- Israel has a very good health system. Perhaps the most fundamental indicator of this is the high life expectancy of Israeli citizens: over 83 – ranked ninth in the world. Since the state was established 73 years ago, its residents live about 16 years longer on average. That is an impressive figure. And it didn’t happen by itself. Very talented health professionals worked – and continue to work – for relatively modest remuneration. They are worthy of our praise and appreciation. At the same time, as the country becomes wealthier, we can – and need – to improve many areas of the health system in order to ensure the best possible care for the citizens of Israel.
- In practice, health care expenditures, as a percentage of GNP and government budgeting, is low by the standards of developed countries. At the same time private expenditures are considerably higher. This suggests that a warped reality is emerging in which citizens who live in the right part of the country, with the resources to upgrade basic services provided by the national health system, receive better access, better care and better life expectancy than other citizens. For example, Arab men in Israel live 7.5 years less than Jewish men. Part of the reason is linked to lifestyle, or smoking rates. But the gap is primarily linked to access to and quality of available medical services.
- The crowdedness in Israeli hospitals is among the highest in the West. When the British left the country in 1948, there were more than 3 hospital beds per 1000 citizens. Today the number has fallen below 2 – a drop of some 33%. We must significantly increase the capacity of Israeli hospitals. The aging of Israel’s populace, along with a 2% annual increase in population size create a situation where already several hospitals frequently operate above 100% occupancy. Patients sleeping in beds in hospital corridors is no longer a rare phenomenon. And it is expanding. Israel must build four new hospitals during the next ten years, mainly in the geographic periphery. The government’s decision to establish a hospital in Kiriyat Ata by 2029 is a good first step in this direction.
- There is not only a shortage of beds in Israel – but also of medical staff. Israel has less than 6 nurses per 1000 people. In Norway the number is 20. Israeli doctors are by far the oldest in the world – apparently it is simply impossible to let them retire, given prevailing scarcity. Ironically, Israel trains fewer doctors per capita than any other Western nation. As a result, 60% of Israeli doctors studied medicine outside the country. In many cases, the professional training there is inferior to that in Israel. Israel needs to double the places available in its medical schools for all health professions, starting with doctors. As a first step, government funding for any Israeli university program that trains the hundreds of foreign students who study in the country’s international medical schools every year, should be cancelled. When there is such an acute shortage of human resources, it constitutes an irrational policy that harms the future of the health system.
- It is clear that a significant part of the country’s future health strategy needs to include strengthening the medical infrastructure in Israeli communities. It won’t happen by itself. A five-year plan for expanding local health infrastructure across the country so that a citizen who chooses to receive community care, medical advice “on line” or even home hospitalization will not pay a price in terms of health outcome for their decision.
- The income of senior Israel doctors and health care works is not high in Israel. But neither is it low by international standards. At the same time, during the first years of their careers, the pay for nurses is extremely low. This is also true for medical interns and residents. There is also a significant gap in the earnings of male and female nurses. Salaries for young health professionals need to be increased in order to prevent young professionals from “dropping out”. Israel needs to guarantee that talented people do not give up a career in health care because the anticipated income is low.
- The absolute consensus in medical research is that with less than eight hours of sleep, human functions begin to deteriorate. The less people sleep, the more their physical and mental performance decreases. Israeli interns and residents are on call for 26 hours continuously. Many complete ten such marathon shifts a month. The level of care offered by a doctor after a sleepless night is hardly optimal – to put it mildly. The mounting protest of young physicians about these conditions is justified: we need to accelerate the transition to shorter shifts for interns and offer them some semblance of a normal life – while offering Israeli citizens better health care.
- The Covid epidemic has made it clear how vulnerable Israel is to global pandemics – a phenomenon which does not appear to be ephemeral. Among the lessons learned during the Covid crisis is the significance of a rapid, professional and measured response that integrates all possible partners, including the military. It is essential to present precise information to the general-public effectively, in real time, while debunking fake news. Mostly, decisions made during health crises must rely on empirical, evidence-based assessments made by health professionals rather than politicians.
- Air pollution and other environmental hazards continue to increase morbidity for a large segment of the Israeli public, even contributing to mortality. According to recent research, in Haifa alone, some 3000 citizens develop serious illness due to air pollution each year. One hundred of them die. Many pollution sources remain unregulated in Israel. Such an example is wood-burning stoves that emit a third of the country’s hazardous air pollutants during the winter months. The Ministry of Environmental Protection in practice does not address the problem. In general, the Ministry lacks environmental health experts and therefore does not always prioritize the most significant health risks in its ministerial agenda. In addition, in contrast to many countries, there are no health impact assessments prepared during the physical planning process. We need to change this. These are areas focus on as chair of the Knesset subcommittee for environmental and climate impacts on health.
- At the end of the day, public health will improve as a result of lifestyle change and the adoption of healthy habits, including eating right and exercising regularly. These are habits which can be inculcated from a young age. Awareness about these dynamics in Israel is actually improving in all of sectors of society who increasingly recognize the importance of a healthy lifestyle. This trend needs to be strengthened.
