Israel’s Hospitals and Medical System is Broken. Here is Why and How to Fix it.

(As appeared in the Jerusalem Post)

A severe kidney stone attack brought me to the emergency room and then operating room of a major trauma center hospital in southern Israel. Those facilities and care were state-of-the-art. However, for the few days I spent in a recovery room, the room and care were circa 1950s.

This January, a few years later, my mother lay dying in the same hospital. Again, the MADA response was quick and ER care is state-of-the-art. However, the care on the floor after admission was inconsistent, not up to modern medical standards, and the facilities were dilapidated in appearance and antiquated without hi-tech functionality. The hallways were almost always filled with an overflow of beds, as the rooms are consistently full, always with one more bed than they are designed for.

This is in stark contrast to the many news headlines of constant new and exciting cutting edge medical advances developed by the “Start Up Nation.” In actuality, current medical care, especially hospitalization, provided to the average sick and injured general population is shockingly poor.

Examples range from unanswered shouts of patients calling for a nurse to help them, to vitals being taken and then written down on slips of scrap paper rather than being directly entered into hand-held devices, to electronic monitors that are not hooked up to a main display at the nurses’ station, to bathrooms and showers that look like they’re from a 1950’s mental institution. The list goes on.

While I thought my experiences may be an anomaly, since they are based on my experiences in only one hospital and only compared to hospitals in the United States, it was pointed out to me that I was wrong. It is a serious problem all over Israel.

My cousin, a long-time medical professional here in Israel, showed me some disturbing statistics. Israel belongs to, and benchmarks itself against, the OCED (Organisation for Economic Co-operation and Development). Israel does not fare well at all. Here are just a few surprising data points:

 

·         Nurses: Israel has only 5.1 per 1000 inhabitants, as compared to 8.5 for Russia, 12.0 for the US (which America considers to be a nursing shortage crisis), and 18.4 for both Norway and Switzerland. Of the 32 countries listed, Israel is #28!

 

·         Doctors: Israel has only 3.3 per 1000 inhabitants, as compared to 4.2 for Russia and 5.3 for Norway. Of the 37 countries listed, Israel is #21.

 

·     Hospital Beds: This is a good indicator that provides a measurement of resources available for delivering services to patients in terms of number of beds that are maintained, staffed, and immediately available for use. Again, Israel fares poorly at only 2.9 per 1000 inhabitants vs Germany at 7.8 (Japan and Korea were the outliers at 12.6 and 12.7, respectively). Out 37 countries listed, Israel is #24.

 

·         Health Spending, This research study measures the current health expenditure of health care goods and services, such as personal health care (curative care, rehabilitative care, long-term care, ancillary services and medical goods) and collective services (prevention and public health services as well as health administration). Since Israel’s health care is consider “socialized medicine” vs a private health care system, let’s look only at the “government spending and compulsory health insurance” spending data for comparison. Germany came in at $6,351 and Norway at $6,044. Israel spends a mere $2,166 per capita!

Let’s add another dimension to the delivery of care: culture. Most of the healthcare professionals seem to be of Eastern European and Arab origin. This is not a comment on their education or professional skills. It is only an observation based on how they deliver a different (more often, lower) level of customer service based on their cultural backgrounds. (It also must be remembered, that based on the OECD statistics above, they are all over-worked in an under-staffed environment, which can, of course, lead to stress and a lack of patient consideration.)

One more thing. Any profession as critical as medicine, that has everyone saying “Pee-pee and Kah-kee” as technical terms and with a straight face, needs to be fixed.

How do we fix this? Here’s how:

 

1.      A Knesset committee, with a budget, deadline, and clear directive, should be set up to oversee some of these remedies and initiate their implementation. I suggest this somewhat hesitantly as a rabbi I admired once said, “If Moses had been a committee, the Jews never would have left Egypt.”

2.      C.A.S.E. (Copy and Steal Everything). Look at countries that rank high in customer service, medical treatment delivery, and staffing. Invite them to advise Israel on how to replicate what they do and how they do it. This includes their medical delivery infrastructure, as well as hospital/hospitality administration.

3.      Budget. Once an overhaul plan is developed and budgeted, the Knesset must allocate enough funds. It must be remembered that their job is to serve all the people first and their political special interests last. Since it is realistic to assume that the Israeli government would not be able to afford the changes needed to create and execute an ideal solution, see more on how to fund this endeavor is below under “Municipal Bonds.”

4.      Recruit medical professionals from Western Europe, Asia, and the Americas. The objective is to diversify the culture of the people in the Israeli medical profession to include those who are more intuitively based on providing a greater level of customer service and communication.

This has already begun on a small but important scale by Nefesh b’Nefesh (NbN), a 20-year-old non-profit organization that has been very successful in helping thousands of people from North America and the UK make aliyah. They have allocated staff and resources specifically, to help medical professionals navigate the difficult and confusing process of transferring or obtaining their medical certification.

 

In addition, NbN has created MedEx a unique event that provides medical professionals who are potential olim with the opportunity to meet with representatives from Israeli Ministry of Health Licensing Division, Israeli Medical Association (IMA), Israeli health funds (Kupot Cholim), and hospitals to help speed up their accreditation and to provide a clear path towards medical employment. While a 9-year old event, the second annual stand-alone MedEx will be held this March 19 and 20 in New Jersey.  This effort should be immediately supported, expanded, and accelerated by the Israeli government.

5.      Municipal and Special Israel Bonds. First a definition: Municipal bonds are debt securities issued by states, cities, counties and other governmental entities to fund day-to-day obligations and to finance capital projects such as building schools and hospitals, highways, or sewer systems. In return for often lower interest rates than corporate bonds, the interest earned is usually tax free. 

In 2020, Scientific Research Publishing, one of the largest Open Access journal publishers, posted a research paper entitled “Municipal Bonds for Improving Operational Efficiency” from a major Israeli university concluding the immense benefit such a financial instrument would have.

Israel has a wealthy segment of its population. If there’s an incentive of tax-free income, we can be very confident of raising significant funds by issuing Israeli government-backed municipal bonds, specifically to contribute to the funding of modern-day hospitals and staffing.

According to the Israel Ministry of Foreign Affairs there are 73 municipalities, 124 local councils and 54 regional councils. Imagine if some of them offered Municipal bonds backed by the Israeli government to fund area-specific medical projects. It is important to note that many cities around the world are twinned with Israeli cities, plus many people have an attachment (memories, family, etc.) to special locations. This uniquely creates ideal fund-raising opportunities.

Special Israel Bonds. Back in February 2022, Israel Bonds announced $47 billion in worldwide sales. Imagine if they issued some bonds as “Israel Medical Infrastructure Bonds.”

Additionally, based on leading global rating agencies, Israel’s financial rating is very strong. Therefore, the sentimental feelings combined with financial incentives would present a strong and winning combination for success.

While Israel is often ranked highly as a healthy and happy country, over time, many of us, or our loved ones, will get injured or become ill. Wouldn’t we all want their care to be the best Israel can offer in both personnel and medical services?

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