BGU | MY PATH, Haim Doron, MD

in Israel rank together with the United States and South Korea and few other countries among the top countries in the OECD in the percentage of total national health expenditures that come from private resources. It was clear to me from the start that supplementary insurance would lead to further services requiring supplementary coverage and would lead to even greater discrimination by means. Today, when Israelis call to set up a doctor’s appointment with their sick fund in the regular public health system, before they can do so, there is a pitch for a host of special “platinum services” of one kind or another. Today it is being suggested that such ‘Platinum Plans’ include life-saving pharmaceuticals, with everything such means-based accessibility entails. Another grave result of introducing SHABAN plans was the change from a concept of competition on level of a sick fund’s service in the public basket, to a concept that generates competition among SHABAN plans. Put bluntly, we have gone from competition on quality of health service as an entitlement, to competition on a comfort commodity one consumes. Introduction of Co-Payments Another item, added to the 1998 Arrangements Law was specific co-payments. In the past, Clalit had a policy of symbolic co-payments for prescriptions, a nominal sum. But there were never co- payments for visits to doctors, and even today there is no co-payment for visits to one’s primary physician. By contrast, Maccabi does have a nominal co-payment for visits to doctors. The Arrangements Law of 1998 converted the concept of symbolic, nominal co payments, into payment of a specific percentage of the actual cost of a given pharmaceutical. This change led to a rise in the sick funds’ revenues from selling pharmaceuticals from 5 percent to 11 percent, plus additional income from their pharmacies. While there were ceilings on patient expenditures, nevertheless, out-of-pocket outlays on pharmaceuticals can accrue to substantial sums. Today, when I pay for my and my wife’s prescriptions, and we enjoy a 50 percent discount as employees of Clalit, I ask myself how a senior of limited means can pay such sums. More than once the pharmacist has told me about insured persons who don’t have the money to buy the pharmaceuticals they need. Then the insured person says: “This month I’ll take my prescriptions, and next month I’ll take my wife’s”; or “I won’t take such-and-such because I don’t have the money.” I know there is a portion of the population that vacillates between buying medicines and buying bread at the grocery. In the years when I was a member of the Ministry of Health’s health council, I often spoke against this state-of-affairs, where low-income seniors must pay for prescriptions. Each time, I was promised that this injustice would be rectified, but it has never been addressed. This appears to be the upshot of a situation where the Ministry of Finance manages health, and there is no balance between the economic considerations for the state vs. medical and social considerations for the individual. Israelis are proud of the longevity we enjoy. Our life expectancy is one of the highest in the world for both men and women. When talk turns to the shortage of hospital beds and staff, immediately someone changes the discussion and starts to speak of the achievements of the health system. True, the achievements are impressive, but if the policies of Arrangements Laws from the mid-1990s continue, there will be a deceleration of improvements in morbidity indexes and longevity.

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