Medical Miracle

Israel's Population Grew but Number of Hospitalizations Unchanged for 10 Years

Two trends affect the mix: More medical services are provided in the community and the elderly are hospitalized in more serious condition.

In 2012, there were 284,000 hospitalizations of Israelis in internal medicine wards – a number similar to the figure for the year 2000. But relative to the population, that 2012 figure represents a 21-percent decrease from 2000 in the rate of hospitalizations, due to the large growth of the Israeli population during the intervening years, according to a new Health Ministry study.

The study is based on information from 133 internal medicine departments in 28 hospitals in Israel, which together have 3,697 beds for inpatient care.

The long list of numbers in the 60-page report give a statistical picture of the situation in the hospitals’ internal medicine wards – the heart of Israeli hospital care.

Most of the numbers are not at all surprising: The elderly fill most of the beds, and many of those hospitalized return. But the figure the ministry chose to highlight makes the Israeli health system look wonderful, even a modern medical miracle: While the overall population grew by 1.8 percent a year over the period, the number of internal medicine hospitalizations held steady for over a decade.

The message wrapped inside these figures is that the health care system is a combination of efficiency and progress – or that the Israeli public is getting healthier. But this list of exacting details, down to the tenth of a percent, is obviously missing the data on the rate of occupancy of these wards and the overcrowding they have to deal with constantly – which seems to be the more relevant figures regarding the quality of the treatment the patients receive.

The crowding in the wards did not decrease over the past decade, said one internal medicine department head to Haaretz. Her ward reaches peaks of 150% occupancy, she noted. Two main trends characterized the last decade: The improvement in health services provided in the community, and the rising age of patients who are hospitalized, said the ward chief. Many of the elderly patients need full-time nursing care, which keeps the system much busier than in the past, she said. The combination of the two trends has only made the situation in the hospitals worse — even though the number of patients is the same, the condition of those hospitalized is much more serious.

The most common diagnoses for patients hospitalized in internal medicine departments are vascular and pulmonary problems, chest pains, infectious and parasitic diseases, including those of the respiratory and urinary tract, though not pneumonia. The percentage of patients who suffered a stroke or heart attack has fallen over the past decade, though it seems that part of this reduction comes at the expense of their being hospitalized in other departments such as intensive care, neurology, cardiology and vascular surgery.

A large number of patients also return to be hospitalized within a month of being released the first time, about 20 percent, with 8 percent returning within a week. In 2012, a quarter of all hospitalizations for those over age 75 were “returnees,” and the ministry found that the longer the first hospitalization period, the higher the chance the patient would return.

The chance a of a patient returning also rises with age. For example, at age 85 and older the chance for rehospitalization is 1.8 times that for patients aged 18 to 44. But there are other interestingstatistics concerning returning pateints: Married people have 0.9 times chance of returning compared to singles. Patients who arrive via the emergency room have a possibility 1.6 times higher to be rehospitalized.

Nir Kafri