A healthier framework for the ‘health basket’

A fixed annual budget allocation to enlarge basket must be determined and clear criteria should be drafted on what it should cover.

YA’ACOV LITZMAN (photo credit: (Ariel Jerozolimski)
(photo credit: (Ariel Jerozolimski)
As is the case every year, a Solomonic dilemma faced the members of the public committee responsible for recommending which drugs and medical technologies would be added to the 2011 health basket and which would not. The end result, presented to Deputy Health Minister Ya’acov Litzman this week in the Knesset, could mean the difference between life and death for some patients. For many more, patients who do not have the financial means to pay out of pocket and must rely on the state to provide them with the most modern medical technologies, the decisions were almost as critical.
Of about 430 drugs and other technologies that were considered, costing in total about NIS 1 billion, only 61 were added to the basket due to a budget limit of NIS 300 million set by the Treasury. Drugs that treat multiple sclerosis, psychiatric illnesses and numerous other diseases were left out of the basket. In parallel, items that do not belong in it – such as helicopter evacuation services that transport the sick and injured from the outlying areas to centrally located hospitals, and a rotavirus vaccine for preventing severe diarrhea in babies – were nevertheless included because the Health Ministry lacked Treasury allocations in its regular budget, where they belong.
Indeed, if not for Litzman’s and Health Ministry officials’ last-minute wheeling and dealing with Treasury officials, the addition to the basket would have been just NIS 200m., which means that even fewer lifesaving drugs and other technologies would have been included.
WE ARE well aware that our government, like any other, does not have limitless funds. However, we do believe the annual addition to the health basket should be updated automatically by some 2 percent a year. This would be less than in Canada and Britain, where all new technologies that are regarded by medical experts as beneficial are added.
The addition to the health basket, which this year is the lowest in the past five years, should not depend on the negotiating skills of politicians such as Litzman or on the whims of Treasury officials. Furthermore, services such as helicopter evacuation or vaccines like rotavirus, which has been around for years, have no place in the health basket addition, which is specifically designed to include new drugs and other medical technologies Unfortunately, there are a number of players who have a strong vested interest in perpetuating the status quo. The Treasury, which often seems to be governed solely by cold economic calculations, is wary of giving up control over hundreds of millions of shekels a year. And politicians heading the Health Ministry enjoy the opportunity to receive positive media coverage by showing their constituents that they have managed to pry additional funds out of a stingy Treasury.
This politicization of the health basket has become a part of our culture. Ahead of the 2006 elections, for instance, former attorney-general Menahem Mazuz postponed the work of the health basket committee.
Mazuz was rightly concerned that political parties would exploit the timing of the deliberations by demanding more money for the sick in populist election campaigns.
We respect the Treasury’s desire to keep a cap on expenditures. But when it comes to health expenditures, there appears to be room for some fiscal expansion.
By international standards, our healthcare system is not very costly, amounting to just 8% of our GDP. It is equivalent to the average of countries in the Organization for Economic Cooperation and Development (OECD), and well below the American or German standards.
What’s more, the public sector’s share in funding is significantly lower than the OECD average, while a larger portion of the national health bill is footed privately, primarily via out-of-pocket payments for medications and some services, plus supplementary health insurance policies.
The politicization of the health basket must come to an end. The best way to achieve this goal is to determine a fixed annual budget allocation to enlarge it. In addition, clear criteria should be drafted on what should be covered by the basket and what must be provided by the Health Ministry’s regular budget.