‘Priorities will be given to life-saving medicines’
While priorities will be given to life-saving medicines, the health care system is the last thing that interests the politicians, Prof. Zev Rothstein, head of the Health Basket and Hadassah CEO, said in a panel held at the 2019 Elections Conference sponsored by The Jerusalem Post and Maariv.
The panel included: Rothstein; Dr. Roy Eldor, head of the Diabetes Unit at Ichilov Hospital; and advocate Eyal Tzur, chairman of the Association for Support of Crohn’s and Colitis Patients.
At the beginning of the discussion, moderator Hila Elroy, who is Channel 13’s health reporter, asked Rothstein to clarify the nature of the committee.
“This is a public committee consisting of both medical personnel and public representatives who determine which medicines the state will supply to health insurance policyholders under the state insurance law. By January 1, there will be a new health basket,” he explained.
“The amount which is determined by the Treasury is the primary constraint and is dependent on the state budget. No one on the committee feels that the amount is sufficient, and the heads of the committees have said this in the past. The committee decides by consensus what new treatments will be budgeted by policy holders in 2020.”
Elroy then turned to Tzur, who by virtue of his role is identified with the patients’ side, and asked him about his thoughts about patient representation on the committee.
“There are four representatives for the Health Basket, and not a single one represents the patients. Despite statements that the patients are represented, they are not there. As the head of an organization that represents 50,000 patients, I am not permitted to express my opinion. Doctors, on the other hand, speak from a different point of view. Why, among the four public representatives, can there not be a single representative from a patient organization? While this year’s initiative to send patient testimonies is welcome, it’s not enough. For example, no representative of the public will speak on the importance of giving a drug to patients who are chronically ill,” he said.
Tzur continued, “We expect the members of the committee to see patients, and speak with them, and understand their distress. We need to consider drugs for patients who have exhausted all of the options available in the Health Basket and have no treatment.”
The panel also discussed the health budget for the chronically ill, and the low priority it is given compared with lifesaving and life-extending treatments. Rothstein noted that preference is given for life-saving treatments, but no general rule is in force.
Nevertheless, Eldor, who treats diabetes - the most common chronic illness, said that “even diabetic treatments save lives. Treating diabetes, an illness that has other associated illnesses, is very significant over the long term, both for saving lives, for future budgetary savings, and for preventing future hospitalization. It is the most widespread illness in the world and there are more than half a million diabetics in Israel. It is illogical that the economic pie is divided between life-saving drugs and drugs for treating chronic illnesses. Life expectancy in Israel has increased not because of clean air, health food and the like, but because we have given effective and life-saving treatments for these chronic illnesses.”
Rothstein interrupted to say that “The health system is the last thing that interests the politicians, because they will not get elected on this issue. Otherwise, there would be a discussion about adding NIS 1 billion to the health basket budget.”
“With just NIS 500 million, we are going to have to make cuts in essential areas,” agreed Elroy, who referred to his previous comment about his intention to raise the deductible amount for certain drugs in order to increase the number of medicines that would be included.
Asked if a drug is too expensive, will patients not take it, Eldor said, “For diabetes patients, it is a matter of spending hundreds or thousands of shekels per month. Diabetes is very widespread in the lower socio-economic levels which can make things very difficult for them. It would be very good if more medicines become included. But at the same time, we need to find a solution for those patients with limited means.
“It is painful that we established a fund because the deductible is painful for them,” said Tzur, who added, “Prof. Rothstein’s suggestion is a good one. We need to remember that on the other end, there are people with health insurance who can get medicines that are not included in the health basket. But if so, I insist that we add two patients’ representatives. This way, there will be someone to speak with. It is not realistic to send faxes. Give us representatives for the patients to make valued and more accurate decisions that only benefit them.”
Rothstein explained that “in the current situation, if from a total of five drugs, we can get only get one, and we must give up on the other four, then if we increase the deductible by 20%, it will be possible to buy all five. The intention here is not the type of drugs, whether they are life-saving drugs, or reduce pain, etc. Regardless, I intend to pressure the incoming Treasury ministry to increase the budget to NIS 700 million for the current budget. In addition, there are intensive negotiations going on with the health companies to convince them to significantly lower their prices. If the company will not agree to lower the price, I will not vote for the drug. It will be unfortunate for the developer of the drug not be able to enter the Health Basket, because it means is that the entire country will not use it.”
Rothstein summarized, “We will also check the effectiveness of the existing medicines and will ask for a refund based on the percentage of their effectiveness. This is a matter of common sense for the purpose of effectiveness. In addition, we will ask for a refund from the health organizations on surplus medicines which have been set aside but were not used, (surplus by quantity, not by price).”