POLICY - May 2019

POL I CY The Israeli Insurance , Pension&FinanceNewspaper 24 Tel Aviv Re 2019 The full-timers reform has started. Tens of doctors in public hospitals will receive a salary increase of between 20 and 40 thousand shekels, and in return will undertake not to engage in any private work over and above their work in the public hospitals. The doctors will also undertake to increase the scope of their work in the public hospitals by 14 hours a week. In the initial stage, the arrangement applies to the government hospital and will be extended later on to the health care service providers (HCP’s). The program is budgeted at up to 80 million shekels per annum, with the intention of increasing it substantially in the future. This is undoubtedly that start of an important reform which if it is carried out correctly could change the face of the public health system for the better. The question, of course, is whether it will be carried out correctly. The question is whether and to what extent it will impact on the private health insurances industry. It needs to be borne in mid that this reform comes in addition to a number of steps that have been taken recently by the Health Ministry and the Finance Ministry with the aim of limiting the activity of the doctors within the framework of the private health insurances. The instruction preventing the insurance companies from paying compensation to insureds receiving service from a doctor who does not have an agreement with the insurer and the regulation preventing a doctor who sees a patient within the framework of the public system from taking care of him within the private system for six months, are regulatory instructions aimed at reducing the power and impact of private insurance on the public. At the same time, the desire of the patient to receive the best possible treatment, to choose the surgeon according to his wishes, to choose a doctor who he believes in and who has been recommended to him, is a very powerful desire for many patients – being based on the faith, that only that particular doctor is able to save him and that recovery is possible only with him. Thus there will always be patients and there will always be doctors who will continue treating them, in the private system. Or perhaps black market medicine will return to center stage? The only real way to deal with the problems of the health system is not to segregate between the public health system and the private health insurance industry, but to combine them. This is a ten billion shekel per annum industry – money which can be injected into the public system, but which is not reaching it. At the same time, the governments existing policy restricts freedom of choice and diminishes the share and the importance of private health insurances covering surgery. Since the decision of where to carry out surgery is for most part determined by the doctor, and since under the newmodel the doctors will want to carry out activity in the public hospitals and will want the project to succeed, and since these doctors are more well-known and influential, it is reasonable to assume that the number of operations carried out within the framework of the private health insurances and in private hospitals will decrease. This will not happen tomorrow morning, but as the full-timers program succeeds and accelerates, this will happen more and more. Are private health insurances out? Definitely not! Alongside the process of bringing doctors back into the public system, a process is taking place simultaneously, in the health system in Israel and around the world, a process where the component of medications and medical technologies is becoming a very significant element in the funding of the recovery services given to the sick person. Advanced medical technologies, genetic treatments, personally adapted medicine, organ printing, immunotherapy medications and so on, increase the chances of survival and longevity of many patients, but also dramatically increase the costs of medical treatment. A big share of the new technologies end up in the health basket, but the time period elapsing from a medication or medical technology becoming readily available and it being added to the basket, can be very long, between 3 and 10 years. The only way that these technologies can be made available to patients in need of them when they are still not in the basket, is only via the private insurances. This being the case, we expect to see in the near future new private medical insurance policies, in which the weight of the surgery section will be smaller and even cheaper, with the medications and technologies section becoming more significant and more important. The full-timers reform has arrived – how will it affect the private health insurance industry? ‏ • The full-timers reform is going into top gear, tens of doctors will receive salary increases and will not be permitted to work more, other than only in public hospitals • How will this step impact on the private health insurance industry? Is it good, is it bad, and indeed is it in fact a significant change? By Dr. Udi Frishman