Recently the position paper – “No Difference Between Rich and Poor” was sent to senior officials in the Ministry of Health and Members of Knesset. The document details the necessary steps required to equally safeguard the right to health for all Israeli citizens.
We have suggested 10 steps to the German Health Committee (so named after the committee head Health Minister Yael German), which will soon make a final decision on the makeup of Israel’s health system, specifically on the balance between private and public insurance. The current debate on the privatization of healthcare in Israel is focused on the legitimacy of introducing private-for-profit services into the heart of the public system. ACRI strongly believes in the value of public services, which are the only way to ensure equal access to health services and the right to health for every Israeli. This stance is even more crucial in an Israeli society that is plagued by some of the most entrenched social and economic gaps in the developed world.
Our model, designed by experts in the fields of health, public policy and economics, is designed to strengthen the public health system, shorten the queues, allow the patients to select their own doctors and increase healthcare services within communities all at no extra charge.
The key points of this 10 point plan can be found below.
Increasing Healthcare Services and Shortening Queues in the Public Health System
- Stemming the Erosion of the Budget – A dramatic change must occur in the method of calculating the health cost index, causing a much needed recalibration in the budget transferred by the state to HMOs. The health cost index must consider the cost of a full day of hospitalization as linked to real-time inflationary pressures, a measure demanded by a recent High Court of Justice ruling. It must also regularly update the rate of population growth, so that the money transferred to the HMOs for the operation of services will be optimized to the actual number of people insured.
- Integrating Private Supplemental Insurance Premiums into the Public Health Basket as a Progressive Tax – The money currently invested by the public within supplemental private insurance (over NIS 3 Billion per year) is equivalent to raising the national health tax by 1%. Changing the expenditure on supplemental insurance into a progressive tax, as a component of the currently existing health tax, will promote equality and improve public services. The public must come to understand that Israel’s national health expenditure (private and public combined) is low compared to other western countries, and that our current health tax is also relatively undersized.
- Shortening Waiting Times – The availability of doctors participating in the full-time scheme will significantly shorten waiting times in the public health system. But alongside this, a computerized system must be established to improve the accessibility of health care services, improve transparency and provide up-to-date information to the public, all of which will contribute to the shortened waiting times (similarly to the Canadian model – see the full position paper – Hebrew only).
- Strengthening of Community Health and Preventative Medicine – Resources must be invested in strengthening the relationship between HMOs and the public through a broad information campaign explaining in detail their rights, how the public health system operates and containing information on preventative health initiatives. The role of doctors within communities must be expanded such that the family doctor can engage in a conversation with patients and serve as the central health figure, directing patients through the complicated health system. It has been proved that such actions would have a dramatic impact on health outcomes and that public investment would substantially reduce hospitalizations.
- Public Education Campaign– The government should engage a public campaign so as the persuade the public in the necessity of the policy change. Among the highlights that should be touched upon: the basic principles upon which the public system is based; changes and improvements taking place within public health; the separation between the public and private health spheres and the integration of supplementary insurance into the public health basket, easing the financial burden on households.
- Forbidding Private Health Services from Operating within Public Hospitals – Private health care widens social gaps, contributes to a loss of faith in the public health system and supposedly causes a shortage of doctors within the public health system and therefore longer waiting times. In addition, it was found that in certain circumstances, private health providers increase the phenomenon of “black-market health services”. All commercial health services must be banned from taking place within large government hospitals, especially in the field of obstetrics.
- Disconnecting the public HMOs from Commercial enterprises – This includes private for profit medical imaging institutes such as “Mor Institute”, dentistry for profit chains such as “Maccabi-Dent” and “Clalit-Smile”. First and foremost HMOs must be disconnected from private hospitals (“Assuta” for example is owned almost entirely by the Maccabi HMO, and “Herliya Medical Center” for which the HMO Clalit owns 40% of its shares). This step will prevent HMOs from possessing secondary commercial, and sometimes conflicting interests, that cause confusion among the public.
- Curbing the Excesses of Private Healthcare and Commercial Insurance – According to Finance Ministry officials, private healthcare is an almost entirely unrestrained industry. It has been shown that commercial insurance companies are taking in a goldmine through insurance levies which provide higher profits to the insurance companies, but are a huge waste of money for private individuals and the wider economy. A consequence of the lack of supervision over the private health and private insurance industries is uncontrolled price hikes on the one hand, and escalating costs to the public on the other hand, all without achieving the original goal – ensuring the right to health. The lack of regulation and the absence of relevant information is fertile ground for the exploitation of the uninsured. As such, government initiatives designed to limit the acquisition of services in private hospitals must be strengthened. Close government supervision on the commercial insurance would prevent the exploitation of both insured individuals and the public health system, and ensure that public funds designated for private insurance are utilized efficiently and intelligently.
- Full-Time Agreement – All doctors and medical staff at public hospitals participating in this program will sign up to the Full-Time framework. As part of this system, each doctor will be obliged to select one of the following two options: committing to the public system at a high salary, or moving into the private sphere. Doctors who opt for the public system can not work within the private sphere, and vice versa. In return, doctors will receive a higher salary, an improved reputation, better facilities, the convenience and utility of possessing a single workplace and the right to work according to purely medical considerations. They will additionally gain the right to earn more through the “Brosh Scheme” – whereby doctors who are highly sought after will receive bonus payments.
- “Brosh Scheme”: Selecting your Doctor Within the Public System – Half of the amount invested today within supplementary insurance should be reallocated to allowing the selection of doctors (including receiving second opinions), without requiring any additional expenses. This scheme would be based on the principles of ‘first come first serve’ while taking priority medical needs into consideration. The scheme would operate in the afternoon and evening hours, and would enable highly sought after doctors to earn higher salaries, under defined rules and with complete transparency.
On Saturday March 1, 2014 there will be a large public rally taking place to demand that the government Choose Public Health. Please join us! Details at: https://www.facebook.com/events/410710589074613/
To read the full position paper (in Hebrew), click here.
