The controversy over the use of Mrs. Cohen from Hadera on Finance Minister Yair Lapid’s Facebook page has also reached healthcare.
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The imaginary Mrs. Cohen, as Lapid tells it, is 37 and together with her husband earns a little more than NIS 20,000 a month. Lapid updated his Facebook followers with the information that he and senior treasury officials also held a meeting and discussed the education Mrs. Cohen’s children receive, the quality of service they receive from government offices, her uncertainty as to whether her children will remain in Israel, how she cannot buy a combined ticket for all public transportation − and “that the health system is collapsing around her.”
Lapid’s position is completely opposed to the messages the senior officials in his own ministry’s budgets division have been trying to sell in recent years, in the wake of the long doctors’ strike and that of the nurses. Treasury officials have been telling us for years that Israel is in good shape by various international measures of health such as life expectancy, child mortality and fertility. The publication this week of the Organization for Economic Cooperation and Development’s (OECD) Better Life Index ranks Israel in an extremely presentable fifth place on health issues, with a 8.8 rating out of 10. Only Switzerland, New Zealand, Australia and Canada rank higher on health issues; and such countries as the United States, Britain, France, Japan and Germany came in much lower. At the bottom of the OECD health ratings were Estonia and Hungary.
Live long and prosper?
The leading indicator in the health rankings was life expectancy, in which Israel is well ahead of many Western nations. Israeli men have the second highest life expectancy among developed countries: 79.7 years on average, with only Switzerland above it with 80.3 years. This is well above Britain, 78.6, Germany and France, 78, and the United States, 76.2 years. For women, the life expectancy figure is 84 years, in eighth place, but still very close to the top. Another figure that plays a large part in the index is how respondents answer the question, How is your health? In Israel, 45.5 percent of men and 39.3 percent of women say their health is very good, and another 36.6 percent of men and 37.3 percent of women say their health is good, based on figures from the Central Bureau of Statistics. The figures for self-reported good health were highest among young people, singles, Haredim and high-income wage earners.
There were two major issues that lowered Israel’s health rating, though: A relatively high level of atmospheric PM10 − tiny air pollutant particles small enough to enter and cause damage to the lungs − which was 28 micrograms per cubic meter, considerably higher than the OECD average of 22 micrograms per cubic meter. Israel could also perform better in terms of water quality, as only 59 percent of people say they are satisfied with the quality of their water, compared with an OECD average of 85%.
These impressive figures from the OECD seem to contradict the signs of distress the public health system has been showing in recent years − and as Yair Lapid claims. But there is no arguing with the data showing a severe problem of infrastructure in the health system: Israel is near the bottom of list in the number of general hospital beds, 27th out of 30, with only 1.93 hospital spaces per 1,000 people. The figures for the number of doctors are more reasonable − 11th place with 3.5 doctors per thousand, similar to the OECD average. But the number of nurses is very low, 20th out of 22 with 4.8 nurses per thousand residents, compared to 11.3 in Germany and 9.6 per thousand in Britain. Israel has the highest rate of hospital occupancy in the OECD, 98.8 percent on an annual basis; which testifies to rates of well over 100 percent for almost half the year, again, well above the accepted norm in other developed nations. Britain has 84.3 percent occupancy rate, Germany 76.1 percent and the United States, 64.6 percent.
Despite the overcrowding, or possibly because of it, the average stay in an Israeli hospital is one of the shortest among developed nations: Israel is in 29th place out of 30 with an average hospitalization stay of only four days. This compares to 18.5 days in Japan, 7.5 days in Germany, 6.8 in Britain, 5.4 in the United States and 5.2 in France. Only Mexico has shorter hospital stays than in Israel, 3.9 days on average.
There would seem to be a contradiction between the high figures for life expectancy and child mortality on one hand and the others. But this is easily resolved, said Prof. Gaby Ben-Nun of Ben-Gurion University. “One of the explanations is economic, and anyone who deals with health economics knows that the health system is not the only thing influencing public health, and so even when the public health system is collapsing, it does not necessarily make the public’s health situation worse,” he said.
Another explanation is the high percentage of Israelis who have supplementary health insurance: 80 percent, said Israel Medical Association deputy chairman Dr. Yitzhak Ziv-Ner. “Too many [people] in Israel pay for supplementary insurance, which is gradually becoming an additional health tax above the general health tax. ... this shows the lack of faith the Israelis have in the basic system, which is not enough for them,” he said.
Other explanations for the contradiction are in the abandonment of young doctors and senior specialists of the public sector for the private. Only 25 percent to 35 percent of the contribution to higher life expectancy comes from the public health system, and most revolves around the quality of life, education and environment, said Prof. Gaby Barabash, director of Ichilov Hospital.
But the problem in the erosion of medical infrastructures is one we may not see for some time, but it will come in another decade, said Ben-Nun. It is similar to cuts in education, which are not reflected immediately in test scores, but come later, he added. Another factor is that the surveys do not measure differences among various population groups. There are growing gaps between different groups, and it is worsening, he stressed.