Were Israel’s health funds the secret weapon in COVID fight?

‘A lockdown is like taking an aspirin or an Acamol,” said Ran Saar, who served as the CEO of the country’s second-largest health fund, Maccabi Healthcare Services, until two weeks ago. “It doesn’t treat the situation. Whenever there is a closure, the numbers rise right after.”

Saar has held various roles with Maccabi for the past 20 years, including serving as CEO for 10. This month, he transitioned to becoming the HMO’s part-time chairman of the board.

He has been at the forefront of the fight against the coronavirus, sometimes advising the government, and other times quietly redirecting it when he felt one issue or another could be handled more effectively.

Today, he has the ear of Prime Minister Naftali Bennett, whose approach aligns with his own COVID philosophy, a philosophy that dictates it is time to start learning to live alongside the virus and to stop locking down and trying to hide from it.

“I don’t think we will reach the results of the first closures” if Israel locks down now, Saar told The Jerusalem Post in an interview from his Tel Aviv office. “It won’t stop the pandemic.”

He said the country is tired, and the people will not obey the rules of lockdown. Moreover, Saar said, when the country shuts down, people shut down, too. Israel is already starting to see the economic, social, mental and other health effects of the last year and a half – people who did not come in for their routine appointments presenting at sicker and more advanced disease stages, increasing numbers of people who are depressed or in need of mental health care.

“If we close Israel from the inside, start closing schools or whatever, there is no doubt the economic situation will worsen,” Saar said. “It won’t be easy for a small country like ours to come back.”

Some of Saar’s colleagues from the medical establishment, when they disagreed with the Health Ministry’s or government’s decisions, were outspoken rebels – sometimes to the extent that they harmed public trust in the health system during a pandemic, when it is vital to present a unified front. Saar, by contrast, worked quietly from within.

During the first wave, when the ministry, under the leadership of then director-general Moshe Bar Siman Tov and former head of public health services Siegal Sadetzki, made a decision that Magen David Adom would conduct all coronavirus tests and that they would be processed in only one lab – the Central Virology Lab at Sheba Medical Center – Saar raised a red flag.

“The number of tests was too low, and there were a lot of mistakes,” he recalled. “Things were not going smoothly.”

For example, the results of the tests were often not making it into a patient’s personal electronic health record.

“I started pressuring the Health Ministry to allow us [the health funds] to do the coronavirus testing,” he said. When they wouldn’t agree, Maccabi started doing it anyway – without the approval of the government.

“We had a crisis in Bnei Brak, and we went in and built the first coronavirus testing center there” – the first move that paved the way to reducing infection in the city. “I literally just pushed the government and the other health funds to join, and eventually we managed, as a nation, to do as many as 120,000 checks a day. Everything started running smoothly.

“This is our bread and butter,” he continued. “Why give it to someone else, who does not know what he is doing?”

TODAY, HIS battle is over vaccinating children in schools – and he is not afraid to openly criticize controversial decisions of Education Minister Yifat Shasha-Biton.

“The first question you have to ask the education minister is what do you prefer: a lockdown in which the schools will be closed and children will go back to learning on Zoom, or vaccinating in school, which means ‘putting pressure on kids’?

“If you take the two and try to measure both possibilities, there is no doubt vaccination in schools is better.”

According to Saar, the health funds have reached a certain plateau in which they are not managing to bring out more young adults and youth, especially those 12-15, to get the shot. He believes that offering vaccination in schools will make it easier, because it is often not parental opposition but it is just too difficult to get children to the health funds for the jab.

“Parents do not have time; maybe they don’t have a car,” he said, adding that he understands that there could be  political considerations, “but someone has to speak to her [Shasha-Biton] and decide for her – make sure it happens.”

It seems that the ministers he is advising are starting to come around.

At Wednesday’s cabinet meeting, several members of the government seemed to be on board with the idea.

“I do not understand what pressure it creates if we introduce vaccines in schools,” Health Minister Nitzan Horowitz said.

“Why not during school hours?” asked Transportation Minister Merav Michaeli. “I cannot understand. It’s like regular vaccines.”

Science and Technology Minister Orit Farkash-Hacohen even suggested that the vaccinations could be administered at the end of the day, when parents come to pick up their children.

Saar also has another idea: letting Israel pave the way for inoculating even younger children, such as those between 10 and 12.

“The world has no more information than we have,” Saar stressed, “and the whole world is not in a very good situation. We gave the vaccinations first. We did a lot of things first that were proved correct.”

He said in some cases Israel, thanks to the data so carefully managed by the country’s health funds, has a lot of information that others don’t have, and Israel should make decisions that are “good for us. We have enough capable people to make decisions for ourselves.”

He added that if he were in charge, he already would have approved third shots for everyone who received their vaccinations six months or more ago, because there is already enough “proof that your immunity goes down as times passes, regardless of whether you are young or old.”

At this stage, several other health officials are likewise pushing for the move.

Health Ministry Director-General Nachman Ash said this week that a decision could be made to give boosters to people over the age of 40 as early as this week or next. And Prof. Eran Segal, a computational biologist at the Weizmann Institute of Science, told the Post that he presented a scenario to the coronavirus cabinet on Wednesday where people over the age of 40 would get a booster and it would “help very, very much.”

SAAR WAS born in South Africa. His family made aliyah when he was young, and he grew up in Israel on Moshav Beit Yannai in central Israel. He served in the IDF and then joined the Mossad, where he worked for 24 years.

He was recruited to Maccabi by a friend and at first turned down the job. It was only at his wife’s prompting that he checked it out and agreed to become the director of the Sharon region.

“I did not know what to expect when I arrived at Maccabi,” Saar recalled. “But right away, I was very surprised and saw especially the devotion of the personnel, from the doctors to the clerks. I fell in love with the passion and the people.”

Saar has now been with Maccabi for 20 years. He also served as regional director for the central region before becoming CEO 10 years ago. His new role as chairman is only part-time. He said he hopes to use the free hours to visit grandkids in London and Israel and a son living in New York.

His plan was to step down from Maccabi six months after coronavirus started, he admitted. But because of the situation, Saar “felt it was wrong” to leave.

“Although we are deep in coronavirus now, we learned about the disease,” he said. “We are pretty organized, as an HMO, to deal with it now.”

Saar was replaced by Sigal Dadon Levi, whom he helped groom at Maccabi. He said that he always believed in women being placed in top roles, since they constitute the majority of staff in the healthcare system. At one point under Saar, Maccabi had four women regional heads and only one man.

During his tenure, Saar focused on strategic planning for Maccabi – setting long-term goals, with a focus on medical quality, service and economics. Each year, the health fund ranks top in these areas, according to the ministry.

He also put an emphasis on innovation, launching an innovation center for early adoption of health technology that could benefit the fund’s patients.

For example, Maccabi has a digital pathologist system that it uses to offer a second opinion in its lab. The system looks at the decision made by the pathologist and the pathology itself and, using artificial intelligence every now and then, “raises a virtual hand and says to the pathologist, ‘You made a mistake,’” Saar described. “In the future, it will give the first opinion, no doubt.”

SAAR WAS at the forefront of Bennett’s decision this week to invest in home hospitals that will be largely run by the health funds.

Maccabi was the first health fund to inform the public on Tuesday that it had begun preparing for the hospitalization of hundreds of moderate and severe patients in their homes, first in coordination with Tel Aviv Sourasky Medical Center, Rambam Health Care Campus and Sheba.

The home hospitalization program will focus on patients who have the means to be treated at home, such as people who live with another family member or caregiver who can assist them, and those who have the ability to operate basic medical equipment like a thermometer or portable oxygen tank.

Saar said the prime minister understood the strength of the health funds and gathered all the CEOs together to come up with the plan. Bennett also met with the hospital heads before announcing an infusion of some NIS 2.5 billion into the health system with an aim of increasing its ability from managing 1,200 serious patients to 2,400.

He said that the future is not without challenges, however.

Saar said the health funds will be faced with a challenge of providing the regular medical assistance its clients need while caring for COVID patients. He said the decline in medical services during the last year had a negative effect on discovering cancer and other diseases.

The other goal this year should be addressing the mental health problems of all kinds that developed from lockdowns and social distancing.

“The crisis brought to the table all kinds of problems that we have to start taking care of,” Saar said.

“At the end of the day, I am optimistic,” he continued. “We will survive this pandemic as a world, as a nation and as a people, and Maccabi will always be here to assist.”