It's not Obamacare, but there are holes in Israel's healthcare system

Minister Litzman, are you listening?

Dr. Harold Goldmeier

OpEds Dr. Harold Goldmeier
Dr. Harold Goldmeier

My wife and I made aliyah four years ago following which I began a series about our acculturation and assimilation. Much in Israel mimics life in advanced Western countries, leaving an Anglo oleh feeling welcome and snuggly. We promised ourselves the new challenges living in the Middle East are not to be mocked but can be risible. Kudos to the change in Israel bureaucrats, their current personal demeanor and helpfulness is a great leap forward in customer service since we began visiting Israel nearly two decades ago.

It’s a stimulant ginning up confidence in delving deeper into Israel society. But peeling back the onionskin, there are distinct differences. Below are the good ones: 

Doctors, nurses and many aides speak English, Russian, and some French. It’s comforting for new-to-Hebrew olim, because medical jargon is not learned in ulpan or picked up in general conversation. Second, access to general care providers is pretty easy. Third, direct costs for prescriptions and office visits are largely manageable.  Primary care is seldom problematic.

Per the bigger picture, the financial costs to patients with good kupa (insurance) coverage are minimal compared to prices in America. There is the same high quality of care. Israel is a small country only a short time out of the pioneer stage of development spending a lot of money on hi-tech self-defense. Nevertheless, it is continually expanding its healthcare budget basket of treatments, drugs, and availability of medical technologies each year.

Studies reveal young and healthy citizens in every country make little use of their healthcare system. They cannot appreciate the anguish a poor or middle class sick person in need of serious medical care for chronic and acute conditions experiences. My suggestions may fall on deaf ears, but Rabbi Kook knew; he said it best, “And if I am weak of body, shall my soul also suffer? And if my flesh oppresses me a thousand times, should my spirit also be oppressed?” 

And dealing with the health and medical care system in Israel, despite its above-mentioned positive aspects, makes me feel edgy and anxious because there are holes in the fabric.

Here are some suggestions for cementing over the holes in the Israel health and medical care system. A primary care doctor’s diagnosis leads to a referral for care by a specialist, perhaps a cardiologist. It might take two to four weeks to see the cardiologist on the kupa list that makes the appointment for the patient. Unless one goes for private care (at extra cost), it might demand a two-weeks to months long wait to see the specialist if the family doctor recommends a specific specialist. Hafnaya (permission slip) in hand, one must get approval from the kupa to get appointment for follow-up tests or treatments. Another few days or even a week is added to the waiting time for the hafniya. (On the other hand, on some plans, one is allowed to choose and make an appointment with a specialist on the kupa list without a hafnaya at the cost of about 100 IS three times a year.)

If tests like an MRI or CT scan are ordered, or if one needs a heart monitor, or echocardiogram, it is likely to take a month or more for appointments in non-emergency cases. Perhaps two months have passed. Once the tests are completed, results can take anywhere from one to three weeks before being sent to the specialist. Since the patient does not know when the results will be sent, an appointment for follow-up assessment and treatment can be delayed another few weeks.

The primary care doctor of my colleague found a lump on her breast. She waited three weeks to get an appointment with the specialist. A biopsy was ordered and done ten days later. She waited three weeks for the test results, and another week to get an appointment with the specialist to discuss the results and settle on a treatment plan. Besides the threat to her life from delays, she was depressed, anxious, and her work suffered. She told me, “My life is on hold” during the dark days of know-nothing.

Another woman suffered a stroke. She spent five days in the hospital’s neurology department, but they were unable to identify the cause. They handed her a sheaf of papers with orders for a range of cardiac tests as an outpatient. Weeks passed before seeing the local specialist. More weeks passed before tests were completed. More time passed before test results were available.

Desperate that another stroke might occur the patient "went private."  She personally paid to see a cardiac surgeon for speedy repair of the medical cause of the stroke. The surgeon had to use the influence of his good office (protectsya in Hebrew) to get results from ten days old heart monitoring test.

When asked why the neurology department did not order cardiac tests while the patient was in their care though neurology obviously suspected a cardiac cause of the stroke, one doctor simply shrugged and sheepishly observed there’s not a lot of good communication between specialty departments in too many hospitals.

The importance of communication to patient safety cannot be downplayed. All medical tests are recorded on computers and results can be transmitted instantaneously to specialists. Delays are playing Russian roulette with the lives and well being of patients.

Kudos to Minister of Health Litzman recognized as the most admired minister in the government. Minister Litzman, use the power of your good office, the weight of your personal recognition, and good name to fill these holes. Technology is only as useful as the people using it for better patient care.

Dr. Seuss knows it all comes down to people, not drugs, machines and devices. On the whole, the Doctor concludes there is not much chance people will ever “live without doctors, with nary a care.”

The writer is a former Research and Teaching Fellow at Harvard University where he received his doctorate.  He served in the administrations of three U. S. Governors, is a business management consultant with a personal interest in education and NGOs. His soon to be published e-Book on Healthcare Insights, discusses the topics in this article and many others in more detail.