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Health

As part of the process of establishing the “State of the art”’ a team was formed, composed of visionaries and people of action, and including leading lights in the world of industry. The team put together initial proposals aimed at developing the field, strengthening it and creating socio-economic resilience.

The current crisis hit an already-overflowing system in which hospitals were already dealing with a severe shortage of beds. The inability of patients to reach the hospital emphasizes the need to move towards home hospitalization and treatment in the community. This move will free up beds, prevent unnecessary spreading of infectious disease, and even increase the quota for positions at medical schools. A step must be taken which will be supported technologically and count on the assistance of manpower retrained for this purpose

A healthcare system vision

Comprehensive healthcare, equal for all citizens, in life-saving time spans, while providing a sense of protection and constant ability to help, no matter where, with maximum efficiency both in normal times and emergencies while using advanced technologies.

Main recommendations

  1. A health services law – defining the healthcare available to all citizens in every location.
  2. A broad-based opening of the world of home hospitalization and community medicine – the healthcare system will create resilience in both emergency and normal times, will become more efficient and save massive resources.
  3. Carrying out adaptations, simple regulation of standards, accreditation and budgeting, and billing methods with the kupot cholim (health funds).
  4. A reconfiguration of the hierarchy of medical professions and creation of a support system for the main caregivers.
  5. Support for elite industry to develop and broadly implement technology which will permit home medicine and long-distance treatment, as well as encouragement of traditional industry to modify the medical production system to create resilience among manufacturers in the field during times of crisis.

Principles

1. Cooperation between the government and local authorities and the business and non-profit sectors (PPP) will aid in transforming the healthcare system.

2. Focus will be placed on the confidence of the public in the health system and on the trust placed in it as affecting daily life, as well as on the welfare of the patients themselves.     

3. The State’s support for the healthcare system will be based on investments to strengthen activity in the sector through development of growth engines in new horizons to broaden the circle of employees in the field and instigate activity, rather than by compensating for a loss of income in the current period.

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MAIN RESEARCH POINTS

Status report and forecasts

Israel’s health system is advanced, efficient and innovative, relative to the resources available. Israel is at the bottom of the rate of hospitalization beds per thousand people among OECD states and the highest rate of capacity (94%). This fact raises the efficiency level but lowers the level of resilience since the system does not have broad enough margins (if any) to handle a crisis.

If there is an uncontrolled outbreak, an enormous burden will be placed on the hospitals. They will experience a lack of ventilators and ECMO machines along with other medical equipment, potentially leading to an increase in the number of victims both of the epidemic and of treatment resources being rechanneled from “regular” patients whose only option at the moment is the hospital. The crisis is also liable to lead to political conflicts and reallocation of resources from needy populations and from the periphery. It should be pointed out, that even prior to the Corona crisis, Israel suffered from inequality in healthcare, which was expressed, among other ways, by the gaps in life expectancy among the demographic groups and geographical regions.

Risks, challenges and weaknesses

Demographic trends in Israel forecast a massive rise in the percentage of the elderly in coming years, which will be accompanied by additional strain on a system which is already stretched to its limit insofar as resources, capacity and the exhaustion of the professional manpower.

Establishing new hospitals will not suffice to fix the shortage of beds. This shortage is estimated at around a thousand to two thousand beds. A new hospital in Ashdod added only 370 and took an extremely long time to build.

Dangers of infection, falls, or malpractice due to medical staff being overworked (a phenomenon which has become the second most common cause of death in the United States) act as a trigger to finding alternative solutions to hospitalization in hospitals.

Opportunities and capabilities

The Corona pandemic raised awareness of all of the abovementioned risks and at a time when patients needing treatment are “waiving” it and not going to hospital out of fear of catching the virus, it seems clear that for a significant amount of the patients, both during Corona and normal times, hospitalization or in-hospital treatment is not the best road to take. Hospitals should be saved for those cases in which surgery, the ICU, or special technologies are required.

Hospitals are complex, sophisticated systems whose construction and running costs are extremely high; costs whose burden then falls on the healthcare system. Changing some of the services provided in hospitals with more protected, cheaper alternatives, including better user experiences, is a big opportunity available right now.

We have the opportunity to expand the home hospitalization model.  According to this model, any patient requiring hospitalization and supervision and whose life is not in immediate danger will be sent to home hospitalization while receiving the best possible care through a system able to provide the treatments required in the patient’s own home. Moving significant amounts of hospitalizations to the patients’ homes will release thousands of hospital beds, reduce the likelihood of overcrowding and increase the preparedness for waves of demand (as in a pandemic), while increasing the resilience of the healthcare system, which directly affects household resilience and their faith in the system.

The numerous advantages of home hospitalization

  • Through expansion and upgrading of training in multiple professions and the creation of a multi-disciplinary team to strengthen the ability to provide care in the community, it will be possible to provide a range of accessible medical services in community clinics, in order to reduce the burden on the teams of physicians and specialists and to increase satisfaction among patients and open new horizons for employment.
  • If it becomes possible to recognize that home-care is a clinical field within medical studies and relevant specializations (including: internal, geriatric, rehabilitation, pediatrics) there will be a significant increase in capacity for medical schools and physician training in Israel in accordance with the system’s needs.
  • Operating a system which is able to provide medical services at the patient’s home will make it possible to upgrade medical services in those areas of the periphery which are far from existing hospitals.

Leveraging the crisis – Implementation methods

  • Health services law – defining the health response for all residents in all locations.
  • A broad expansion of the world of home hospitalization and community medicine – the health services will create resilience in normal and emergency situations, become more efficient and save vast resources.
  • Simple adaptation of standards, accreditation and budget, and billing methods with the kupot cholim.
  • A shift in the hierarchy of medical professions and creation of a support system for the main caregivers.
  • Support for elite industry to develop and broadly implement technology which will permit home medicine and long-distance treatment, as well as encouragement of traditional industry to modify the medical production system to create resilience among manufacturers in the field during times of crisis.

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