BGU | MY PATH, Haim Doron, MD

Elements Missing from the Law Together with the positive elements, there were also elements that were absent from the original law, as passed. These were shortcomings that the State of Israel, to this day, suffers from. The National Health Insurance Law made no mention of the linkage between hospitals and the sick funds. It entirely ignored the 1981 agreement to open all the hospitals within a regionally based hospitalization system to the insured persons of all sick funds. This would have given freedom to a physician to weigh hospitalization for particular patients in different hospitals in special circumstances. Instead of implementing this agreement, to this day Israel has a patchwork system based on improvised and makeshift solutions. Members of the Knesset on the finance committee are split in two: Those who are for the sick funds are in favor of deeper discounts on payments for acquisition of hospitalization services, and those who are for the hospitals are in favor of more modest discounts. The real solution lies in opening all the hospitals to all the sick funds equally on a regional basis. Under the existing scheme, patients are moved from pillar to post, from one hospital to another, since it is worthwhile to refer them to a hospital where their sick fund pays less. Such “economic sense” often results in the new hospital redoing tests. Thus, the total cost is actually higher. Also, mental health was not included under the original Law. Fortunately, this was corrected in the past years (2015) with the reform in mental health care. I have previously mentioned that in Clalit there was never any division between physical health and mental health. 137 Clalit’s “Invalid Fund,” which underwrote the opening of psychiatric and rehabilitation hospitals, was established quite early in the sick fund’s existence. That was coupled with Dr. Bruhl’s program of mental health doctors conducting visits to community clinics to discuss cases being handled by family physicians, which I adopted for Clalit as a whole; and it was coupled with the development of the teamwork model in Clalit clinics which helped further integrate mental health with the physical aspects of community-based care. For the other sick funds, mental health has amounted to a new topic. Long-term care in Israel should also receive greater attention: Recently, the media, after visiting 14 long-term nursing facilities, broke a story about their horrible state. This was no surprise. For years I have known that in contrast to Clalit’s long-term facilities (Harzfeld Geriatric Hospital, Rivka House, and Loewenstein Rehabilitation Hospital) the government-run nursing homes, due to meager government funding, were operating on a very low level. I think, in general, that in the face of increasing longevity accompanied by an increased prevalence of chronic illness, the State of Israel’s approach to the issue of providing long-term care is truly deplorable. I have made a proposal to the current deputy minister of health, Yaakov Litzman, to raise the health tax by half a percent or more. The increase would make it possible to institute long-term care insurance as a part of national health insurance. I am at a loss of words when it comes to my feelings about the fact that this proposal has not been accepted. Willingness to do so hinges on the degree of compassion we as a society have towards elderly people of meager means living among us. The number of these people is growing fast. And this is relevant not only for seniors whose condition requires intensive nursing care, but senior citizens as a whole. For example, the matter of dropping co-payments on prescriptions by senior citizens was not addressed by the Netanyahu Commission among its recommendations, out of fear of the high cost. Economics were the decisive factor, and they wanted at least the clauses they had recommended for health reform to be adopted. The truth is, even in the period when the Parallel Tax existed (1973-1997), it would have been possible to solve this issue.

Dental care was also not included in the original Law. Deputy Minister Litzman, to his credit, has introduced free dental care for children up to the age of 14. Prior to this, 95 percent of the

137 See Chapter 8

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