BGU | MY PATH, Haim Doron, MD

Proposals Not Adopted in the Arrangements Law Ironically, things could be worse. I want to note two proposals that I am happy to say, didn’t pass into law through the Arrangements Law. But, the fact the people at the Ministry of Finance dared to propose them is indicative to what an extent they were prepared to retreat from a public health system. One proposal was to establish a for-profit sick fund. This proposal arose from the insatiable ambition for competition, and I would even label this an obsession with competition. We all know about the high costs of healthcare in the United States, the highest in the world. There is no question that had this proposal been accepted, it would have led the State of Israel down the road to a similar situation. Another proposal that did not become law was for a differential basket of services, that is, the sick funds, as service providers would compete among one another over the types of services and pharmaceuticals they would offer. There would be competition on who offers more pharmaceuticals, who offers the newest, and so forth. This proposal is also linked to the Ministry of Finance’s obsession with competition and the American perspective. I want to share a story: When the National Health Insurance Law was passed, I was on sabbatical. I was walking the streets of San Francisco, accompanied by Prof. Mordechai Shani. He told me about the latest deliberations following passage of the Law. Among others, Shani told me that health insurance would be based on the four existing sick funds. I retorted spontaneously with a question: “Why four?!” And Shani said it was for competition. I thought then, and I still think to this day, that competition needs to be within the clinics and between medical teams. Also, after the bill was passed into law, when we convened in New York as the international advisory committee of the National Institute for Health Policy Research, one of the participants was Prof. Stuart Altman, an internationally renowned health economist. At one point, the two of us were together. I turned to Altman and asked his opinion of health insurance being based on four sick funds. He replied: “No, you’ll see. There will be many sick funds, and there will be competition.” I said that with all modesty, I doubted this would happen. Today, over twenty years later, just four sick funds exist. Let me reiterate: In my view competition in the health system needs to be competition over the quality of service of the staff teams in the clinics, not competition of the type of services covered by SHABAN’s .” Erosion of Machinery for Updating the Cost of the Basket of Health Services It’s a matter of fact that if one wants the preserve the level of the health system, it is imperative to update costs annually. In the first years of operation of the National Health Insurance Law the costs of the basket of services was only partially updated, solely accounting for population growth. Afterwards. other components were taken into account, such as age of the insureds, cost of medical equipment and pharmaceuticals on the market, wages, as well as technological changes. Updating the basket was tailored, or, more accurately, cut, to fit into the budget, not to fit the health needs of the people. This left the health system without a budget the size it needed to carry out its mission. Privatization Since Arrangements Laws were first introduced in the mid-1980s, the Israeli economy has witnessed creeping privatization in health matters. If this trend continues, nothing will remain of public medicine in Israel. And, it is well known that in many cases private medicine does not ensure a fitting level of medicine for all of the people who need care.

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