A bill to integrate mental and physical health services is working its way through the Knesset.
By ELI SHAMIRKnesset 224.88(photo credit: Ariel Jerozolimski)
The National Health Insurance Law defines the entitlements and the basket of health services available to all residents suffering from physical maladies. But mental disorders are provided for separately and ambiguously - mainly by direct government budget and services (including hospitalizations in psychiatric hospitals) and partly by the health funds (through their medications basket), with no clear responsibility delegated for ambulatory services.
After years of attempts to reform the system, a government-sponsored mental health insurance reform act mandating complete integration of mental and physical health services is now on the Knesset agenda. It was approved for its first reading in July 2007 and is now being processed in the Knesset Labor, Social Affairs and Health Committee.
In most Western countries, mental disorders are defined as the "plague of the 21st century," affecting about one in four people at some point in their lives. They shorten life expectancy by at least 15 years and, through suicide, kill more people from ages 17 to 35 than do all other physical ailments combined.
The cost to society is staggering. Accordingly, Western countries allocate to mental health more than 10 percent of the total public health budget. But in Israel, the mental health share of the budget is only about 5%.
In addition, the already hard-pressed public mental health budget is loaded with responsibilities other than mental health: autism, drug addiction, sexually abused women and more.
AS A RESULT, public ambulatory services in mental health facilities are continuously reduced. Waiting lines at the public clinics are impossibly long. In fact, more than half of mental health ambulatory treatments are carried out in the high-priced private market (second in size only to dentistry). Many cannot afford treatment and therefore go without.
The slogan "privatization and relinquishing of state responsibility" proffered by boisterous opponents of the reform (which include some MKs) is devoid of logic, concealing narrow professional and economic interests.
The government has agreed under the reform proposal to expand the budget gradually by NIS 200 million - but the health funds are asking for more. The reform's goal is to add some 100,000 more publicly treated patients per year - four percent of population - nearly double the current size.
THE REFORM features these advantages:
• Insurance security - assuring a basic treatment basket for each patient.
• Pure medical logic - mental and physical health are intertwined, and primary medicine (general practitioners, pediatricians and family physicians) is involved.
• Operational efficiency - services are provided by the same managing agent.
• Decrease of the public stigma toward mental disorders.
• Equitable annual updating of the basket of mental health services.
• Freeing the government from providing medical services directly to individuals, allowing it to concentrate on policy-making and supervision and control of services.
Acting together to pass this law would be one of the most important public health reforms of the past decade.
The writer is chairman of the Israeli Forum of Families of Mentally Ill Patients (Ozma - www.ozma.org.il).
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