Winter has struck again in Israel, and once again the newspaper headlines are screaming about the intolerable overcrowding in hospital corridors, emergency rooms and even the dining rooms, which have been turned into field hospitals. Why are we seeing the same pictures year after year, and why does it seem that the situation is only getting worse? The answer, in cut-and-dried numbers, is that Israel is at the bottom of the OECD countries in terms of its number of hospital beds per capita. Israel has less than two beds per thousand inhabitants in comparison to an average of 3.5 in developed countries.
It’s not only the number, but also the trend, that’s worth a look. Since 2000, Israel's number of hospital beds per capita has fallen by 14 percent. The population is aging and increasing, yet there are few new beds to accommodate that growth. These statistics have obvious ramifications: the occupancy rate in Israeli hospitals is the highest in the world, with huge numbers that reach 150 percent of capacity and higher still on peak days. At the same time, length of hospitalization is among the world’s shortest since beds, even the ones in the hall, are needed so badly. Beds are hardly empty, with hospitals sending patients home as soon as they can to make room.
The state has several answers to the problem, none of them practical. According to one, the entire Western world is moving from hospital treatment to community treatment. While that is true, it is important to remember the starting point: 1.9 beds per 1,000 inhabitants in Israel as compared with 3.5 in the Western world. In Israel, there is no more room to cut back, as every hospital patient sent home prematurely to make room for the next patient can testify. Another answer is that 1,000 hospital beds have already been added as part of an agreement between the Health Ministry and the Finance Ministry – one of the biggest accomplishments of Deputy Health Minister Yaakov Litzman and the ministry’s director general, Ronni Gamzu. But adding 1,000 beds was not enough to keep up with the rate of increase and with Israel's aging population. Even worse, only 322 of the 1,000 beds – the addition of which is to be spread out over six years – have been added so far.
There’s also the saying that one commonly hears in the corridors of the Finance Ministry and among those who do not want to see the hospital system grow larger: “One doesn’t add hundreds of new beds just for a few days in winter.” This sentence doesn’t apply anymore because hospitals are often overcrowded in spring, summer and fall, too.
The situation is making hospital directors scramble for any solution they can find. These include expanding medical tourism (what irony, adding to an already overburdened system to fund Israelis’ medical treatment!) and raising money all over the world, as well as from Israel’s own residents, to pay for basic services. So what to do? As worn-out and unrealistic as it sounds, certainly in light of the approaching cutbacks in the state budget, the only solution is to increase the public health budget. The alternative is more and more privatization of large parts of the system. The formation of the new government may be a golden opportunity to avoid cutbacks in the public health budget and solve the crisis of overcrowding.
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