A Health System With Heart

Jerusalem — When Shoshana Balofsky gave birth to a daughter in October 2013, she already knew her baby had a life-threatening heart defect.

Her daughter Tehilla was born with Hypoplastic left heart syndrome (HLHS), a rare congenital defect in which the left side of the heart is severely underdeveloped.

“The left side of Tehilla’s heart is so underdeveloped it’s useless, so the right side of her heart has to pump for both sides,” Balofsky told The Jewish Week from her home in Jerusalem.

To date Tehilla has undergone four heart surgeries, the first when she was 2 days old, as well as four risky heart catheterizations. She has spent weeks at a time in the pediatric intensive care unit. Although she isn’t cured, “she’s very stable,” her mother said.

In the U.S. each surgery, testing and follow-up care would have been billed “at close to $1 million,” said Balofsky, who made aliyah from the U.S. “These kids are jokingly referred to as million-dollar babies.”

Balofsky wondered out loud how U.S.-based families with even excellent health insurance pay for treatment, given the high deductibles and spending caps, and expressed gratitude for Israel’s universal healthcare.

“Because of Israel’s healthcare system we’ve paid virtually nothing for Tehilla’s care,” she said.

At a time when many Americans are worried about the future of the Affordable Care Act, better known as Obamacare, spending caps and the possibility of losing coverage for pre-existing conditions, the Israeli healthcare system can serve as a model, health industry experts say.

“As someone in public health I find the universal aspect of care in Israel has made a tremendous difference in my ability to provide adequate care to the people I treat,” said Donna Zwas, a Harvard-trained cardiologist and director of the Heart Wellness Institute at Hadassah Medical Center in Jerusalem.

Zwas said the likelihood of her Israeli patients failing to continue taking a certain medication is much lower than it would be if they were insured by American health insurance, because medication in Israel is so much more affordable and co-pays tend to be very low. In Israel, the cost of hiring a surgeon privately rarely exceeds $7,000 or $8,000, and much of that may be reimbursed by a health fund (HMO), depending on whether the patient has a basic or upgraded plan.

Gabe Pransky, who created the Shira Pransky Project, which helps English-speakers navigate Israel’s healthcare system, said Israel’s universal healthcare provides “a tremendous amount” of resources to citizens and others who pay into the system.

Pransky, who founded the project in honor of his late wife, said the “basic basket” of health services offered to all Israelis and permanent residents regardless of their health and employment status “is pretty comprehensive.”

Services covered by the basic health basket include diagnosis, treatment, medications, hospitalizations, rehabilitation, medical accessories and hardware.

Pransky noted that as of Jan. 1, an additional 100 drugs were added to the basic health basket and that the law “requires the kupot [health funds] to provide services within a reasonable amount of time and distance.”

Patients may have small co-pays for drugs, including expensive heart medications and procedures, but they are a fraction of what Americans typically pay. The health system’s funding is derived from taxes all Israelis are required to pay to the National Insurance Institute, a kind of Israeli Social Security. The poor typically pay a minimal fee, which is roughly $40 per month.

Israelis can also pay for supplemental coverage, which provides them with greater out-of-network choices and other benefits.

Regardless of one’s coverage, “it’s a great comfort to know healthcare is accessible,” Pransky said.

Just because the resources are there doesn’t mean patients know how to find them, however. The Shira Pransky Project recently helped an older man who had just had open heart surgery find a cardiologist for his follow-up care, as well as heart rehabilitation options.

“Choice is built into the system,” but that can make it even more difficult to navigate, Pransky said.

Few Israelis are as grateful for Israel’s national health system as Michael Liben, whose daughter Liel was born with multiple health problems, including Double Outlet Right Ventricle, a severe congenital heart defect.

“Liel had three open-heart surgeries and four heart catheterizations,” Liben recalled. “Luckily she was born with a hole in the wall between the two heart chambers, so at least the oxygenated blood found its way to the aorta, on the wrong side, and it mixed with the oxygenated blood. Her repair was to put a bridge across that hole.”

While doctors ordinary want heart holes to close, when Liel’s began to close it created an additional health crisis. Surgery widened the hole and she was given a pacemaker.

Although the surgeries gave Liel a good quality of life, she died at 15 from epilepsy.

Three years after Liel’s death, Liben continues to be grateful for the affordable, high quality of care she received. He paid privately for only one of Liel’s surgeries, and his health fund reimbursed him for a large part of the cost. Then a representative from Hebrew University, where his wife worked, called the family to offer a one-time health grant (about $2,600) for employees facing daunting expenses.

“If we lived in the U.S., I’m absolutely certain we would have gone bankrupt” from Liel’s medical expenses, said Liben, who made aliyah from the U.S. three decades ago. “People ask me why I live in Israel. I joke that I stayed for the health insurance.”

Liben said he worries about U.S.-based “heart families” for whom “the Affordable Care Act was a godsend, even with all its problems. I’ve never been so grateful to live in a country with universal healthcare,” he said.