How long can Israel get away with low public spending on health?

It is perhaps common knowledge that Israel enjoys a good system of public health services, far better than the system in the US. However, in a recent article, veteran health reporter Ronny Linder-Ganz expressed dismay at the continued under-financing of Israel’s health services: “The Health System is on the Way to Certain Crash” (The Marker, August 15, 2018, Hebrew). Linder- Ganz opined that the “miracle” of universal health services at low public cost will not last much longer: either Israel must invest more in health or see the quality of its health services decline.

And indeed, Israel’s Central Bureau of Statistics just released new figures on health, revealing that the percentage of Israel’s national expenditure on health that is publicly financed is a low 63%, compared to other developed nations, which average 74%.

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More telling still, the Bureau reported a 9% increase in what Israeli households pay for health insurance above and beyond the services provided under the National Health Insurance Law. Unlike health care under that law, to which all permanent residents of Israel are entitled, other health insurance policies provide services for those who can pay more – and what’s more, they bestow on policy holders priority when it comes to visiting specialists and having surgical procedures done.

Social advocacy organizations, including the Adva Center, Physicians for Human Rights and the Association for Civil Rights in Israel, have for years recommended absorbing private health insurance benefits that are now considered essential health services into the universal system, so that monies spent on health benefit everyone.

And that’s not all that ails the system: Another problem is the lack of public financing for “full-timers,” that is, physicians who are paid well to remain in hospitals all day long rather than just coming for the morning, after which many run off to private clinics in order to supplement their income.

And one more negative development that deserves mention here is a new law designed to regulate medical tourism that stops short of doing so: among its other shortcomings, it fails to set limits on the number of medical tourists a hospital can intake. Under better conditions, medical tourism might be an excellent way for Israeli hospitals to balance their books; under present conditions, which include understaffing and an insufficient number of rooms and beds, medical tourists compete with Israelis for both space and medical attention.

In short, there is no room for complacency about Israel’s public health system. Its low budget can only be stretched so far, after which we will see the decline of what was once one of the best public health services in the world.

The writer is director of the Adva Center, a non-partisan Israeli policy analysis institute.

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