The Rejuvenated State


A State of Health

I write this section at the height of the COVID-19 scourge, secluded in my home. Relative to other states in the world, Israel is reputed to have handled the crisis well, quickly locking down the population, quarantining the sick, voiding public gatherings, and shuttering non-essential businesses. But the economic and social costs have been excruciating. More than a million Israelis have been rendered unemployed and many more traumatized. Recovery may take years.


Official sources justify these draconian measures by the need to save lives, which is fully understandable. But they also warn that Israeli hospitals could easily be overwhelmed, which is not. As a Member of Knesset (2015-2019), I visited hospitals throughout the country, in urban and rural areas, north and south, serving poor populations and the affluent. In all, I found the same situation: underfunded hospitals chronically short of medical staff and operating at or beyond capacity. Even during healthy periods, wards were routinely over-packed with patient beds often lining the corridors. Every hospital administrator I met made the identical prediction: without swift and massive intervention, the entire system will collapse.

A glance at the statistics explains why. Israel significantly lags behind other OECD countries in the per capita number of beds, doctors, and nurses. Little wonder that the mortality rate from infections has doubled over the past twenty years, exceeding the OECD average by 73%. Per capita health spending also falls below the mean OECD levels.


The severity of the situation is often masked by the quality of the health care available in Israel, its universal health care system and national data base, and the excellence of its medical personnel. Hospitals are paragons of co-existence, with Arab and Jewish physicians working side-by-side in numbers proportionate to their communities’ size. Most impressively, Israel is listed among the leading nations in terms of longevity—82.6 years, eighth in the world—though this ranking is also expected to fall.


The picture emerges of a system which, despite its emphasis on excellence and assuring care for all, cannot keep pace with international standards or the expanding needs of the state. A principal reason is population growth which, at more than 2% annually, is triple that of the OECD average. Through its family subsidies, Israel incentivizes this rapid birth-rate but fails to enlarge its health services commensurately. The result is a dangerous 94% hospital occupancy with an accelerating decline in the relative number of care givers. There are only five medical schools in Israel, annually graduating less than seven doctors per 1,000 inhabitants—the second lowest among industrialized states.


But in addition to these critical shortfalls, Israel’s system suffers from an even more chronic malady. In place of a centralized network of state-sponsored and supervised facilities, Israeli hospitals are divided into a dizzying array of categories—government-owned (19), health care fund-owned (12), and the remainder (13) run by private companies, religious groups, and NGOs. The state makes little adjustment for the needs of the populations served, which vary markedly according to ethnicity, education, and income levels. The consequent wastage and shortages are staggering.


To grapple successfully with the current crisis—and reach its hundredth anniversary as a healthy state—Israel must address these defects now. It must immediately build and certify two new medical schools along with programs for training nurses and medical technicians. It must increase the total number of beds from 35,000 to 50,000.


Such measures will prove palliative, though, without an overhaul of the entire hospital system. All must be brought under a single national authority answerable to the ministry of health, streamlined and calibrated to meet the needs of each population served. The management structure must be standardized, its operations coordinated to eliminate redundancy. Whether in Kiryat Shmona or Ashdod, a patient must receive the same quality care and, if required, the same conditions of hospitalization. One state, one system, working efficiently, transparently, and with compassion.


And Israel must prepare now for future crises by stockpiling ventilators, protective gear, and medicines. Inter-ministerial contingency plans for pandemics and other natural disasters must be drafted. Draconian measures may again be necessary, but only to save lives and not a system on its deathbed. On the contrary, adequate health care for Israelis will help ensure that no cure will be more damaging than the disease.



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