physicians for human rights-israel: waiting times for specialists, january 2010

8/8/2019 Physicians for Human Rights-Israel: Waiting Times for Specialists, January 2010

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November 2009Waiting Times for Appointments with Specialists in the Community:A Comparison between Different Sick-Funds and between Different Geographic Regions

There is very little information, research or discussion about waiting times for appointments with

secondary medical service givers in Israel. This paper presents new information received from the

various sick-funds following an application by "the Be'er-Sheva group for equity in Health" and

Physicians for Human Rights-Israel (PHR), which was unknown to the public up till now. In this

report the term "secondary medical service giver" means a specialist in medical branches other

than family and Pediatrics (e.g. Orthopedic surgeon, dermatologist, gynecologist etc.), a term

which is referred to also as "specialist" or "professional doctor" below.

Reserved Regulation: Information hidden from the Public Eye

This report is intended to reveal, for the first time, detailed information received from the different

health funds pertaining to the waiting times for appointments with specialists in community

clinics. The paper discusses eleven different medical specialties and various geographical regions.

In the end of 2006 the Be'er-Sheva group and PHR-IL applied to the Ministry of Health asking for

information about several parameters which could shed light on the availability of medicalspecialists in the community, comparing the different health funds and regions. The response was;

"the ministry of health has no data bases referring to the information required. The data may be

available at the various health funds."

It is true that the ministry of health encounters difficulties in getting information about the

availability of secondary medical services in the community; it is only in 2006 that the ministry

first conducted a control round on the subject among the different health funds, and they agreed to

cooperate provided that the findings of the review are not publicized. The ministry of health

indicated that the findings of the next (control) survey round, intended to be held in September

2007, will be made public. To the best of our knowledge the results of the control survey of the

health funds by the ministry of health have not been publicized, and there is no publicly availableinformation about any other surveys, except for the one conducted in 2006.

The data we collected, most of which were made accessible to us only after an appeal based on the

freedom of information act was served, point to a considerable difference in waiting times

(measured in number of days) for an appointment between the various health funds, between

different geographic regions and between the different medical specializations. The report also

points out that waiting times for some of the specialists are unacceptable.1

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It is noteworthy that a systematic comparison between the various health funds was impossible to make due to thevarious measuring methods of the different parameters and because the data available referred to different years. For

the reservations please see the full report.


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Waiting times for an appointment

Gaps in waiting times for appointments between health funds and regions

The findings point to considerable gaps between the different health funds; thus, for instance, in

the Northern district, waiting time for a lung specialist in the "Me'u'chedt" health fund is 3.28 days,compared to 21.52 days in the "Klalit" health fund, and 31.85 days in "Maccabi" health fund.

Moreover, within the health funds, there were gaps found between regions:

In the Klalit health fund regions did not considerably differ in the average number of waiting days.

The central district's average number of waiting days was higher compared to all other districts

(although only in four of eleven medical specializations), while in the northern region the number

of waiting days was the smallest compared to the other regions (in four of eleven medical

specializations). The regions distinct for the longer than the national average waiting times,

compared to other regions were the Sharon district, the Dan district, the Haifa district and the

central district. In the central district, for instance, the average number of waiting days for an

appointment with an optimologist was 18.02 days as compared to 9.84 days in the northern

district.

In Maccabi's southern district the median number of waiting days was higher compared to all the

other districts (in five of 11 medical specializations). In the Jerusalem district the number of

waiting days was the lowest (though only in four of eleven medical specializations). In the south

and the Sharon districts patients had to wait longer than the national average for an appointment

with a specialist; For instance: In the southern district patients waited an average 31.12 days for an

appointment with a lung specialist, as compared to 11 days in the Jerusalem district.

In the "Me'uchedet" health fund the longest average waiting time was found in the southern districtfor eight out of the eleven medical specializations we examined. Thus, for instance, we found 6.97

waiting days for a laryngologist there, as compared to 2.4 days in the central and northern districts.

The "Le'umit" health fund claimed that the calculation of waiting times for doctors is done by the

center for appointments at a given time and for a given location, i.e. waiting times may differ from

one week to the next and from one location to another. The fund does not have data on waiting

times for consultants by (medical) specialization or by regions which pertain to the whole

population of patients, including those who prefer to wait for an individual consultant. These data

cannot be collected inside the existing systems.2

Exceptional waiting times3

Exceptional waiting times (over 28 days) - in days for an appointment

Among the medical specialization branches we examined, exceptional waiting times (for an

appointment) were found for the following consultants:

2Jemima Mazuz, Legal counsellor. Le'umit (health Fund's answer of Octobet 10th 2009).3For the purpose of this paper, 28 days were defined as an exceptional waiting time, as defined in a research on this

subject carried out in Canada:The college of Family Physicians of Canada (2006) : When the Clock Starts Ticking: Wait Times in Primary Care.

Discussion Paper.


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Rheumatology: In the Klalit (General) Fund 58.57 days in the Haifa district, 46.64 days in the

Dan district. In the Maccabbi Fund 88.1 in the southern district, 87.5 in the Sharon district and

52.85 in the central plain district.

Gastroenterology: In the Klalit fund - 97.58 in the central district, 54.74 in the Eilat district. In

the Maccabbi fund 46.9 in the Sharon district and 31.85 in the northern District.

Neurology: In the Klalit fund -34.53 in the central district; In the Maccabbi fund 32.67 in theJerusalem district.

A Need for Change of Policy

In Israel there are significant gaps between populations and regions in health status (life

expectancy, infant mortality, morbidity rates etc.). This inequity exacts a personal and human high

price in the form of higher mortality and morbidity rates and also a high social price. The health

system has a significant, although not an exclusive, role to play in narrowing the gaps by

organizing a health system which is more egalitarian, and deploying the services more equally and

acting to promote more egalitarian accessibility and availability of services.Although the availability of community secondary medical services, which has been examined in

this survey, has but a limited effect on health results, it has a significant importance in the context

of the (equal) right to enjoy equal medical services. Moreover, Availability of the services has a

considerable impact on the trust the public attributes to the public health-care system, and it's

confidence in the system's quality and the latter's ability to fulfill the public's needs.

Much as treating other variables of inequality in health and health services, some measures have to

be taken regarding waiting times for an appointment with a consultant. Besides the immediate

necessity to shorten the exceptional waiting times discovered in the present account, the ministry

of health has a central role and a professional duty to act in order to reduce substantial gaps among

geographical regions (in waiting times) within and between the various health funds. The ministry

of health should prepare a structured intervention plan which should include, among other steps,

the following:

Define objectives and commitment to maximal waiting times; suggesting alternatives for those

who wait longer than the maximum waiting time set; Set a clear and uniform definition of

criteria for collecting comparative data on waiting times (a comparison of systems of data

collecting an identical definition of districts, systems of measurement, which spheres of service

are to be examined, etc. ); The publication of comparative data on waiting times across the

various medical specializations, across procedures, different geographical regions, the health

funds, and about the progress of the various functions towards the goals set by the ministry,

currently and in a manner accessible to the public (e.g. by internet and publication in mass media);

enlarging the medical personnel: As the waiting times for an appointment with a specialist areclosely related to the availability of trained staff and with the shortage of certain medical

specializations, some nationally, and some in the periphery only, the ministry of health should

establish a function in charge of planning the training and placement of medical (and paramedical)

personnel in Israel, whose task would be, among others, to gather exhaustive information about

medical personnel who actually practice medicine, act to mobilize manpower in peripheral

regions etc.

Data in this paper is based on a paper by "Be'er-Shava Group for Equaity in Health" and

"Physicians for Human Rights- Israel":


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"Secondary Medicine in the Community Size, Deployment and Waiting Times for An

Appointment: A Comparative Observation Between Health funds and Geographical Regions",

written by Shlomit Avni.

physicians for human rights-israel: waiting times for specialists, january 2010

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