India’s hospitals draw 3,000,000 patients and $2 billion a year to their medical tourism industry. Medical tourists come from around the world for a wide variety of treatments.
Israel draws maybe 40,000 patients and $150 million a year to our own medical tourism industry. Medical tourists come primarily from Eastern Europe, Cyprus and the US. There is a major emphasis on discount IVF treatments and dead-sea spas, although some Cypriots also come for bone marrow transplants, which they can’t get at home.
Israel has major pharmaceutical, medical research and medical device industries. And yet, despite our world-leading position in these fields, medical tourism isn’t a major Israeli industry. If you want the best care possible, you travel the United States and spend the big bucks. And if you want the discount deal, you go to India – where the care is often excellent.
Few people come to Israel.
‘Jewish doctor’ is one of the strongest brands in the world. It’s right up there with Coke and Michael Jordan. Not only that, but Israel has a lot of ‘Jewish doctors’, with 3.3 practicing physicians per 100,000 people. So why aren’t we a world-leader in medical tourism? Why do so many American doctors who make aliyah continue to work in the United States? Our healthcare system is strapped for cash, and yet we haven’t tapped this source of funding in any significant way.
What is wrong? And how can we fix it?
I am an oleh chadash – a new immigrant. I don’t the intricacies of the healthcare system here. Perhaps my position as an outsider has led me to a few answers.
First and foremost, the words ‘service’ and ‘healthcare’ share a shaky connection in Israel healthcare services. The front-line General Practitioner and local clinical services offer excellent customer service – at least in Modiin. But once you enter the labyrinth of the hospital system, that changes. My wife has had children in Australia, the United States and Israel. We expected that when it came to process of childbirth, Israel would be the best of the bunch. No developed country delivers as many children as Israel does. The process should have been streamlined, efficient and – in some way at least – painless. It was none of that. Everybody was dedicated to providing the best possible services – but what was delivered was disjointed, impersonal and inefficient. Yes, the outcomes are fine – Israeli Jews have lifespans comparable to American Jews. But there is no ‘service’ in Israel health services.
Contrast that with India. Indian hospitals are increasingly offering superb service. A journalist I read (Claire Berlinksi) had her nose bitten off by a dog several years ago while visiting India. This is her account of the resulting ER visit:
“Within seconds of my arrival, the team was taking my medical history, doing a skin-test to check for drug allergies, then injecting me with what turned out to be antibiotics, although I didn’t understand that. I thought they were giving me something highly narcotic, so I immediately decided I was high as a kite. (This was the most profound proof of the power of the placebo effect I’ve ever experienced.) Dr. Sharma arrived minutes later. They wheeled me off to the operating theater, and he stitched my nose back on so fast and so ably that now you’d truly never know. See my avatar, it’s unretouched. No rabies, no infection, no disfigurement.”
The bill came to about $50. Imagine that here – or in the U.S. There’s a famous Indian doctor – Doctor Devi Shetty – who has opened chains of specialized hospitals, including the largest heart hospital in the world. His business is treating medical tourists, but he treats locals as well. The mortality rate from his hospitals rivals that of the United States. I wouldn’t want to go to a rural hospital anywhere in India – but in urban areas and in hospitals focused on the export market – things have changed.
Much of the Indian niche is focused on cost. By contrast, an Israeli product will always be a premium product. I’d like to think we have the skills and technology to deliver it and draw the patients to support it.
What do we need to do? The answer fundamentally comes down to empowering hospitals to do things differently.
First, we need to unleash our people. They are the engine of our healthcare system. Specifically, we need to empower doctors. In Israel, allied health professionals (nurses, audiologists etc…) are very limited contributors to healthcare. Audiologists (who specialize in measuring and treating hearing loss) can’t look in ears to see if there are blockages – much less remove them. They can’t know if something as simple as wax is skewing results. As things stand, this is reasonable. In Israel, they lack training. In the U.S. audiologists have clinical doctorates – here they do a few courses and then learn on the job. In the United States, they are professionals. Here, they are technicians. The same principle applies to nurses. In the United States, they carry stethoscopes. They are expected to be full participants in the delivery of care including carefully monitoring patients. Here, their role is more akin to that of US nurses in the 1950s. Stethoscopes and decisions belong only to doctors.
The result is that our excellent Jewish doctors are constrained. Rather than being the top of a healthcare organization – dedicating their limited time to those issues that demand their attention – they are examining patients’ ears for blockages. They are akin to Moshe, before Yitro’s system of judges. Everybody comes to them for every little matter, and they don’t have their time to do what only they can do well. The whole system system suffers as a result.
Compare this with Dr. Shetty. He pays his doctors very well – he recruits top Indian doctors in the United States. But he surrounds them with a significant and effective support staff so he makes the most of what they have to offer and he enables them to provide effective and efficient care.
How can we copy this here? We need only recognize higher levels of training in allied health and enable hospitals to choose to use such people if they want to. With a stronger suite of health professionals, we
empower more flexibility and dynamism in our health market. There are many olim with these higher qualifications who could not only work in more dynamic ways – but open schools to train others in the best their allied health professions have to offer.
All of this leads to the second and broader goal. Israel needs to unleash the medical business models. No central planner, government official, or Jewish Press author can predict what is going to succeed. But Israeli hospital business models, constrained by a web of regulations that seem to belong in another century, are far from dynamic. When my wife and I left Modiin to seek medical care in the big cities – we referred to it as going back to ‘old Israel.’ It felt like we were returning to the Israel of socialist grand planning – the same Israel that designed the Tel Aviv Central Bus Station.
Compare this with India where private corporations build massive hospitals around their own dynamic ideas of what makes such facilities work. Dr. Shetty is but one example. Perhaps because India was so underdeveloped and so desperate, there was a greater need for change. Or perhaps they were simply pursuing an opportunity. Health care, due to imposing, inflexible and poorly-designed rules in developed countries, represented a tremendous market opportunity. Whatever the cause, competition for patients both foreign and local has yielded innovation in the business models that determine the structure and delivery of healthcare. The result has been dramatically and continually improving quality of care.
Israel has shown a tremendous ability to be a dynamic and innovative society. We are the ‘start-up nation.’ In fields from mobile phone cameras to drug delivery to defensive technologies, Israel leads the world. But our healthcare remains stuck in ‘old Israel.’ By unleashing our doctors and our hospitals, we can fundamentally change this.
How do we do this? There are plenty of highly-trained allied health professionals ready to help by stepping into new roles – even as educators to raise training levels here. And there are, I’m sure, plenty of opportunistic and gutsy entrepreneurs who would enter this space with official permission.
A few minor policy changes and Israel can leverage the ‘Jewish doctor.’
The world can come here for the best in medical care, and we will all be better off because of it.