Following opposition from the country’s four health care providers, Health Ministry officials will not assign them full responsibility for the medical treatment of addiction, despite the recommendations of government experts and addiction treatment organizations.
On Sunday, the cabinet approved recommendations by a Health Ministry panel that concluded that such a move, which has been under discussion for several years, was premature. The panel recommended instead that the insurers develop new addiction support services at state expense. Sources who spoke with Haaretz on the condition of anonymity said, however, that this would not give the HMOs full responsibility for addiction treatment.
In a statement, the Health Ministry said the committee’s recommendations relate to the need to develop broad community services that don’t currently exist, and that their implementation of the recommendations will provide “a continuum” of addiction treatment services.
The HMOs had objected to assuming full responsibility due to concerns about cost as well as a possible negative impact on other mental health services that they provide. One critic of the final decision accused the ministry of putting the insurers’ interests above patients with addictions. Another source, also speaking on condition of anonymity, said the health care system itself is not free of the stigma attached to addiction.
The ministry panel noted the near-absence of public addiction treatment services. Health Minister Nitzan Horowitz said that in his visits to health clinics and hospitals, one service was prominent for its absence – treatment for addiction.
“I had assumed it was being addressed and that there were services of some kind. I was amazed to discover that it wasn’t so,” Horowitz said, adding that people who need lifesaving medical treatment – psychological, social and pharmaceutical – for addictions had few options, he said.
The true extent of addiction disorders in Israel is unclear. The Health Ministry committee cited figures from the Labor, Social Affairs and Social Services Ministry in 2018 according to which about 120,000 people in Israel struggled with a range of addictions. But a 2019 report from the State Comptroller’s Office said that was probably an underestimate due to a lack of a mechanism in the country’s health and social welfare system to identify people suffering from addiction.
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A study conducted about three years ago by the Israel Center on Addiction estimated that about 10 percent of the country’s adult Jewish population was dealing with substance addiction of various kinds or of related behavior. The study said that the problem cost the country’s economy an estimated 7 billion shekels ($2 billion) per year. The report noted that although there weren’t comprehensive figures on addiction to pain relievers, the problem could be inferred from the increase in their use.
Despite estimates of well over 100,000 people with addictions in Israel, the health and social service ministries treated fewer than 30,000 people for addictions in 2019. The number included people treated at hospitalization units for addiction, other drug treatment centers and various Social Services Ministry programs.
The neglect of addiction treatment in Israel is at least partially the result of a decision to have the problem dealt with separately from other mental health services, which were transferred to the HMOs in 2015. In that regard the Health Ministry committee said emphatically in its report that addiction treatment is to be considered a mental health service and noted that in most of other countries, it is related to in a similar manner as other mental health conditions.
“Instead of providing holistic services, they are dividing the addicts among three agencies, the health and social service ministries and the HMOs, which are responsible for mental health. The result is negligible treatment. There’s no chance that it will work,” one source said.
If responsibility for addiction treatment were to be transferred to the HMOs, they “would be required to provide services to addicts, as the state healthcare law requires them to provide with regard to every other medical problem,” another source said.
As a result of the HMOs opposition, the Health Ministry committee recommended developing new community services via the HMOs such as preventive medicine, early treatment and drug therapy – in part for those addicted to prescription medications and for patients who are suffering for other mental conditions in addition to addiction. The program will run through 2025 and will be given an annual budget of 85 million shekels.
Now that the Health Ministry has retreated from making the HMOs responsible for all addiction treatment, the HMOs appear to be fully receptive to the new plan. “A pragmatic solution,” the official report called it.
“For the first time, we are providing services for comprehensive treatment of addiction,” Prime Minister Naftali Bennett announced. For his part, Horowitz promised the “development of a range of responses and services that had not existed up to now.”
Sources familiar with the plan paint a more cautious and complicated picture, however. “The HMOs will be a supplier to the Health Ministry in treating addicts, but if the annual budget for a particular program runs out, they won’t be required to treat all the people. That’s the significance of the difference between purchasing services and transferring responsibility,” one source said.
The HMOs also objected in 2015 to assuming full responsibility for addiction treatment, claiming that the timing wasn’t ripe, the source said. “If the Health Ministry continues to give in, they will never be prepared. There will always be more urgent things, and the addicts will continue to pay the price.”
The four HMOs have opposed any possibility that they would assume responsibly for the 7,300 patients hospitalized for addiction and at methadone clinics treating patients with opioid dependence. But the HMOs denied critics’ claims that they have a negative attitude towards patients suffering from addiction. They were united in opposing assuming full responsibility for addiction treatment.
“Mental health services in Israel are insufficient,” said Prof. Arad Kodesh, the director of mental health services at Meuhedet Health Services, the third-largest HMO. “Reassigning addiction treatment to the HMOs could be expected to add a large group of patients that is not necessarily recognized now and that would require great expense. There is a reasonable concern that the service provided to all the people with mental illness, which is already in crisis, would be harmed even further.”
There are also only a small number of professionals who have been trained in addiction treatment, Kodesh said, and the time needed to train personnel would also be problematic. The problem, he said, cannot be shifted to the HMOs “as if it were a hot potato.”
Maccabi Healthcare Services, the second-largest HMO, said in a statement that the country’s mental health services are under increasing distress. “A national plan is required that would include creating future personnel and significant funding.”
Clalit Health Services, largest HMO, took a position contrary to the Health Ministry, saying that addiction in Israel “is a social problem with socioeconomic, environmental and cultural aspects” adding that the medical aspects of the problem are less significant. In light of Clalit’s position, it is thought unlikely that it would agree to assume full responsibility for addiction treatment in the foreseeable future.
The smallest HMO, Leumit Health Care Services, did not respond when asked for comment.
Dr. Itay Besser, the chairman of the Israeli Society for Addiction Medicine, struck a more optimistic note, calling the Health Ministry committee’s recommendation “a welcome step that follows a delay of many years.” He expressed support for focusing on the first steps.