Solutions for a Social Healthcare System

I touched upon  the recent developments in the Israeli health system in my last blog When Close is Not Enough.  The Israeli healthcare system is a socialized service similar to Canada or England.  However, it provides a much higher quality of service than most other countries.

It’s primary drawback is its lack of facilities.  Only 62 years old, Israel has 38 hospitals containing 13,000 licensed beds.  This past winter, at the height of the flu season, occupancy reached 200% and prompted much criticism of the government.  The Ministry of Health responded with the promises of 10 Urgent Care Centers and an additional 1,300 beds over 10 years.  Truly a case of treating a gunshot wound with an aspirin.

While service is generally of good quality, access to service providers is not aligned with the demographic distribution of this small but overpopulated country.  Israel is 8,630 sq. miles (roughly the size of New Jersey) with a population of 7.7 million people57% of its population live in the center of the country.  A disproportionate 84% of its hospitals are located in this center portion.  They are mostly clustered around Tel Aviv and Jerusalem and sometimes 45 minutes by ambulance from large population centers.  Even more disconcerting, the periphery of the country can be more than 90 minutes from the nearest hospital.

Israel’s first step to healthcare realignment is to assess the quality and access of care throughout the country.  The system must be viewed and analyzed as a single organism.  What is needed is a process similar to New York’s “Berger” Commission on Health Care Facilities in the 21st Century.

The commission is self described as “a broad-based, non-partisan panel created by former Governor Pataki and the New York State Legislature to undertake a rational, independent review of health care capacity and resources in New York State. It was created to ensure that the regional and local supply of hospital and nursing home facilities is best configured to appropriately respond to community needs for high-quality, affordable and accessible care, with meaningful efficiencies in delivery and financing that promote infrastructure stability.”

I predict that a similar study in Israel will call for a realignment of facility locations.  Terems (Israel’s version of Urgent Care Centers) should be strategically located to fill service gaps.  They will extend the reach of the system by providing primary acute care throughout the country.  Next, small community style hospitals should be introduced into the system to allow quicker access to broader medical care,  providing secondary level care.  Lastly, new Medical Centers should be introduced and placed BETWEEN cities.  These will provide specialized, tertiary and level one trauma care.  These three components will complete a web, making healthcare accessible throughout the country.

The days of tertiary medical facilities being located in metropolitan centers have passed.  Traffic patterns make access to the city centers difficult. Realistically,  these hospitals can only serve one city, instead of one main city and many smaller surrounding ones.  Israel must look toward the future and assess how and where its population will grow.  It will then find that the most natural and logical locations are between cities with triangulated catchment areas.

These solutions are fairly simple and partially intuitive.  The challenge is getting government to follow the simple path and think intuitively.

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