The treasury’s efforts to rein in the deficit will not spare the health system, and the public will probably have to pay more for doctor and emergency room visits and medical equipment, according to a draft budget being discussed Tuesday. If it passes, Israelis may also suffer reductions in their supplemental health insurance coverage, and will not see any new drugs or technologies added to the state-subsidized health basket this year.
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Health care professionals are fuming about the cuts being considered in the state budget and the economic arrangements bill, which are to be brought to the cabinet for approval shortly. According to the draft budget released Monday evening, co-payments for medical treatments covered by the public health basket will be raised to the tune of NIS 200 million. This means patients will be paying more for doctor’s visits, trips to the emergency room, medicines and equipment such as hearing aids.
Under the proposal, Health Minister Yael German will be asked to determine exactly which co-payments will be raised, but the per-family co-payment ceiling will not be increased. The draft budget document explains that low co-payments, “are liable to lead to an uncontrolled rise in quantities because insurees do not internalize the costs.”
Raising the co-payments will lead to a drop in the health tax budget, which is transferred from the National Insurance Institute to Israel's various health maintenance organizations.
The plan has generated sharp criticism among senior health officials, who on Tuesday convened in German’s office to discuss its ramifications.
“This is a scandal,” said Shmulik Ben Yaakov, chairman of the Society for Patients Rights in Israel. “If there is one issue about which there’s a consensus in the health system, it’s the need to reduce the co-payments. Raising them will harm the weaker population of sick people, who will stop going to the doctor, buying medicines and getting treatments because they won’t have the money.”
The draft budget also cancels the plan to raise to 14 the age under which dental treatment will be given at public expense; The plan to go into effect next month. Instead, subsidized dental treatment will continue to be given until age 12 for the next two years.
The proposal would also require housewives to start making the minimum health insurance and national insurance contributions, which are NIS 101 and NIS 61, respectively. Housewives are currently exempt from making these payments. Past efforts to impose the health tax on housewives have met stiff resistance from the Coalition for Public Health – comprised of patient groups and human rights organizations – on grounds that such a tax would contradict the social-welfare dimension of the health tax.
“It’s logical that if there’s no money, the health tax should rise," said Ben Yaakov. "But you can’t collect tax from someone who isn’t working.”
In addition, the draft of the economic arrangements bill that was distributed this week lacks a clause that had appeared in previous drafts regarding additions to the health services basket, which indicates there might not be any. Patient rights groups warn that if the basket isn’t updated in the coming year, there will be an intense struggle that will include demonstrations by patients and broad public protests. Drugs and technologies in the health basket are subsidized by the government, and new treatments are usually added annually.
“If there’s no basket [update], it’s a scandal that can’t be ignored,” said Ben Yaakov. “It would be a catastrophe.” Although some argue that over the past few years there have been generous budgets allocated to updating the basket that might enable the government to skip a year, Ben Yaakov disagrees with this analysis. “There have been new drugs added, but for only limited conditions. There are still medicines that most patients can’t get through the basket, but only privately.”
Another clause in the draft bill has angered the directors of private hospitals because it sets caps on how much the HMO’s supplementary insurance schemes can pay for surgery done in a private hospital. Some hospital officials are threatening to fight this clause in the High Court of Justice.
“It’s a clause that turns the whole health system upside down on a whim, with no open public debate,” said Prof. Shuki Shemer, chairman of the Assuta Medical Centers. Others grumbled that the clause appeared in the bill even though German had declared that a committee would be established to examine ways to strengthen the public health system. Such a panel has yet to be appointed.
Finance Minister Yair Lapid announced last month that he plans to cut some NIS 26 billion from the 2013-14 budget.