way, including the transfer of test results each way.
Clalit Health Services already has a system called Ofek that allows data from its community clinics to be used in its hospitals. Data could also be transferred between health funds for patients who change membership.
Health Ministry director-general Gamzu said this coordination would reduce medical errors and save hospitalization days, as well as minimize unnecessary scans and other medical tests. Litzman said at the meeting that he has “for a long time” been demanding the advancement of a national medical file project, but the Justice Ministry has been holding it back because of privacy considerations.
It was suggested that legislation was needed to set standards for the transmission of medical data, but Litzman said he thought it could be accomplished without any new legislation.
Sheetrit said he felt there was a positive atmosphere all around regarding the unification of medical data. What was needed now, he concluded, was discussions and the use of existing funding. “It’s preferable to unify systems than to invest in the development of a new system,” he said, adding that his committee would follow up on the matter.