The role of Israel’s health funds during regular times and times of crisis
Author: Taub Center Staff

The Taub Center hosted a fascinating discussion (in Hebrew) with the CEOs of each of Israel’s four health funds about their role in the country’s fight against the coronavirus, both thus far and moving forward

The Taub Center hosted the CEOs of each of Israel’s four health funds to discuss the role of the health funds in Israel’s response to the coronavirus crisis. After the event was introduced by Taub Center President Professor Avi Weiss, opening remarks were given by Professor Dov Chernichovsky, the Taub Center’s Health Policy Program Chair.

Professor Dov Chernichovsky

Professor Dov Chernichovsky

Prof. Chernichovsky noted, the health funds are on the front lines of protecting Israelis’ health and have been sorely underrepresented in conversations about Israel’s response to the coronavirus pandemic. “The health funds are the administrators of the health system, at least with regard to personal medical care,” said Prof. Chernichovsky. “What bothered me in the public discourse around the coronavirus is that the Ministry of Health and the hospitals were at the center of the discussion while health funds and community care were almost absent. If the public discussion is really only about hospitals, we will all be worse off.”

Looking forward to the current discussion and beyond, said Prof. Chernichovsky, we need to focus on distinguishing between and coordination among Israel’s healthcare system and other non-medical systems, coordination between the health funds and both the Ministry of Health and other service providers, coordination between general healthcare and corona healthcare, and coordination between community care and the hospital system.

Prof. Chernichovsky’s remarks were followed by Major General (res.) Giora Eiland, former head of the Israeli National Security Council. Major General (res.) Eiland highlighted the importance of asking ourselves what the problem is, because how we define the problem will affect how we go about addressing it. If we look at the current crisis as a “national crisis” as opposed to specifically a “health crisis,” we can involve a greater variety of government bodies in the solution, with each body operating in the space in which it has a relative advantage.

Citing his military background, Major General (res.) Eiland stressed the importance of using resources to the best extent possible, and favoring efficient and potentially more localized policy over universal policies that may be simpler to implement, but do not address that there are different needs in different places.

In terms of managing the crisis, Major General (res.) Eiland concluded by stating the importance of having a clear chain of command: “Saying that we’ll do everything in partnership is a very nice sentiment, and I’m not against partnership. It’s always a good thing to hear everyone’s opinion. But it needs to be clear who has responsibility and who has authority, and it is best for those to be one and the same.”

The conversation then turned to the health funds and the question of their relative advantage, particularly in the age of the coronavirus. The four health fund CEOs shared their experiences thus far and their perspectives on how the response to coronavirus has been and should be conducted.

The first to speak was Mr. Ran Sa’ar, CEO of the Maccabi Health Fund. Mr. Sa’ar said that, looking back, there wasn’t enough thoughtful planning during the first wave of the outbreak and that, when actions were taken to make comprehensive plans, they came too late. Furthermore, the health funds were not sufficiently involved in planning. He then turned his attention to the need to prepare for the coming winter when, he cautioned, the coronavirus crisis will play out much more in community care and the health funds than in the hospitals.

To prepare, the health funds need to gather more information, increase lab and testing capabilities, prepare for a shortage of flu shots, figure out how to separate sick and healthy patients visiting the clinics, and increase necessary resources including those needed to expand home hospitalization. As Mr. Sa’ar said: “In order to manage the battle we will face this winter, we need information because we’ll need to break the spread of the virus very quickly. The country is not ready for this, and it needs to get ready.”

To deal with the national crisis described by Major General (res.) Eiland, Mr. Sa’ar suggested that planning for the upcoming winter first and foremost involve the health funds, as well as municipalities, nonprofits, and the army, among other relevant actors.

Ran Sa’ar

Ran Sa’ar

Mr. Nisim Alon, CEO of Leumit Health Fund, talked about the general principal that the things that function smoothly under normal circumstances also function well during times of emergency, while processes that do not exist during normal times will function during times of high pressure, but will run into many glitches. Glitches we saw in lab testing during the first wave of the coronavirus crisis is an example of the latter. For the broader public and even for other health and policy officials to understand the relative advantage of health funds as it relates to the coronavirus crisis, Mr. Alon said it is important to return to the basics of what the health funds do.

During normal times, health funds have experience in providing medical care within the community, purchasing medical services from other medical providers, acquiring lab testing services, referring patients to inpatient care, providing telemed services from afar, running a 24/7 medical center, and operating a home hospitalization system, to name a few.

Mr. Alon said that, going forward, it is important for the health funds to follow the same processes they follow during normal times: “It’s important to me to relay a message about the process, which I have not given up on and will not give up on no matter what. It is very important, just as during normal times, that the person who gives a referral is the primary care physician who knows the patient best.” According to Mr. Alon, creating separate processes to deal with things related to the coronavirus led to many glitches during the first wave of the outbreak.

The CEO of Clalit, Prof. Ehud Davidson, spoke about the unique perspective of Clalit, which runs both community care clinics and hospitals, and about the need for integration between the two systems to address the coronavirus crisis. He also discussed the health fund’s efforts during the first wave to raise awareness about the virus particularly among the Haredi and Arab Israeli population groups and among high-risk health fund members. In the wake of the coronavirus, explained Prof. Davidson, we will have a new kind of patient, a new kind of medical providers, and new processes for providing medical care.

In terms of the new patient, there are groups at risk like the elderly who need extra attention moving forward and more demand overall for things like mental health services and routine medical services that were stopped during the first wave. Similarly, healthcare providers face new challenges because of the coronavirus including financial stress from the economic crisis, challenges related to working from home, and balancing work and caring for family members. And, at the same time, there will need to be new processes of working which will change community care as we know it. These new processes include using hybrid methods to use resources and staff most efficiently, expanding alternatives to hospitalization including home hospitalization, and expanding the ability to provide medical services from afar.

The Ministry of Health has launched a program to invest billions of shekels in hospitals, an investment which is very important but will take years to implement, and we will face challenges in the coming winter which is only a few months away. Prof. Davidson explained that community care can provide solutions in a much shorter span of time: “additional services provided at home, additional digital services, additional services that take place within community clinics like initial triage, and more.” According to Prof. Davidson, providing these types of services in the community could ease the strain on Israel’s hospitals.

Sigal Regev Rosenberg, CEO of the Meuhedet Health Fund, said that even if the relative advantage of the health funds is their work directly with patients, they should be included in the bigger-picture planning related to the coronavirus – something which did not happen in the first wave. She also noted that during the first wave there was chaos, a lack of transparency, and quickly changing directives from the Ministry of Health. Since the beginning of the outbreak, Meuhedet has moved many of its services online, expanded mental health services, kept the virus out of the nursing homes it runs, and organized volunteers to deliver medicines and even food to at-risk elderly health fund members in their homes.

Sigal Regev Rosenberg

Sigal Regev Rosenberg

Looking forward, says Ms. Regev Rosenberg, we need to prepare for the winter including creating specific plans to protect the elderly, addressing a lack of lab testing capabilities and personnel, protecting healthcare professionals from exposure to the virus, and improving communication with partners like Magen David Adom. As Ms. Regev Rosenberg noted, “The preparation for the winter is already a little too late. Even if someone in the Ministry of Health decided today to prepare for it, the winter is only 4 or 5 months away and it takes a long time to create a mass home hospitalization system. Right now nobody at the Ministry of Health is providing their opinion, resources, or a plan to prepare for the next wave.”

Throughout the discussion there arose a number of suggestions for the Ministry of Health: to address the issues with testing capabilities before the coming winter, to collect more information on the outbreak thus far and coronavirus symptoms, to improve integration between different actors addressing the crisis, to enact quick epidemiological studies, to provide support for resources for home hospitalization, and more. The many issues raised over the course of the event were summed up nicely by Miri Mizrahi Reuveni, Deputy CEO of the Maccabi Health Fund: “There are many processes in which the Ministry of Health has a relative advantage and needs to act immediately and quickly, and there are other processes in which we, the health funds, have a relative advantage and need to act immediately and quickly, and most importantly there is a need for integration.”

She continued: “That is why I hope that, as a result of this special meeting, all the health funds can work together to create a position paper together with the Taub Center to ensure that these things happen and happen soon, because the time that is passing now cannot be recovered.”

The Taub Center is grateful to all those who participated in this important discussion and looks forward to continuing to work together with the health funds on these issues.

Click here for a video of the full event (in Hebrew).

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