Doctors take on ministry health basket

New forum to submit recommendations for "patient-minded" basket; Ben-Yizri blasts move as "provocation."

yaakov ben-yizri 224.88 (photo credit: Ariel Jerozolimski [file])
yaakov ben-yizri 224.88
(photo credit: Ariel Jerozolimski [file])
Representatives from a wide array of disciplines have come together to found a Public Forum to advise and "improve the deliberations" of the public committee that sets the government's priorities for medical technologies. The Public Forum for Updating the Basket of Health Services, was established by the Israel Medical Association (IMA) to include some of the country's most prominent physicians and experts from fields such as economics and law in decisions regarding which technologies are included in the state's health basket. The forum is expected to challenge the state to increase the current budget by more than the NIS 275 million that Finance Minister Ronnie Bar-On already agreed to allocate. The IMA's decision was immediately denounced by Health Minister Ya'acov Ben-Yizri, who called it a "provocation aimed at disrupting the work" of the state-appointed "health basket committee." IMA chairman Dr. Yoram Blachar, who resigned from the committee before its first meeting earlier this month, announced the establishment of the forum at a press conference on Tuesday. Blachar, who was a member of the "basket committee" since it was first established in 1999, resigned from the new one while charging it was packed with officials oriented towards limiting health spending. The forum is being chaired by retired Supreme Court justice and current Israel Press Council president Dalia Dorner, while its academic adviser is Prof. Yehoshua Shemer, the Health Ministry's former director-general and former director-general of Maccabi Health Services (and now its unpaid president) who was the one who established the basket updating mechanism while in the Health Ministry. The basket of health services comprises all the medications and medical technologies that the four public health funds must supply at highly subsidized prices to patients with relevant medical conditions. Although NIS 1.5 billion-worth of drugs and technologies have been proposed for inclusion in the 2008 basket, the Treasury has allocated only NIS 275 million for expansion of the basket's budget for 2008 and has long refused to automatically update it annually by two percent, which would mean some NIS 600 million next year. Other forum members include Blachar; Ben-Gurion University president Prof. Rivka Carmi (former dean of BGU's Health Sciences Faculty); prominent BGU health economist Prof. Dov Chernichovsky; former Sephardi chief rabbi Eliahu Bakshi-Doron; Dr. Nurit Wagner, chief of the nursing branch of the Hadassah Medical Organization; Rabbi Benny Lau; prizewinning Weizmann Institute biochemist and Israel Prize laureate Prof. Michel Revel; former Rambam Medical Center director-general Prof. Moshe Revah; former Health Ministry director-general and chairman of the previous "basket committee" Prof. Mordechai Shani; former Israel Defense Forces chief of staff Amnon Lipkin-Shahak; Tel Aviv University ethicist and Israel Prize laureate Prof. Asa Kasher; and journalist Eitan Haber. Five senior medical professors are observers. In addition, the forum named a 16-member professional medical committee for updating the basket of health services comprised of leading physicians from hospitals, health funds and medical schools around the country. The forum, said Blachar, "is not intended as a replacement" for the state-appointed basket committee but rather to "assist decisionmakers, the government and committee members, to receive broad and comprehensive information about technologies and contribute to their making more intelligent decisions." Blachar said that IMA representatives had met with doctors and public representatives on the basket committee and "some of them welcomed the establishment of the forum." The forum also intends promote the expansion of the basket beyond the limited funds allocated by the Treasury with Health Ministry consent. Thus, the forum will raise this issue for public discussion, said Blachar, "which [will] balance the needs of patients, the doctors‚ views, and ethical, social and economic considerations." The forum's medical committee will give their own numerical ranking to the candidate technologies according to their importance and medical benefits. Unlike the "basket committee," whose deliberations are closed to the press and the public, the forum will hold public hearings and invite interested organizations and non-profit groups to appear and voice their views. At the end of its deliberations, the forum will present its recommendations to the government, the public and the state-appointed basket committee. "We hope the members will consider our recommendations," he added. Ben-Yizri's personal spokesman, Tal Harel, admitted that the forum members are of top quality, but charged that they "will unintentionally create delusions and mislead the public, especially the sick, who will wrongly think its decisions have any weight." He maintained that Blachar chose to "place roadblocks in the way" of the basket committee because he was "disappointed that an additional IMA representative" (secretary-general Lea Wapner) was not named a member. Harel added that Ben-Yizri and the Gil Pensioners Party "continue to put pressure on the government to add funds to the basket for the benefit of Israeli residents."