BGU | MY PATH, Haim Doron, MD

In 2015, health expenditures were 7.5 percent of the GDP in Israel at a time when the mean average for OECD countries in 2014 was 9.4 percent of the GDP. Israel is falling behind. Moreover, as already noted, in Israel in 2015, the source of total health expenditures that are private already stood at 38 percent. To this day, those at the head of the Ministry of Finance allow the sick funds and hospitals to fall into deficits. Recently, the Minister of Health announced that a hospital that went over budget would not receive compensation to cover this. As I write, the Finance Committee of the Knesset is discussing the 90 million NIS (approximately 26 million dollar) deficit at the government-run Rambam Hospital in Haifa, and an additional deficit at the smaller Nahariya Hospital. At the end of the year, after all the deficits are closed, the horse trading with all the sick funds and hospital begins, with the government trying to pay out as little as possible. This results in deficits being carried forward for years. All this comes from the practice of only partially updating the cost of the health basket. Another expression of this situation is the ratio of hospital beds per population, particularly in hospitals in the periphery. The winter months in particular are marked by scenes of more and more people turning to private medicine for service due to lengthy waits for the same service through normal channels of the public health system. One should keep in mind that public hospitals still lead in levels of service. When complications develop at the private hospitals, the patients are transferred to the public hospitals. While a high level of medicine still exists in public hospitals for regular patients, there is erosion of bed availability within the public system, with private beds bing supplied for patients entering under the sick funds’ SHABAN supplementary coverage. The Maccabi sick fund was a leader in this practice when it established its network of Assuta hospitals as private hospitals funded by the commercial insurance company, Clal. Several years ago, I was very pained to hear that, fueled by competition issues, Clalit purchased private beds in the private Herzliya Medical Center. Those who champion private medical services argue that the biggest flaw of public medicine is the lack of free choice of doctors and hospitals. This was one of the arguments in favor of the SHABAN plans, since they include the option for a second opinion, and choice of private surgeon, with reimbursement of some sort. In my opinion, a second opinion could be incorporated into basic insurance coverage. It is not a major expense, and it would be preferable to bolstering SHABAN services and private medicine. The situation today has reached such a state, is so over the top, that prior to the opening of the new hospital in Ashdod, the Ministry of Finance agreed to Assuta’s receiving public permission for building the 300 bed hospital including allotting 25 percent of the new hospital’s beds as private beds. At one point, in a meeting of the health council, I proposed to the Minister of Health that this 25 percent of Assuta Ashdod’s beds serve ‘medical tourism’ only, 142 and not divide Israeli inhabitants into “haves” and “have-nots”. This year, the Ministry of Finance paid approximately 340 million NIS (98 million dollars) to Assuta so it all is beds would be public. Summing Up the State of National Health Insurance Law Today I was educated in the spirit of Dr. Yosef Meir’s doctrine based on the principles of public medicine: an appropriate medical level; mutual liability; seeing to it that all stages of health are addressed; and ensuring money would not be a factor in relations between patient and physician. Only in the framework of a social security system and its sources of funding, can one ensure the fundamental conditions of flexibility in provision of service and long-range planning essential for maintaining such a health system.

142 For general information about medical tourism in Israel, see: https://en.wikipedia.org/wiki/Medical_tourism_in_Israel

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