Bait Balev, a geriatric hospital in Nesher.
Bait Balev, a geriatric hospital in Nesher. Photo by Yaron Kaminski
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The heads of the four health maintenance organizations have been summoned to a meeting in the Prime Minister's Office early next week, as part of Deputy Health Minister Yaakov Litzman's bid to push through a comprehensive reform of geriatric health care.

The HMO bosses were called to the meeting in the office of the PMO's director general, Harel Locker.

Officials of the HMO have warned that the proposed reform, one of whose main proposals is transferring responsibility for long-term geriatric care to the HMOs, could lead to their financial ruin. Today, responsibility for these services is divided among the HMOs, the National Insurance Institute and the Health and Social Affairs ministries.

Litzman has been promoting the reform for nearly a year.

The first stage of the reform calls for increasing the number of weekly hours paid by the state for home health care from 22 to 30 and making the HMOs responsible for supervising home health-care aides and for evaluating geriatric patients. The premiums for state-subsidized health insurance would rise by 0.5 percent to cover the additional expense of the increased services.

In recent meetings with Litzman, the HMO heads raised fundamental objections to the proposal. They told him the cost of implementing the first stage of the plan alone could exceed NIS 300 million, according to estimates made by the health system.

And if the number of people classified as needing long-term care is raised to 142,000, one senior figure in the medical establishment said, "an additional 182 geriatricians will be needed - double their present number - and this is a specialty that young doctors are avoiding."

The second and third stages of the reform involve the administrative transfer of responsibility to the HMOs. One senior HMO official said that making the HMOs, rather than the NII, responsible for determining nursing-care eligibility would "turn the HMOs into cops who will be asked to look at the payslips of [the patients'] relatives." He said the HMOs have no interest in making financial decisions about what drugs and services to fund at this stage.

A colleague argued that the cost of the reform has been estimated at around NIS 8 billion a year, which could ruin HMOs and disrupt their ability to provide essential services to their patients.

Litzman recently said that if the reform is not passed before the next general election it will have to be made part of the governing coalition's platform in the next government.