Israel’s top priority right now is to get the economy back on track as soon as possible, according to Sigal Regev-Rozenberg, CEO of Israel’s third largest health maintenance organization (HMO) Kupat Holim Meuhedet. The coronavirus (Covid-19) induced lockdown enacted a few weeks ago should continue until after Passover, she said in a recent interview with Calcalist. After the holiday, Regev-Rozenberg suggested, Israel should go back to normal, for which end it needs to start doing 30,000 tests a day to keep ahead of the pandemic. The elderly population, however, should prepare to remain in lockdown for a lengthy period that could last months, she said.
The current lockdown policy is working, but it was only necessary because lack of swabs meant Israel’s testing capabilities were limited, she said.
HMO clinics must remain open, Regev-Rozenberg said. Like food, access to medicine is a basic and urgent human need. “We must not repeat the mistakes made at the beginning of the crisis, when we hesitated,” Regev-Rozenberg said. Israel did not order enough swabs, masks, and medical machinery, and the lockdown was implemented late, she said. “With a quicker response, we could have been seeing the end a week or two from now, but we will not,” she added. Regev-Rozenberg predicted however that the end is not far and that Israel will return to normal function again by May 1.
One question that keeps popping up globally concerning restrictive measures is that of measuring the economic damage against the number of deadly cases. “The longer the lockdown, the more problematic the pandemic’s ROI (return on investment),” Regev-Rozenberg said. “When paralyzing the economy to save people, you must take the cost into account. It is like subsidizing specific drugs: every technology has a price and you need to know how much ‘health’ you get for every shekel you put in.” Inthe end, she said, there is no escape from considering how many shekels mean lengthening the lives of how many people.
While dire, the coronavirus crisis cannot be allowed to take over the entire healthcare system, Regev-Rozenberg said. “It is important that these systems will stay afloat because, otherwise, people will perish from heart attacks and car accidents, just because they cannot go to the hospital.”
Meuhedet stopped almost all its routine activity until Passover, Regev-Rozenberg said, to see what happens. “We are not doing checkups, we stopped testing for serious illnesses and conditions, we halted our child development units,” she said. “You can do this for a short period, but if this lasts longer, patients’ conditions will deteriorate as they will not be able to receive proper care,” she added.
Regev-Rozenberg hopes that as the government appoints a team to handle the economic ramifications of the current crisis and outline the country’s fiscal strategy, the public healthcare system will also be taken into account. “After it has seen all the blunders—unprotected teams, lack of equipment, a non-digitized industry—the government needs to invest more in public healthcare and understand its importance,” she said.
As head of one of Israel’s four HMOs, Regev-Rozenberg thinks that not enough attention is paid to these organizations, considering the role community medicine is playing in this crisis. Israel has gone through a lost decade in terms of opportunities to advance the healthcare system not seized due to lack of leadership, she said. For ten years, we had all the technological and digital tools needed to revolutionize the healthcare system, and instead we just talked and played around with digital solutions but ended up choosing case-by-case solutions,” Regev-Rozenberg said. “We did not build a technological-digital healthcare system that can provide full services remotely. We could have reached the coronavirus era capable of answering the needs of many groups remotely, but we did not prepare ahead,” she said.
The current opportunity cannot be squandered, however, as viruses will be the main battlefields of the future, Regev-Rozenber said. Currently, there is talk of about a budget boost of NIS 5 billion (approximately $1.4 billion), which is less than 10% of the overall budget of the health ministry, she said. “If they give 60% to hospitals and only 40% to HMOs, that will barely cover the deficits, because as part of our function, 55% of HMOs’ budgets eventually goes to the hospitals. The critical resource mass must go to the community, to redesign the system,” she said.
Regev-Rozenber thinks it is wrong to focus on specifics like buying ventilators, as the next pandemic could attack the heart, for example, rather than the respiratory system. “There are never enough machines and personnel to handle a pandemic, and you cannot know what the next outbreak will be. You cannot ready a hospitalization mechanism for every possible pandemic. But you can strengthen the community to create a strong population with less pre-existing conditions, which will be better positioned to survive the next pandemic,” she said.
The health ministry’s announcements make it clear that it thinks of this as a hospital crisis, meaning the hospitals should get the resources, Regev-Rozenber said. “I am currently taking care of 700 coronavirus cases. What hospital is taking care of 700 cases now?” Meuhedet is one of the smaller HMOs, she emphasized, but it is the hospital managers who are being hailed as national heroes. Meanwhile, the HMOs are handling 95% of Israel’s coronavirus cases, she said.
“The focus is not on the right target. They are building the strategy for the day after and my economic sensor says it is based on three principals: beds, beds, beds. And, maybe, ventilators. Everything goes to the hospitals, and it doesn’t matter if the price is a 5% wage cut or layoffs for community medicine personnel. But the opposite is true: a shekel invested in the community is worth a lot more than a shekel invested in hospitals.”
Israel will pay a heavy price if all the money goes to hospitals, Regev-Rozenber said, as such a decision will doom the public healthcare system. “I do not believe in the private healthcare system. It does not accept coronavirus patients. People are starting to understand that we all need public healthcare,” she said. “Now, you are in danger even if you have money.”
Some people have bought ventilators for their own private use, but that is useless without trained personnel, Regev-Rozenber said. “There is no option of buying a solution and saving only yourself now. One of the interesting things we are seeing now is that decision makers are understanding that this time, nepotism is not going to make a difference.”