Once upon a time there was adequate health care in Israel

“The directors of Israel’s public hospitals announced last night that as of this morning they are canceling non-urgent surgeries, in the absence of a government plan that would permit them to receive the hundreds of millions of shekels which have been promised to them,” Israel Channel 10 Television reported Wednesday.

Once upon a time in the 1980s, I was the nurse of a Bedouin Mobile Unit. Myself, a driver, and 60,000 patients in a 60-kilometer radius surrounding Soroka Hospital in Be’er Sheva.

The hospital and the national health insurance services grappled constantly with the challenge of caring for folks living in tents, tin huts, etc. in the middle of the Negev. One of those challenges was providing dialysis. It was not feasible for many Bedouins to make the journey to Soroka’s dialysis unit three times a week. A three-hour drive on dirt roads for most of them and a five-hour ride on a donkey for the old-timers. Soroka’s renal unit dreamed up the still revolutionary concept of peritoneal dialysis, a procedure in which patients perform their own dialysis at home via a catheter in their abdomens. I will leave the technical problems of sterility in a tent without electricity up to your imaginations.

Several months ago, I was talking to a successful American lawyer in one of the finest rehab facilities in Israel. His heart condition had gone south, he could not walk more than a few steps, and his kidneys had failed.

He wanted to go home and the hospital wanted him to go home. He was taking up a precious room in a facility in which the halls were lined with patients in beds waiting to take his place. His HMO would not pay the hospital for him to stay one more day. But he needed dialysis.

What to do, asked the staff? He lived in a fourth-floor apartment in an upscale suburb. But the building had no elevator and his ailing wife could not escort him down the stairs, to the bus, etc. Neither his HMO nor his private supplementary insurance would pay for a taxi or an escort to take him to the dialysis unit, and paying out of pocket for years could doom his wife to the street.

His HMO wanted to send him to an assisted-living facility in an ultra-Orthodox haredi neighborhood. Most of his fellow-patients there would be highly observant women who would have nothing to do with a secular, married man, he argued. He would be lonely and isolated.

“Peritoneal dialysis,” I said to him, to his wife, and to the staff, careful to conceal my alarm that a wealthy lawyer in the center of the country could now have to resort to the same solutions I offered my Bedouin patients in the 1980s.

But does that mean that “No one has adequate health care”?

In 2013, the OECD (Organization for Economic Development and Cooperation) reported that Israel had 3.3 doctors per 1000 residents, roughly equal to the OECD average of 3.2. But a previous report cited severe physician shortages in specialties including anesthesia, general surgery, geriatrics, and primary care, and this report noted that there were more physicians retiring than students enrolling in medical school. In other words, these shortages were expected to continue.

In 2013, the OECD reported 4.81 nurses per 1000 population compared to the OECD country average of 8.7 nurses per 1000 population. Israel had one of the lowest nursing ratios in the developed world.

The OECD reported in June this year that Israel had only 1.9 hospital beds per 1000 residents. Israel ranked well below the OECD’s 3.3 average and surpassed only Canada and Mexico. This overcrowding increases the risk of infection to every patient in an Israeli hospital.

The Israel Forum on Prematurity reported to the Knesset in November that the death rate of very small premature infants delivered before the 27^th week of pregnancy exceeds twice that of other Western nations. The forum attributed this to a lack of skilled manpower.

And the health ministry recently reported that these problems were far more acute in the nation’s geographical and socioeconomic periphery.

We lack doctors, nurses, and beds. And non-urgent surgeries in public hospitals have been canceled. Does that sound like adequate health care to you?

Some may say that America is no better. I don’t know whether that’s true. I haven’t lived there for 36 years. But we did not come here to recreate America.

What to do, you ask? For starters, vote like your life depends on it.