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17 Cheshvan 5761 - November 15, 2000 | Mordecai Plaut, director Published Weekly
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Home and Family
Your Medical Questions Answered!
by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

PROBLEMS WITH ISRAEL'S MEDICAL SYSTEM

I haven't studied the medical systems of Europe or Australia, but I know the USA and Israel. If you are traveling to Israel, live here or have relatives here, understanding this article is important.

Israeli medicine is socialized, and every citizen has automatic medical insurance. That is the good news. However, medicine is not held in great esteem nor is health seen is an important budgetary item. There are not enough hospitals, there are not enough good physicians, there is little spent on educating the public on the prevention of disease, water purity and food purity attract little notice.

Let's say you don't feel well. In Israel you go to Kupat Cholim, where a general doctor checks you out. He may have any credentials in the world. Due to politics, many physicians that received poor training have received medical licenses. Specialists may have no credentials in their field other than experience. The general physicians are in general overworked and are scared of malpractice, so you may have many tests that are not necessary, be shipped back and forth to specialists and be put on antibiotics for reasons that defy reason. The results are delays in diagnosis, and overuse of antibiotics which result in the emergence of bacteria that are resistant to antibiotics. The doctors are under big pressure to save money, therefore they may ship a serious problem to a specialist in some office rather than send to the emergency department, which costs more money.

[Editor's Note: Reports from America say that in recent years doctors there are also under increasing pressure to save money and that the experience there is similar to here.]

Hospitalization costs too much as well. So the kupot try to minimize the hospitalizations and the days you can be in the hospital, to save money. Should the Kupah have an agreement for a gross fee to be paid to the hospital for the whole year, the hospital itself may seek to not hospitalize or release you early to save money.

Kupot by law must cover certain medications, but necessary ones that are new may not be covered. Operations for cancer and transplants may not be covered especially if not done here in Israel. Nevertheless, they spend millions on advertising, because they get a stipend from the government for each new member of the Kupah.

Should you need to go to the emergency department, you need a doctor's note or you must pay out of your pocket. During the day you must wait in a long line at your Kupah for this, but in the evening when you have no doctor (your family doctor will not be on call usually), you can either take your chances going yourself to the emergency department or call a doctor for a home visit. These doctors are usually not of very high quality and are under the same pressures to not send to the hospital and save money. Many times you will be sent to an urgi-center with again, varying quality. Any medical service by the way is with a co-payment which seems to get worse every year.

Want good medical service in the community? You'll have to arrange it privately. It can be very expensive, even as high as 1000 shekel for a consultation, but at least you can depend on the quality. Most people are unable to afford this.

While we are on the subject of the community, medical knowledge in the community is on a very low level. Many people think that smoking is good for you, that antibiotics help cure fractures and headaches, and that herbs and Chinese medicine are good treatments for diabetes instead of insulin. Dogs run wild in this country, so rabies is a problem, and water purity is a myth. Dysentery is rampant and sewage and industrial waste are dumped into the ocean, rivers and in wadis. Good nutrition is also problematic: foods are spiked with high sugar content, and the use of saturated fats is commonplace. Many medications and vaccines that could help people have not been approved for use here yet, while many old fashioned drugs are still in use. Child safety caps are not necessary by law.

This is all in the community. Write me in care of the Yated.

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