Heal the health system

More resources need to be invested in increasing the number of hospital beds. And more nurses and doctors need to be trained.

Hospital beds 311 (photo credit: Ariel Jerozolimski)
Hospital beds 311
(photo credit: Ariel Jerozolimski)
First the good news. Israelis – particularly Jewish Israelis – have one of the highest life expectancy rates in the world, according to data released last week by the Organization for Economic Cooperation and Development. On average, Israelis lived to the age of 81.6 in 2009, compared to 79.5 among all OECD member countries.
Relatively low infant mortality (3.8 per 1,000 compared to an OECD average of 4.4, though among Muslims, particularly Negev Beduin, the rates are significantly higher); a low rate of death and a high rate of recovery from heart attacks, strokes and cancer; and better treatment of diabetes are all part of the reason for our higher life expectancies.
Even obesity rates are relatively low at 14 percent of the adult population compared to an OECD average of 17%. (The newly announced Health Ministry campaign to fight obesity might further improve the situation.) Now for the bad news. Compared to other OECD countries, the Jewish state spends too little on health.
In 2009, national healthcare spending in OECD countries was on average 9.6% of GDP, compared to 7.9% in Israel. More worrisome, however, has been the steady “Americanization” of our health services.
Like Americans, Israelis pay much more out of pocket for services that used to be provided by the state. In the mid-1990s, when the Knesset passed the National Health Insurance Law guaranteeing universal medical coverage regardless of political affiliation, almost 70% of national healthcare expenditures were paid by the state. In 2009, just 58% were, compared to an OECD average of 72%. Since 1997, private expenditures for health services have risen by over 100%, more than twice the rate of inflation.
In other words, medicines, medical technologies, doctors’ salaries and other healthcare costs make up a larger percentage of an average household’s expenditures.
As a result, poor families are finding it increasingly harder to pay for basic medical care. If this trend does not stop, we might soon reach the point where poorer families will be forced to forgo basic health services. This could reduce life expectancies.
Also, since the state is footing less of the national healthcare bill, fewer resources are being invested in the upkeep of hospitals. That’s because private expenditures on healthcare are directed primarily toward specialists’ fees, medicines and surgical procedures, while state funds are used disproportionately for the upkeep of infrastructure.
It should come as no surprise, therefore, that according to OECD figures for 2009, Israel had only 2 hospital beds per 1,000 citizens, compared to an OECD average of 3.5. And this leads to overcrowding. The average occupancy rate in Israeli hospitals is 96.3% – it is not uncommon during the winter months for occupancy rates to reach 200% – compared to an OECD average of 76%.
Several positive steps have been made toward improving health services. Deputy Health Minister Ya’acov Litzman introduced publicly funded dental care for children, which significantly reduced the health-cost burden on large families, who tend to be poor. And the agreement signed in August by the Israel Medical Association and the government, which, among other things, encourages doctors to work in outlying areas, will help improve healthcare on the periphery. The agreement also makes it more financially rewarding for doctors to remain in the public health system.
But as Prof. Dov Chernichovsky, head of the Taub Center’s Health Policy Program, noted in a recently published position paper, the state’s share in healthcare must return to its previous level of 70% of the national expenditure on healthcare. Raising the ceiling on income subject to the health tax to make it more progressive can help fund some of the costs.
More resources need to be invested in increasing the number of hospital beds. And more nurses and doctors need to be trained.
At a time when the media limelight is being dominated by a protracted struggle between the Treasury and a group of doctors and interns over salary issues, the OECD data released last week should be a reminder of the many ills plaguing our health system.