Israel’s public health system is considered to be one of the best in the world. We have doctors and nurses at the highest professional level and outstanding minds. However, our health care system suffers from a number of worrying problems and trends which leads it to struggle to give the Israeli public the appropriate level of care for their medical needs. These trends stem primarily from a significant decrease in public investment in the system alongside a worrying increase in private health care spending. The average private expenditure on health care in the OECD stands at 28.5% and public investment at 72% while Israel invests only 60% and the public pays for the other 40% out of their own pockets with most of the money spent on private medical insurance and personal contributions.
We are witness to widening gaps in the health care system, whether between the country’s center and the periphery or between different sectors in our society. The lack of resources leads to overcrowding in hospitals, long waiting times at emergency rooms for operations as well as financial difficulties for the health care providers.
With the aim of providing solutions for the system and for the public and to stop the downward trend in the public health system, former Minister of Health, MK Yael German created the Committee to Strengthen the Public Healthcare System in Israel (‘German Committee’). The German Committee included members from a range of government ministries including Health, Finance, Justice, Prime Minister’s Office, Justice and the Bank of Israel as well as senior academics in the field and representatives of the public. The committee sat for a year and representatives of all the organizations in the health care system presented before the committee. The committee published a series of conclusions and recommendations which propose an overall program to improve the public health care system and to strengthen it.
Yesh Atid adopted the report and will work to put its findings into practice.
Strengthening the Public Healthcare System
Shortening waiting-times for medical treatment in the Public Healthcare System
Former Health Minister, Yael German, initiated and funded a one billion shekel, nation-wide plan for shortening waiting-times for appointments by, for example, hiring 'Full-Timers' (doctors who work only in the public health system and work overtime). Under the new model, specialists will support the in-patient clinics during afternoon hours for the benefit of the Israeli patients, in return for extra pay. Additionally, a detailed plan for adding tens of thousands of operations in the public system is ready for implementation.
These steps will significantly increase the number of medical procedures that are carried out each day and will lead to shortened waiting times for operations. Similarly, additional funds are budgeted to implement the "Or Commission" recommendations for making Emergency Room procedures more efficient and will shorten waiting times at the urgent medical centers. Expected waiting times have already been publicized thanks to the "German Commission" and will continue to be transparent and open to the public.
As noted, in order to implement this plan, there is a need for an additional one billion NIS in funds. This increase has been approved by the former Finance Minister, Yair Lapid, and was included in the state budget.
Financially strengthening the public health system:
Yesh Atid believes that health is a basic right for every citizen and so it is the responsibility of the state to appropriately budget the public health care system. That is why we worked to strengthen the public health system in order to reduce the need for private health care, bring down the cost of medical insurance and bring down the cost of living.
In the 2015 budget formulated by former Minister of Finance, Yair Lapid, the investment in health care increased dramatically by 4 billion NIS. This was to enable the recommendations of the German Committee to be implemented and the treatment and improve the service provided to the Israeli public. During their tenure, Yael German and Yair Lapid increased the health care budget by circa 1 billion NIS and managed the crisis which threatened to close Hadassah Hospital including emergency assistance worth 1.3 billion NIS.
On the subject of financing the public system the committee recommended not to allow Private Medical Service (known by its Hebrew acronym as SHARAP) into public hospitals and that the limitations on privately funded activities within public hospitals should be maintained; in the public hospitals where there is SHARAP, we must ensure that the waiting times for medical procedures are equal, wherever possible, between the public and private options.
Yesh Atid adopted the findings of the German Committee to match the cost of the health basket to the demographic index of Central Bureau of Statistics and that recommendation was included in the 2015 budget (which didn’t pass before elections were called). The budgetary implications are an increase of hundreds of thousands of NIS for the core budget of the health care providers.
A special committee will be founded to re-examine the price structure in the health system and the current accounting relationship between the health care providers and the hospitals. Until the accounting system is changed the growth of private hospitals will be limited so as to strengthen the public hospitals and return patients and doctors to the public system.
We believe that the private system contributes to the state and to the overall health care system and answers the need for freedom of choice. With that, the private system also has some negative impacts on the public system (use of the same manpower – doctors and nurses) and these negative impacts should be reduced.
Reducing overcrowding in hospitals
The State of Israel is the most crowded in terms of inpatients in hospitals. The level of inpatients in Israel stands at 98% of capacity and in the winter exceeds 100% and reaches impossible levels. The German Committee gave its verdict on this issue and recommended a number of solutions to improve the situation in emergency rooms and urgent health care centers.
Aside from extra beds and staff and aside from the government’s multi-year plan, the committee also recommended the following:
Inpatient places for geriatric patients at geriatric hospitals and not emergency rooms by increasing staff levels in those departments;
Strengthening the outpatient care by the health care providers so that they can assist chronic patients and those who are severely ill at home;
Developing and strengthening the technological capabilities in the field of tele-medication;
Reducing unnecessary visits to emergency rooms by strengthening the ability of health care providers to deal with urgent medical issues with high quality staff and infrastructure;
Appointment of administrative staff to assist the medical staff with tasks they unnecessarily undertake today;
Appointment of a contact person with the health care providers who will coordinate release from hospitals and enable ongoing and appropriate medical treatment;
Strengthening the urgent medical care centers and adopting the findings of the Or Committee, including improving urgent care and increasing staff in emergency rooms;
A budget of 1 billion NIS targeted to reduce waiting times will also be used to strengthen the urgent care centers and implementing the Or Committee. This budget has been frozen due to the elections and the 2015 not being passed.
Widening the health basket and technological additions:
The health basket is the list of medical services and medications which are given to the Israeli public and paid for by the government through the health care providers. Each year there are painful struggles by patients who demand that the treatment they need be included in the basket. Yesh Atid believes in the responsibility of the state to provide citizens with a publicly funded, wide-ranging health basket. We support the decision that the annual technological increase with regards to services provided by national health care law will not fall below 0.8% a year.
Former Finance Minister, Yair Lapid, and former Health Minister, Yael German, signed an agreement to increase the budget for technology and new medication in the health basket by 900 million NIS over three years (2013-2015). The decision led to a real increase of 600 million NIS in 2013-2014 and 300 million NIS which should have increased with the 2015 budget which didn’t pass before elections were called. As a result of these significant increases 88 new medications and technologies were included in the health basket with a focus on preventative medicine to prevent people becoming ill.
With the discovery of new medication which treats diseases like Hepatitis C more money should be allocated to the health basket which will be both multi-year and ring-fenced and allow the funding of the new medication.
Yesh Atid opposes the inclusion of life-saving medication within health insurance plans so as to ensure that the state will continue to fund them.
Structural changes in the health care system
Creating the Agency for Public Medical Centers
The creation of an Agency for Public Medical Centers is the first recommendation of the German Committee, and it deals - for the first time - with the problem of a conflict of interest in the Ministry of Health: it has the role of the regulator of the government-run hospitals, but is also the owner of those hospitals.
This decision, which allows the Ministry of Health to focus and strengthen its role as the regulator of the Health system, takes the role of oversight out of the Ministry of Health and transfers it to a new independent body – the Agency for Public Medical Centers.
The Agency functions as a support unit to the Ministry of Health, but is directly responsible to the Minister of Health and it will boost the oversight and control of the management of government run hospitals.
Creating 'Term Rotation' of Directors of hospitals and Department Heads
Today, the management roles in the Healthcare system are not allocated by time periods and, therefore, a reform is needed to supply motivation and a time horizon to the people working in the system that will encourage professionalization and specialization in their management roles. Additionally, given the absence of a medical career development horizon in the medical institutions, many of the top professionals in Healthcare and Research do not find a place to fit into the public system.
Former Health Minister, Yael German, brought the start of a new 'Term Rotation system for hospital managers and department heads for government approval. This decision limited the term of senior positions in hospitals. In the framework of the agreement, the terms will be limited to two 'sessions' alone and this will preserve the good quality human capital within the public health system.
Expanding the choice of general admissions
Today, a person needing admittance to a hospital is sent by the Kupat Holim for treatment in a hospital appropriate to the person's residence. This is a financial choice that is anchored in earlier existing admissions policies and agreements. These arrangements do not take into account situations where a person would prefer to be admitted to a different hospital for any variety of reasons, such as proximity to other family members.
We will act to implement the recommendation of the German Committee to ensure a choice of three hospitals offered to patients, according to fixed criteria, and thus empowering the public with greater choice.
Reforming Medical Tourism
Yesh Atid supports the recommendations of the German Committee for reforming medical tourism to protect the status of the Israel citizens and to ensure the rights of foreign patients.
The proposed reform will correct the absurd situation in which medical tourists often receive preferential treatment in hospitals, to the detriment of Israeli patients. A model has been created on the basis of a number of principles: Treatment of tourists will not come at the expense of treatment of Israelis; funds from medical tourism will be directed to the benefit of Israeli patients and strengthening the public health system; tourists who use Israeli infrastructure will be taxed accordingly and this will generate billions of NIS towards the benefit of the Israeli tax-payer; and the pool of medical travel agents will be regulated by the creation of a mechanism for the protection of the rights of medical tourists.
National Plan for the Prevention of Suicide
Every year more than 500 people in Israel commit suicide, and over 6,000 people annually attempt suicide. The estimate is that there are many more attempts that go unreported.
Former Health Minister, Yael German, took the lead, in conjunction with a number of government ministries and local authorities, in battling against the phenomenon of suicide. It was decided to create a national plan to prevent and reduce the incidence of suicides and suicide attempts and to provide aid to families whose members had committed suicide.
The national plan was implemented in all towns across the country in a staggered roll-out over a number of years. Its implementation is directed by a special office that was created for this purpose by the Ministry of Health.
Yesh Atid is committed to this national plan for the prevention of suicide and will ensure it is funded in the upcoming budget.
Reforming Medical Insurance
The driving force behind the disproportionate growth in private medicine today is medical insurance, private insurance and supplementary insurance plans by the health care providers which are based on the fear of the public for their health, and their desire to ensure medical coverage for every scenario, along with the lack of clarity of the plans offered to them.
When a citizen purchases supplementary medical insurance from their provider or a private policy they don’t have the option to choose the level of insurance coverage and are required to pay a premium even for services which they do not want. In addition, most people find it difficult to understand the details of the policies and they purchase coverage which is doubled up and unnecessary, without knowing what the full policy includes.
The reform will increase transparency, reduce double coverage and bring down the high cost of medical insurance. Within the framework of the reforms the health care provider’s policies (supplementary) will be broken up into three different and unrelated elements: operations and consultations; medication, pregnancy, dental care, child development; general category for all the rest. The content of the first section (operations and consultations) will be determined in a uniform way by the Ministry of Health and Ministry of Finance, and will be identical among all the health care providers and private insurance companies so that everyone will be able to avoid instances of double coverage.
The reform will allow the insured person flexibility in purchasing insurance and a way to avoid paying for double coverage which occurs in 25% of the population. Additionally, the reform widens the options of every citizen to make an informed choice regarding the services they require and pay only for them thereby bringing down the cost of health care and the cost of living.
Finally, a website will be created on which a citizen with insurance can check their policies and the medical coverage included within it.
Increasing transparency in the public health system
“All Health” website
The Ministry of Health, led by former Health Minister Yael German, created a website entitled “All Health” (Kol Habriyut) which allows every citizen to easily find out their rights and compare the different health insurances offered to them.
Through the website, the transparency it created and the strength it gives to the public, the competition between health care providers and the private insurance companies will be increased. The competition will lead to a reduction in insurance prices and allow the public to carry out up to date and ongoing comparisons of the products on offer.
Yesh Atid will work to include private medical insurance details within the “All Health” website so that every citizen will be able to compare every insurance policy in Israel in a timely and accessible manner as well as adding a personal section on the website to allow every citizen to see which policies they already have and where.
Publication of waiting times for operations at different hospitals:
The publication of waiting times for operations in the different hospitals provides patients a useful measure of the availability of procedures in the hospitals which offer them. Measurement of waiting times for operations is a necessary component of the plan to reduce waiting times proposed by former health minister German. The scope of measurement would be increased to include additional procedures which have been identified as problematic with regards to the length of the wait.
Strengthening the health care system in the periphery and increasing equality:
As part of the efforts to reduce the discrepancies in levels of public healthcare between the periphery and the center of the country, budget funds were allocated by the Ministry of Health to upgrade the infrastructure and the medical facilities and to increase the basket of services in hospitals in the periphery.
In this framework a new catheter department was set up in the "Haskoti" hospital in Nazareth; approvals and funds were given for the addition of 5 MRI machines for the "Ziv" hospital in Tzfat, "Hillel Yafe" in Hadera, "Haemek" in Afula ,"Puria" in Tiberias and "Wolfson" in Holon. Approvals and budgets were given for installing linear accelerators in the "Ziv" Hospital in order to give radiotherapy treatments to cancer patients in the North. It was decided to set up new heart and chest surgery departments in "Puria" in Tiberias, three rehab centres in the South – in "Soroka" in Beer Sheva, "Barzilai" in Ashkelon and a rehab village for people with special needs in Aleh Negev. A Pet-CT machine was approved for the hospitals "Ziv" and "Augusta Victoria" in Jerusalem. It was decided to increase the budget for renovations of the infant clinics in the South and to create 6 additional advanced emergency treatment centers in towns in the South and a plan to advance the training of nurses in the Bedouin sector. The implementation of these decisions is depending on the upcoming budget decisions and the placing of healthcare improvement at the top of the country’s economic priorities as per the budget for 2015 that was prepared for the government by former Finance Minister, Yair Lapid.
Promotion of Creation of new Hospital in Beer Sheva
Former Minister of Health, Yael German, brought a bill for government approval to create a new hospital in Beer Sheva. Soroka Hospital in Beer Sheva currently provides medical services to more than one million residents of the Negev, but with the increasing population in the South, the ability of the hospital to provide healthcare services to the public is being reduced and waiting times are increasing.
The process to create a new hospital in Beer Sheva, which will provide more advanced medical services to residents in the South, in parallel to Soroka, reflects the aspirations of Yesh Atid to reduce the gaps in service, to supply every citizen of Israel a high standard of healthcare equally and fairly, and to answer medical needs whilst reducing the costs to residents of the South who are suffering due to the overload on the existing system and are thus forced to turn to more expensive private healthcare providers.
Increasing the Grants given to continuing education in the Periphery and for professions that are less in demand.
As part of the work to strengthen the public healthcare system in the periphery and to ensure doctors are still equipped with skills to carry out less in-demand professional procedures, former Finance Minister, Yair Lapid, increased the size of the grants given to students in fields that have fewer practitioners in areas where there is less interest in studying these fields.
In an agreement between the Treasury and the doctors, 620 million NIS were allocated for grants over a number of years as grants to encourage doctors in the periphery to acquire less-used skills. In the light of great demand for this initiative, and the distribution of all the available funds in 2014 alone, Ministers Lapid and German decided to continue the project and expand it by a further 75 million NIS in 2015.
Professions that were added to this group in 2015 were adult psychiatry and family medicine in the periphery. These professions were added to Geriatrics, Pathology, Neo-Natology, Anesthetics, Emergency Medicine and Pediatric Psychiatry.
Bolstering Night Centers in the Periphery and strengthening Medical Services
Night-Centers (Centers for Emergency Medicine) and Emergency Rooms supply immediate medical aid to residents in the Periphery who often live far away from hospitals.
As part of the efforts to improve the quality of aid and availability of medical services, former Health Minister Yael German acted to obtain government approval and funding for the opening of 6 emergency medical centers in the periphery. These centers are intended to open in Netivot, Ofakim, Arar, Lakiah/Hura, Rahat and Cesifa. This is in addition to continuing the support for of existing 6 Night-Centers in Kiryat Gat, Arad, Dimona, Central Arava, Yeruham and Mitzpe Ramon. The budget for these centers is part of the proposed 2015 budget.
We will continue to act to create new centers in areas far from hospitals and to improve the quality of the medical services in the periphery.
Securing Barzilai Hospital in Ashkelon
Former Finance Minister, Yair Lapid, and former Health Minister, Yael German, increased the budget for securing Barzilai Hospital in Ashkelon by 30 million NIS.
The sum was given as an addition to the security project following a decision to transfer 120 million NIS to protect the hospital which is on the front line of rocket fire and large sections of it remain unprotected.
This additional support will allow for rapid and unimpeded building to ensure that all the operating rooms are secured as well as the intensive care unit and the sterile zone of the hospital.
Equality between sectors:
Yesh Aid will act for a specific budget to reduce inequality between different sectors of Israeli society and to increase the medical services given to different sectors such as the Arab and Bedouin populations. Within this framework an emphasis will be placed on fighting diabetes and obesity within the Arab sector. As part of the 2015 budget 100 million NIS was dedicated to reducing gaps between different sectors.
Changing the surrogacy Law
The right to start a family is a basic right for everyone. In regular circumstances it doesn’t require the permission of the state to be fulfilled. To allow same sex couples and women without partners to fulfil their right to become parents, former Health Minister, Yael German, initiated a change to the Surrogacy Law, which passed the first reading in the Knesset.
The change in the law allows men and women access to the surrogacy services in Israel, will reform the surrogacy procedures from abroad and widen the criteria to increase the number of surrogates in Israel. The law also protects the rights and welfare of the surrogates but limits the fee that can be paid to them.
Yesh Atid is committed to the reform in the surrogacy law and will work to ensure it passes the second and third readings in the Knesset.
Changing the policy on blood donations
The current guidelines discriminate about various groups without medical justification from the potential blood bank, including those of Ethiopian descent and from the LGBT community.
In order to change this discriminatory reality, former Health Minister Yael German created a committee to re-examine the policy on blood donations. The Knesset was dissolved as the committee was preparing to make its final recommendations.
We will act to change the policy of blood donations in Israel to ensure it is no longer discriminatory, protects the dignity of all groups in Israeli society and doesn’t harm the health of the public.
“Yesh Atid” worked to allow families to provide their children with a range of necessary social services without dipping into expenses that would otherwise impede the cost of living. To this end, the former health minister, Yael German, extended the services provided as part of the national public health services to include early childhood care. Starting with dental health education in kindergartens, then continuing by extending accessibility of early childhood development services in communities that participate in the “360 Program” (a program for at-risk children and youth), we established a pilot breast milk bank and financed the construction two such banks in hospitals in the periphery.
Preterm birth has become a widespread phenomenon in Israel. In 2013 alone, 12,516 preterm births were recorded, comprising 7.32% of the total 171,088 babies born in Israel that year. In order to treat these infants, the former health minister, Yael German, promoted a long list of new initiatives. Among these initiatives was “Ashlim”, a program to improve the monitoring of MCHC levels in premature infants by training nurses to recognize and give treatment for the unique needs of these infants. In order to improve the health of these premature infants, we initiated the “Stars Model” which allocates NIS 80 million per year for dispersal over the next four years to fund the “Touch None” program, a program that will bring down the infection rate in premature infants.
Accidents involving children in public and private are the number one cause of mortality among Israeli children. These mental and physical injuries cause an enormous economic toll on parents, employers, insurance companies, and the health care system. The estimated economic cost of damage to the health and welfare of children in Israel is over NIS 1.6 billion per year. “Yesh Atid” views the protection and safety of the Israeli children as an issue of national importance and will work to reduce the harm done to them as much as possible, while strengthening the tools to prevent child harm and to increase child safety. We will work to implement the Ministry of Health’s national child safety program, to develop educational programs about prevention and safety, and to implement these programs at the municipal level, all while advancing relevant legislation.
Bringing down the cost of living
Reform of importing food and cosmetics
Today, import of food and cosmetics requires many checks and approvals at the hands of the Health Ministry. This complex import process creates costs to the importers which are then passed on to the consumers, increasing the price of food and raises the cost of living.
During the last Knesset session, we promoted a reform of food and cosmetics imports which was based on cutting down the bureaucratic process of importing these products, opening up the markets to parallel importing and strengthening enforcement and punishment of importers who violate Health Ministry rules. We are committed to completing this reform and to reducing the cost of food and cosmetics.
Promoting benefit payments to Celiac Disease patients
The population of celiac patients in Israel have to expend large sums of money on special diets, in particular purchasing gluten-free products that are very expensive.
Former Health Minister, Yael German promoted targeted subsidies to celiac patients to reduce their monthly expenditure. In the framework it was decided to create an inter-ministerial commission to present recommendations on how to make it easier for celiac patients to purchase gluten-free products.
Aliya, Absorption and the Public Healthcare System
Many of Israel's doctors are new immigrants who struggle to be accepted to specialist positions in Israel despite having acquired education in their countries of origin and despite having garnered much experience in their fields. As a result, many of them are forced to move to another speciality, in fields that are more in demand in Israel's Healthcare system. Many of them do not succeed and become general practitioners without specialties and who can then not train others.
Former Health Minister, Yael German, opened up 50 new positions to address this issue. With their help, specialist doctors with experience in their countries of origin, can continue to practice in Israel, to find their niche and to share their experience in the Israeli medical arena. This is in addition to the other improvements made to the public healthcare system which will only benefit from the addition of these experienced professional doctors.
Easing the licensing exams for students studying abroad
60% of Israeli medical students today study abroad. In order to overcome the troubling shortage of doctors in the public healthcare system in Israel, it was decided to ease the licensing requirements for those who study abroad as they enter the public healthcare system in Israel without lowering the required professional standards.
In this framework, former Health Minister, Yael German MK, gave exemptions from the third stage of licensing requirements and from part of the USMLE practical examinations – actions which made life significantly easier for those who studied medicine abroad and who, in the past, were obliged to travel to as far as the USA to complete their practical examinations.
People with Special Needs in the Healthcare System
Yesh Atid sees it as vitally important that in the healthcare system specifically and all public offices in general, that services be accessible to all who approach them.
Under the Minister for Health Yael German, the Ministry of Health began a reform to improve the efficiency of services offered to people with disabilities. In this framework, services are to be offered around the clock to people in motorized wheelchairs, offices where patients were received are to be made accessible, committees were computerized, and more.
We must work with the Welfare Ministry, the Treasury and National Insurance Institute to ensure that access is made easier to people with varying disabilities.
Yesh Atid is committed to creating a joint mechanism which will shorten waiting times and prevent the need to obtain multiple approvals from medical boards and committees to obtain accessories and transport for people with disabilities.
Population Aging and Geriatric Care
The average life-span in Israel is one of the highest in the world and the population continues to age. Many elderly citizens experience difficulties in financing geriatric care, some of whom do not meet the strict criteria that would open up government funded care for in-patient treatment and who struggle to pay out of their own pockets.
Yesh Atid will create a national multi-ministerial team to resolve the issues of our aging population. The team will review, among other items, aging trends in Israel and will generate a mechanism for Geriatric Care Insurance and the creation of a national Agency to help the elderly. A solution to the shortage of skilled human resources and a change in the criteria for receiving help will be produced. Funding the conclusions of this team will come from profits of gas production.
Promoting Public Health
Yesh Atid supports giving a special emphasis on all items that prevent sickness and promote the health of the public. We support allocation of specific budget items for health awareness, healthy life-style choices and health improvement. We support the strengthening of the awareness of the need to eat healthily, starting from kindergarten and school-age education and to increase awareness of the benefits of and options for physical exercise and regular check-ups.
Encouraging Organ Donation
In accordance with the recommendations of the 'Ben-Yehuda Committee' Yesh Atid will act to promote awareness of Organ Donation through venues such as education, public lectures, IDF Induction questionnaires and driving licensing centers and the promotion of a National Organ Donation Day.
Today, the purchasing of supplemental (or complementary) medical treatments is increasingly recognized for its value. However, the market is saturated and swollen and many practitioners do not have necessary recognized professional qualifications.
We will work to regulate this industry and strengthen protections for patients from businesses which are not sufficiently professionally qualified.
Veganism is becoming more popular globally in recent years and is more widespread here in Israel too. Many of those who adopted this lifestyle choice did so for moral or humanistic reasons and out of a concern for the environment. A smaller number did so for health reasons.
Yesh Atid will work to ease the challenges faced by vegans in Israel due to the cost of food products, availability in dining establishments and the way that government agencies relate to the matter.