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05 May 2024 | Country Update
Reforming the provision of rehabilitation and mobility devices
Rehabilitation / intermediate care
Rehabilitation is included in the NHI benefits package and responsibility for its provision, therefore, lies with the HPs.[31] Rehabilitation services are provided in the general hospitals, in designated rehabilitation hospitals, in geriatric medical centres and in the community. Outpatient services include clinics for child development and rehabilitation, clinics for general rehabilitation and day-care rehabilitation. All these services are provided in community facilities of the HPs. All rehabilitation services incur a co-payment. The co-payment for inpatient services is approximately NIS 1000 (€235) per month, and for community clinics it is approximately NIS 30 (€7) for three months.
In mid-2014, there were 732 general rehabilitation beds in Israel. Of these, 37% were in two big rehabilitation centres, 35% in 10 rehabilitation wards in general hospitals and 28% in six geriatric rehabilitation centres. Approximately one third (31%) of the beds were for neurological rehabilitation, 25% for people comatose for an extended period, 18% for general rehabilitation, 13% for children and 13% for orthopaedic rehabilitation (Haklai, 2014).
About 35% of these beds were owned by the government, 37% by Clalit, and 28% by profit-making or other non-profit-making providers.
The general rehabilitation bed rate per 1000 population was 0.09 in mid-2014, compared with 0.14 at the end of 2006 and 0.10 in 2000. Between 2006 and 2009 there was a temporary growth in the number of beds, which was attributable to beds for people who were comatose for an extended period of time. The definition/target of these beds was then changed from rehabilitation beds to complex-supportive beds. Since the end of 2009, there has been a decrease of 9% in the number of general rehabilitation beds per 1000 population. Although the rate of general rehabilitation beds has remained steady for more than a decade, when taking into account the ageing population, there is a notable decrease in capacity relative to potential needs.
About 70% of the general rehabilitation beds are concentrated in the central region of the country with fewer beds in other regions, especially in the southern and northern regions.
The overall bed occupancy rate in 2014 was 100%. Average length of stay was 44 days, although it has been decreasing steadily since the early 1990s. Stays in hospitals specializing in chronic diseases are longer, on average, than stays in rehabilitation hospitals (Ministry of Health, 2006).
The four HPs operate rehabilitation clinics within the community, offering specialist physicians and physical, occupational and speech therapy. In order to receive care at one of these clinics, a patient must obtain a referral from a family physician or rehabilitation specialist, and this incurs a co-payment. The clinics provide neurological and orthopaedic rehabilitation services, as well as child development services. Many clinics contain the latest equipment and are operated by licensed professionals who remain abreast of the changes within their fields. Clalit operates several day-care rehabilitation centres, which is equivalents to 72 beds. To a limited extent, the HPs also provide rehabilitation services in the home, through their medical home-care services as well as pioneering work in tele-rehabilitation.
The Ministry of Health participates in the cost of purchasing some rehabilitation equipment and provides a limited number of devices to the population, such as walkers and vision aids, without requiring co-payment. Yad Sarah, one of the largest non-profit-making organizations in Israel, loans a wide variety of rehabilitation devices to the public free of charge.
In 2014, there were approximately 7625 rehabilitation professionals in Israel up to age 65: 122 physician specialists in physical medicine and rehabilitation (0.915 per 1000), 3170 physical therapists (0.46 per 1000 population), 2670 occupational therapists (0.39 per 1000) and 1790 speech therapists (0.26 per 1000). Israel has 15 schools for rehabilitation professions. Most of them operate within faculties of medicine and health at the country’s four large universities and a few of them in colleges. Nevertheless, there is a significant shortage of rehabilitation professionals both in hospitals and within community-care settings; the shortage is particularly striking in geriatric rehabilitation services and in psychiatric hospitals.
- 31.This section was written by Netta Bentur.
A reform related to the provision of rehabilitation and mobility devices has taken effect on 1 April 2024. The responsibility for financing and supplying these devices has shifted from the Ministry of Health (MoH) to the health plans (HPs) (Ministry of Health, 2024). The reform aims at improving continuity of care and reducing bureaucratic processes when requesting a device. Individuals in need will now be seen by their GP or specialist at their HP, who will prescribe the device and help the patient receive the device. The eligibility criteria for a device remain unchanged.
The transfer of responsibility will occur in two stages:
The first stage includes the following mobility devices: Manual wheelchairs and associated devices, walkers, home medical beds, patient lifts, crutches, and pressure-relief mattresses. And the following rehabilitation devices: Eye and facial internal and external prostheses, breast prostheses, special contact lenses, and special glasses for children up to age 18.
The second stage is scheduled for October 2024 and will include: motorized wheelchairs, ramps, supportive and alternative communication systems, and hearing devices.
Authors
References
Critical issues facing rehabilitation
There is a continuing shortage of specialist physicians in rehabilitation. In addition, although there is no longer a shortage of physical and occupational therapists, the relatively low salary of these skilled professionals is an incentive for leaving the field and/or the public sector. The salaries are low compared with those of other trained professionals in the health care system, such as nursing personnel or radiography technicians. Moreover, the high wages paid to rehabilitation professionals in the private sector, where compensation is awarded on a FFS basis, also provide an incentive to leave public sector jobs.
Because of a shortage of outpatient rehabilitation clinics, many patients have to wait months for treatment. Consequently, the clinics often have two parallel queues: one for acute cases, consisting primarily of younger people after a road or work accident and traumatic orthopaedic needs, and the other for patients with chronic problems, consisting primarily of older adults who suffer from back pain or neurological diseases such as a stroke or Parkinson’s disease, or even those with deconditioning (physiological changes following a period of inactivity such as bedrest, with functional losses in such areas as musculoskeletal system or mental status and loss of ability to accomplish activities of daily living). However, because of the constant pressure on these clinics, treatment of patients in the latter group is often postponed for months or even longer. The main victims of this serious shortage of rehabilitation services in the community are older patients with chronic conditions. In the absence of appropriate provision, frequency and scope of rehabilitative care, they suffer from disabilities and limitations that could be treated to improve their functioning and, in some cases, even to postpone the need for nursing care.