As the start of her address to the 2013 Eli Hurvitz Conference on Economy and Society, Health Minister Yael German asserted the point of departure of her presentation is the lack of investment in health: we talk about health, we even die for health, but we are less likely to invest in it.
The current annual expenditure on health in Israel is 7.7%, the government is spending less on public health, and private health costs are going up. Were the government to be willing to pay more for health, such a policy would ultimately be cost effective on a national level.
Minister German asserted that Israel has an excellent health system, with a progressive and socially just national health insurance law. She continued, however, that three basic principles—equality, justice, and mutual responsibility—must be implemented on a daily level. Making the narrowing of socioeconomic gaps a priority in general will narrow gaps in health care in particular. According to the Health Minister, inequality in health care and health access costs the general population a high price, and when weaker segments of the population get sick and have epidemiological diseases, we all pay the price. If the government does not invest in narrowing the gaps, society at large will have to pay hand over fist in order to help weaker societies.
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According to Minister German, recent measures implemented by the Ministry of Health have been very successful, such as incentives for attracting nurses and doctors from the periphery, grants that encourage doctors to work in periphery, the opening a new medical school in the Galilee, cultural training and accessibility courses, the establishment of 10 new emergency wards in the periphery, cancelation of mother and child co-payments for HMO visits, and decreased co-payments for Holocaust survivors and for people with chronic diseases. Additional successes include free medical treatment in schools, which provide care to over 1,200,000 school children, and medical consultation by telephone in Amharic.
The impact of social stigma and social attitudes in the health system exacerbates existing inequalities. Some doctors refuse to provide care to AIDs patients despite the fact that with current medical knowledge and precautions, there is no medical reason to refuse to treat them. As a result of social stigma about suicide, there is no formal state intervention program, and Israel desperately needs a program to prevent suicides. Suicide rates are double the rate of death by road accidents, but while the government spends NIS 400,000,000 on preventing road accidents, it spends nothing on suicide prevention.
Minister German pointed out that suicide rates are higher among minority groups such as Ethiopians and the elderly than in the rest of the population. She also revealed that in the Bedouin and Ultra-Orthodox communities, fewer women suffer from breast cancer than in the general population, yet more women die as a result of their cancer. This is directly related to the taboo surrounding the discussion of health issues.
Another major challenge to the health system that was noted by the Health Minister is the doctor patient dynamic.
Minister German feels that although we should aspire to have state of the art technology and the best tools at our disposal, technology has also lessened the human touch provided by doctors. The two main health providers in Israel, HMOs and hospitals, do not really interact with each other and need to be better integrated. This includes revamping the payment system. Instead of HMOs choosing to reimburse patients for hospital treatments, and limiting the patient's choice of hospitals for treatment, there needs to be a transparent payment system. This would include online publishing of information about types of treatments available at hospitals, mortality rates, the members of the hospital staff, etc. When patients are released from the hospital, there is need for mechanisms for home treatment. This would require further cooperation between HMOs and hospitals.
Minister German expressed her belief that health care must be a defined national priority that will take the above parameters and considerations into account and attempt to combat social stigma. Israel's vision of equality and justice should remain the same, but steps must be taken to maintain and actualize this ideal.