ACRI's evidence is disturbing and compelling, yet it's appalled by the Israeli public's indifference. It aims to change this by publicizing its findings so those in government, the media and general population know them and will react to reverse an ugly and damaging trend. Growing numbers of people worldwide know how Israel harms Palestinians. ACRI's report shows that Jews are also impacted.
Health Care in Israel
Israel's 1994 National Health Insurance Law has noble guarantees - quality health services for every Israeli resident in accordance with justice, equality and mutual support principles. Ever since, however, Israeli governments violated their obligation, and unequal access has increased. It's characterized by inadequate funding, privatized health services, a steady erosion in the extent and quality of services provided, and the crowding out of access for the poor and many in the middle class. Defunding public health means private insurance is as essential as it is in the US. The result is two health systems differing markedly in quality - one for the well-off and another for everyone else, including many in the middle class.
ACRI finds it disturbing. The trend undermines Israel's social contract with its citizens, violates basic rights, and reneges on the state's duty under the International Covenant of Economic, Social and Cultural Rights. ACRI focuses on the problem with special emphasis on a growing hospital crisis, the need for expensive supplemental insurance, and how various population groups cope inadequately under very limited and expensive health service access.
In recent years, budgets have been cut, and the trend continued in 2007. The Ministry of Health's per capita allocation is 14% lower than in 2001, and the Ministry's development budget is 43% lower. Public hospitals have been hardest hit, patient access to quality health care has eroded, and medical personnel are understaffed and aren't able to provide the best care possible.
The Israel Medical Association January 2007 data highlight the crisis:
-- the hospital beds/population ratio has declined; it was 3.27 per 1000 persons in 1970; a year ago it touched 1.94, the lowest figure among western countries;
-- the approved number of beds hasn't increased, the need for them has, and it's been met by adding "non-approved" beds that comprise up to 30% of the total in hospital internal medicine units (IMUs); the result is growing overcrowding and medical staff unable to cope;
-- on routine days, average hospital occupancy is 100% compared to 85% in the West; in IMUs it reached 130% and in pediatric units 112%; and
-- overcrowding and underfunding force early patient releases before they're ready to go; they also contribute to the spread of infections, viruses and diseases and require doctors and medical staff to be responsible for a growing number of patients, more than they can adequately handle.
Ever since the 1994 National Health Insurance Law passed, health services have eroded in violation of its guarantee. The Adva Center advocates for policy changes favoring disadvantaged Israelis. It tallied the damage through last year and found a 44% decline in health service funding with gaps made up for by supplemental insurance. Over 70% of the public have it while the rest rely solely on dwindling national health services that often fail to deliver.
Most disadvantaged Israelis lack supplemental insurance: one-third are age 65 or older; 53% are Israeli Arabs; 42% are Jews of Russian origin; while 11% are from the Hebrew-speaking community. A 2007 Physicians for Human Rights report describes how various population groups are disadvantaged. Those furthest removed from Israel's social center got poorest access. They include: low wage earners; "unrecognized" Negev Bedouins; East Jerusalem Palestinians; Israelis married to Occupied Territory Palestinians; prisoners; Palestinian spouses of Israeli Arabs; migrant workers; refugees and asylum-seekers; and victims of human trafficking. In total, these groups comprise about 1.25 million men and women.
Income alone is a hugely limiting factor, and two studies document it. A 2005 Brookdale Institute one showed that 15% of Israelis forego some medications. Among low wage earners, the figure was 23%. A 2006 Israel Medical Association survey of Israeli Jews found 23% of them abstain from some form of treatment or essential medication with income and family size the main limiting factors. The same survey reported that 56% of Israeli Jews fear they'll be unable to afford needed medication because of cost, and it estimated that the situation for Israeli Arabs is far worse.
The situation is most acute in peripheral areas, especially in southern Israel that's populated by Bedouin Arabs and new immigrants. Here, socioeconomic status is lowest and so is access to health services that are far below what's available in Central Israeli cities like Tel Aviv and Haifa: fewer hospital beds, inadequate specialized equipment, fewer specialists, and waiting periods for appointments can take weeks. In addition, for more complicated cases, patients are at risk. Hospitals can only provide preliminary exams, patients must incur time and expense to get to where proper treatment is available, and it can be touch and go in life-threatening cases.
ACRI believes that distributive justice demands that the state provide local health services where they're lacking so all Israelis get equal access to it. That will require funding boosts not now available or planned.
I am a 72 year old, retired, progressive small businessman concerned about all the major national and world issues, committed to speak out and write about them.
