A central point in the report is the number of imaging devices that exist in Israel. Since the audit in 2015, devices have been added, and today there are 60 MRI devices, ninety-three CT devices and 20 PETCT devices, but the amount of devices still does not match the population growth and the increase in demand for these tests. The State Comptroller emphasizes that even according to the current audit, the number of MRI and CT devices per million people in Israel is less than the number in the 13 OECD countries examined – 6.6 MRI devices per million people, and 9.8 CT devices per million people, this compared to 38 MRI devices per million people, and 43 CT devices per million people in the USA. According to the report, the number of PETCT devices per million people in Israel is greater than the number of devices in only 3 countries – Poland, the Czech Republic and Greece. However, the report states that a number The tests for the device in Israel is the largest among the 13 countries tested, so that in fact the utilization of the devices is greater in Israel than in the other countries. at night or to wait a long time for an appointment,” the report states.
The claims made by the auditor also refer to the geographical distribution of the devices. From the current report, similar to the previous report, it appears that there are gaps between the different regions. For example, the number of MRI machines per capita in the Central District is smaller than stipulated in the regulations by a gap of 18%. The number of CT devices is still less than the regulations in the central district and the northern district. The southern district, which at the time of the previous audit did not meet the regulations, has had about 6 CT devices added since then and therefore meets the standard in the current audit. Also regarding the PETCT devices – there is still no complete equality between the districts in the allocation of the devices – in the North District, where there was no device at the time of the previous audit, three devices were installed, but this district still did not comply with the regulations at the time of the follow-up audit.
Long waiting times, sometimes over six months
One of the reasons for the small number of devices is the existing policy of limiting the number of devices in Israel, which is intended, among other things, to reduce the demand for expensive tests by limiting the supply of medical devices. The Public Health (Special Medical Devices) Regulations, 1994-55, state that it is possible to purchase or use a “special device” only if a license is granted for this purpose “in writing by the director”. This means that the process of obtaining a license to operate imaging devices continues for many years , and includes a bureaucratic procedure until the licenses for the medical tender are approved. This point was already raised in the previous audit report in 2015, but was not addressed by the Ministry of Health over the years.
Indeed, the auditor’s current examination shows that the waiting times for an MRI examination have lengthened in some medical centers in recent years since the previous examination report, and that there is a difference between the waiting time for examinations performed in the morning, which is longer, and the waiting time for examinations performed in the afternoon or evening, which is smaller. For example, at Billinson Hospital, the waiting time has been extended since the previous report, from three months for an examination in the morning hours, to 4-5 months. However, in Ichilov the waiting time for an MRI has improved, it is currently estimated at a month and a half in the morning hours. The situation regarding the waiting times for children’s examinations under anesthesia is even worse – in all hospitals, with the exception of Schneider and the central one in Emek, it was found that the waiting time for an MRI examination under anesthesia for children in the morning hours has increased compared to the previous report – in Ichilov, for example, the waiting time for an MRI examination has increased In anesthesia for children from 3 months in the previous report to 7 months in the follow-up audit and in Rambam from a month and a half to 6 months.
Moreover, according to the auditor, there are gaps between the checkouts in the waiting times. At Maccabi Hospital, the waiting times for MRI examinations in all areas are the longest, and generally the shortest. In the field of neurology, the difference in waiting time between the general and Maccabi is about 155% (59 days), and in the breast field the difference is noticeable at 54 days. Maccabi stated in its reply to the auditor regarding these findings that a cash register that approves more tests and thereby better locates the clinical needs of the patients, “suffers” from less favorable waiting times.
According to the State Health Insurance Law, 1994-5544, the health services in the health basket must be provided within a “reasonable time”, but the law never defined what a reasonable time is, so that in fact there is no real measure according to which the Ministry of Health evaluates the quality of the service. The auditor also notes Because the ministry has not defined standards for maximum waiting times and because there is no national information center for queues for imaging tests, through which citizens can know where the shortest waiting time for the test is.
“The Ministry of Health has not formulated a procedure that determines which factors are authorized to decipher advanced and simple imaging tests – and in which cases”
It also appears from the findings of the State Comptroller’s report that the waiting times for decoding the imaging tests are also prolonged. Since the previous report was published, 9 hospital imaging centers extended the decoding time from 10 days at the time of the previous audit to 14 to 30 working days in the current audit. By the way, the imaging centers in the hospitals set for themselves the maximum time for delivering a decoding answer, this is due to the fact that the Ministry of Health does not have a standard on the subject.
Another serious finding is the fact that due to the severe shortage of radiologists who decipher the MRI and CT tests, some of the tests are not deciphered by radiologists, but by attending physicians who are not experts in deciphering these imaging tests. In 3 of the examined hospitals, all chest x-rays, except for children’s x-rays, are not interpreted by a radiologist. In fact, only in 5 hospitals out of the 17 examined are all chest radiographs of adults interpreted by a radiologist. In the follow-up audit, it is noted that the Ministry of Health has not formulated a procedure that determines which factors are authorized to decipher advanced and simple imaging tests and in which cases. The report also emphasizes the importance of quality control in the interpretation of the advanced imaging tests, “since errors in interpretation or inaccuracies may lead to errors in the detection of serious diseases, delays in providing treatment, the spread of the disease and reduced chances of recovery.” According to the auditor, among the factors that affect the accuracy of the decoding are human aspects such as: the skill level of the decoder and his experience, the degree of his fatigue or alertness, and according to him “the Ministry of Health has not regulated a structured and systematic mechanism for quality control over the decoding of imaging tests through repeated decodings”.
The chairman of the radiologists: “We cannot cope with the load”
Prof. Ilan Shelf, Chairman of the Association of Radiologists said in response to the serious findings that in recent years the association has been intensively dealing with the shortage of radiologists. We are not facing an increase in load that is out of proportion to any other field of medicine. We warned in many reports and letters to the CEOs of the Ministry of Health, we came to Knesset committees and talked with MKs and ministers, we ran campaigns and appeared in the media in an attempt to raise public awareness. In the last year, while we are shouting that we need urgent intervention, we find that attempts are being made for ‘solutions’ that will only make the situation worse, such as sending the tests to be deciphered abroad.” Prof. Shelf calls on the Ministry of Health to act immediately to correct the situation. “If the issue is not dealt with, we will find ourselves in 5 years reading another report by the State Comptroller that shows how the field that we managed to maintain good quality against all the odds until now, deteriorated uncontrollably. The heavy price, as mentioned, will be paid by the citizens.”
Only some devices are protected
The auditor’s report also refers to the difficult period of war in which the State of Israel has been in the past eight months: “The first day of the outbreak of the war was characterized by a massive firing of rockets at the territory of the State of Israel, and especially the southern region, with the murder of more than 1,400 people and the kidnapping of more than 250 people. Many wounded On this day, we were referred to the hospitals in the south – Soroka in Beer Sheva and Barzilai in Ashkelon.” According to the auditor, many injured people required imaging tests such as CT, and some also for MRI, including for urgent surgery. “However, it turned out that at the Soroka hospital only some of the machines were in protected buildings: one CT machine out of three and one MRI machine out of two. Only during the fighting days was the second MRI machine also protected. However, it turned out that in the Barzilai hospital all the machines were in a protected building, So that it was possible to check and diagnose patients safely even in an emergency.”
The Ministry of Health must correct the deficiencies
Despite this, the auditor also points to a number of deficiencies that have been corrected over the past 9 years, including the regulation of the radiology and imaging profession by the Ministry of Health, and the appointment of a chief medical ‘imaging’ in the ministry.
It is further stated that the crucial importance of the imaging tests requires the Ministry of Health to correct the deficiencies noted in the report: formulate a work plan accompanied by schedules for responding to the deficiencies, which will refer to the geographical distribution of the imaging devices, establish maximum waiting time standards for performing the tests and interpreting them, and regulate the manpower issues regarding the imaging devices , according to the technological development and the demand for these tests. The auditor also notes that it is recommended that the Ministries of Health and Finance examine ways to simplify and shorten the procedure for granting licenses for imaging devices.
The Ministry of Health responded: “The Ministry of Health is constantly working to improve the availability of medical services and reduce inequality in the system. Israel currently has 61 MRI machines Activists for whom a license was issued by the Ministry of Health. The decision on the distribution of the devices is made after a national needs assessment and in accordance with public health regulations. The Ministry of Health has been working for several years to add devices by amending the regulations, a step that requires the approval of the Minister of Finance.
“It should be noted that as a result of the latest amendment to the regulations, 9 MRI devices were added which are intended to strengthen the periphery (3 devices were allocated to the northern district, two to the southern district, two to the central district and two to the peripheral central district). In addition, the office supports hospitals where services have been opened MRI, authorizes them to have professional units for the subject and conducts professional training for relevant professionals, as a result, in recent years, hundreds of staff members from the entire health system have been trained. The ministry is working to increase the number of MRI machines in Israel in the coming years. Regarding shielding in the hospitals – the Ministry of Health has made a leap forward in shielding the hospitals and has invested hundreds of millions of NIS in this in recent years. During this period, the ministry is investing significant additional sums in the shielding and emergency preparedness of the hospitals, which will enable the functional continuity of the hospitals and will continue to invest in this in the years to come. It should be noted that since October 7, approximately 400 million shekels have been allocated for protection in hospitals. However, the budget given to the health system unfortunately does not allow for full protection of the hospitals, including in the conflict areas, when decisions about protection are made according to the proximity to the border areas.
Regarding the waiting times for tests MRIthe Rambam Hospital reported: “The length of the queues in question refers to the MRI Under anesthesia – the need for anesthesia for the test lengthens the queues. tests MRI Under anesthesia for children with oncology and in other urgent cases, Rambam is performed within a few days outside the appointments of the less urgent cases. Rambam recently started a study to carry out MRI for children without anesthesia, with the use of a screen that will focus the attention of the examined child to the position where he will lie during the examination without moving, and anesthesia will not be needed. We hope that the innovation will shorten the queues for small children, for whom the involvement of anesthesiologists is currently required for examination.”
The Ichilov Hospital reported: “The Tel Aviv Medical Center (Ichilov) performs the number of MRI tests The largest of all the hospitals in Israel, and the availability of most imaging tests in Ichilov is one of the best in Israel. As for the tests MRI For children under anesthesia, this is a national issue. Unlike other tests, this is a more complex test that takes longer than a normal test, and the demand for the test in Israel and the Tel Aviv district is constantly growing. The Tel Aviv Medical Center (Ichilov) will continue to work to shorten the waiting times for all examinations, along with continuing to provide first-rate professional medical care for patients.”
Billinson’s response: The MRI machine operates in Bilinson at all hours of the day and at maximum utilization. Alongside this, the demand for testing is increasing. At the end of the year, another device that the hospital purchased will begin to operate, which is expected to reduce loads.