Health Minister Nitzan Horowitz might have been too quick to declare victory Monday over an additional NIS 2 billion that was added to the country’s health budget.
While the headlines his team disseminated to the press sounded awesome, routing more money for mental health, MRI machines for the periphery and an increase in hospital beds, behind the headlines is the sad reality that NIS 2b. is only two-thirds of the new funds needed to replenish the country’s perpetually starved health system.
According to Israel Medical Association vice-president Dr. Zeev Feldman, the original hope was to infuse closer to NIS 3b. more into health, which would have brought the annual health budget up from NIS 3b. to NIS 6b.
Instead, it now sits at NIS 5b.
“We really don’t know the amount of budget that will be invested now in each of the issues that were published as headlines,” Feldman told The Jerusalem Post. “There are a lot of categories, and there may not be enough money to make real change in each of them. We need to see where the money goes before we can analyze if it is good news, or really nothing new will happen.”
However, there are some obvious points of victory, such as the decision to infuse NIS 400 million into the construction and renovation of mental-health and psychiatric centers.
When Horowitz took office, he made his first official visit to the Yehuda Abarbanel Mental Health Medical Center, which he said at the time was “not accidental” and “symbolizes my priorities.”
“In my tenure as health minister, mental health and psychiatric medicine will move from the bottom of the list of priorities to the first line of issues that I will work to strengthen and promote,” Horowitz said during that visit, and the investment in rehabilitating the mental-health system was at the top of the list of budgetary allocations he disseminated.
A first phase of the rehabilitation program will be transferring some 400 chronic inpatients from mental-health hospitals to community settings, which would place Israel among the most advanced on this issue.
In addition, the money will be used to establish something called “balancing homes,” which will be empowered to provide intensive therapeutic services for people experiencing an acute mental-health crisis for which psychotherapy in a clinic or daycare center proved insufficient.
Another win is the decision to fund the first steps of a move away from 26-hour shifts for residents. The shifts of residents in the periphery will be shortened immediately in emergency, internal medicine, pediatric, women’s, neurology and radiology departments.
In most OECD countries, shifts are up to 14 hours.
Research has shown that these overly long shifts are taking a toll on the mental health and personal lives of the doctors who fill them.
Finally, the budget allotted for another 270 “chairs” for medical students and 1,500 for nurses each year to be trained at the country’s academic institutions. This is a strong and necessary first step toward improving nurse and doctor flows.
For perspective, in 2017, the annual number of nursing graduates in the OECD was 47 per 100,000 people, nearly three times the Israeli number of 16, according to Prof. Dan Ben-David, head of the Shoresh Institution for Socioeconomic Research.
The number has not improved since then.
The budget also expressed a lot of vague statements, such as a plan to “continue budgeting additional hospital beds” without indicating how many and how quickly.
It further stated a plan to add more than NIS 130m. in 2022 to help correct budget deficiencies caused by the aging population. Elderly people tend to be sicker and need more medical services. Israel is expected to end the decade with 70% more people in the over-75 age bracket thanat the beginning.
While the budget says health funding per citizen “will increase automatically each year in accordance with the rate of population aging,” there is no indication as to exactly how much money the country is planning to earmark or to how those funds will be guaranteed.
Lastly, there are plenty of losses.
The NIS 500m. budgeted for public hospitals is even less than the NIS 630 provided to them in emergency funds during the COVID-19 crisis, Feldman said. This means the money is unlikely to fill the gaps.
Additionally, while the decisions to maintain the 600 doctors, 1,550 nurses and 700 administrative and support staff hired to support the hospitals during the pandemic can be celebrated, the additions don’t come close to making up for the deficiency of medical personnel.
Israel has one of the worst nurse-to-population ratios, with five nurses per 1,000 people, which is significantly lower than the OECD average of 8.8. In other words, in nearly every hospital, there is a shortage in the number of nurses compared with the number of beds.
During the peak of the pandemic, the National Association of Nurses went on an emergency strike in protest over the government’s failure to stop the collapse of the nursing system, which was becoming increasingly stretched thin as nurses contracted coronavirus and entered isolation with no one to back them up.
When it comes to physicians, Israel has only slightly fewer doctors per capita than the average OECD country. However, that is primarily because of the huge influx of new MDs in the 1990s from the former Soviet Union, and those doctors are aging.
While doctors over the age of 75 make up only 1% of the entire workforce in OECD countries, in Israel they make up more than 10%, Ben-David said. And like nursing students, Israel is at the bottom of the OECD in terms of the number of new medical-school graduates.
“I think while the focus on the budget is necessary, since the government will fall if there is no budget, the primary issue – the need for major healthcare reform – is being swept under the rug,” Ben-David said.
He stressed that “just throwing money” at the system will not solve its challenges. What’s needed is strategic thinking.
“The current budgetary arguments are shallow and superficial power struggles rather than what they should be, part of a serious national strategy identifying where the government wants Israel to be in five, 10, 20 years, and then creating the programs and requisite budgets that will get us there,” Ben-David said. “It’s like the Wild West, with everyone shooting from the hip.”