Why Israelis Carry Their Own Medical Files

This post was originally published on The Times of Israel and is reposted here with permission.

Last week, after a specialist visit at Ichilov Hospital, I found myself doing what millions of Israelis quietly do every year: photographing medical documents, uploading PDFs, chasing approvals, and carrying files between systems that do not speak to one another.To obtain a simple MRI and physical therapy referral, I had to navigate hospital portals, HMO applications, administrative offices, and outdated authorization forms known as “Tofes 17.” I paid a refundable deposit — a “pikadon” — while waiting for approvals that should have been automatic. Once again, I became my own medical courier.

This is not an exceptional story. It is routine. And it is a disgrace for a country that prides itself on being the “Start-Up Nation.”Israel is rightly admired for its technological innovation. We lead in cybersecurity, defense systems, artificial intelligence, and medical research. Yet in basic healthcare delivery, we remain trapped in fragmented systems that waste time, money, and human energy.Hospitals, health funds, imaging centers, and specialists operate in silos. Their databases communicate poorly, if at all. Patients are expected to do the integration. We carry documents, upload files, chase signatures, and follow up endlessly. We become unpaid case managers for our own care.

I write this not only as a psychoanalyst and counterterrorism expert who has spent decades studying institutions under stress, but also as a senior citizen and an olah who lives alone in Israel. I am fluent enough in Hebrew to lecture and teach, yet navigating the health system still requires constant translation — linguistic, bureaucratic, and emotional.For those without nearby family to advocate, organize documents, or chase approvals, the system is simply not user-friendly. It assumes an invisible support network that many older immigrants and single seniors do not have.

When I fell last year and shattered my wrist, I was told in the emergency room that I was “too old” for surgery. I was 76 at the time. It was said casually, without sensitivity, and without real medical justification by a resident and intern probably under the age of 30! My overall health was good. What was missing was not capacity, but curiosity and care.

Since then, assembling my medical care — specialists, imaging, authorizations, follow-ups, and rehabilitation — has felt like solving a bureaucratic puzzle with missing pieces. Each institution holds a fragment. No one holds the whole picture. The burden falls on the patient. I pay for top-tier medical services through my health fund because I believe in planning responsibly for aging and health. At the same time, I do not have private medical insurance — which is a separate issue altogether. Yet I encounter the same delays and obstacles as everyone else, regardless of coverage level.

At one point, I was offered an MRI appointment in Haifa at three o’clock in the morning. I live in Tel Aviv. I am a 77-year-old woman living alone. I do not have family members who can drive me across the country in the middle of the night.Who is expected to accept such an appointment? In what world is this reasonable access to care?

When I declined, I was told the alternative was to wait four to six months for an appointment closer to home. For a senior citizen managing pain and limited mobility, months of delay are not a minor inconvenience. They are a real cost to health, independence, and dignity.

All of this is taking place in the shadow of an ongoing war. I have deep concern and empathy for our soldiers and their families. Many are returning with physical injuries and invisible trauma, PTSD. Some are lone soldiers, without parents or relatives in Israel to advocate for them. If navigating this system is exhausting for an older civilian with education and persistence, what must it be like for a wounded reservist, a traumatized veteran, or a lone soldier trying to manage appointments, authorizations, and rehabilitation alone?

A society that sends its young people into danger owes them more than bureaucratic indifference when they return.

Too often, in clinics and administrative offices, I encounter staff members who lack basic interpersonal skills — patience, clarity, empathy, or simple courtesy. I know many are overworked. But when efficiency replaces humanity, the most vulnerable pay the price.

Adding insult to injury, patients are routinely asked to complete superficial “service surveys” after appointments — clicking through generic questions about satisfaction and courtesy. These surveys consume time and public money, yet rarely lead to meaningful improvement. They create the illusion of accountability while leaving underlying problems untouched. Staff professionalism, communication skills, and patient treatment should be monitored and addressed within the employer’s domain, through serious training, supervision, and evaluation — not outsourced to exhausted patients clicking boxes on a phone screen. Healthcare quality cannot be crowdsourced through meaningless questionnaires. It requires institutional responsibility.

Imaging remains one of the clearest examples of systemic failure. Hospitals and HMOs rely on incompatible platforms and proprietary viewers. Patients receive CDs, expired links, or files that cannot be opened elsewhere. In 2026, this is indefensible. Why do Israel’s health funds still lack comprehensive MRI infrastructure? Why are HMOs forced to purchase imaging services from hospital “fiefdoms” at high cost and long delay? Is this monopoly, regulation, or inertia? From a cost-benefit perspective alone, this makes little sense. Independent imaging capacity and true interoperability would reduce duplication, shorten waiting times, improve continuity, and save public money. Instead, patients pay in time, stress, and declining health. This is not a technological failure. It is a governance failure. Decades of fragmented regulation and competing interests have left no authority willing to impose national standards. Health funds protect market share. Hospitals protect revenue. Patients absorb the cost.

Three reforms would transform care almost immediately.

First, Tofes 17 should be abolished and replaced with automatic, real-time billing between institutions.

Second, Israel should mandate a national medical imaging exchange with standardized, accessible formats.

Third, health funds should establish professional care-navigation services for seniors, immigrants, and wounded veterans, so vulnerable patients are not forced to manage complex systems alone.

None of these reforms requires new technology. All require political will. Israel’s population is aging. More citizens live alone. More immigrants navigate systems in a second language. More soldiers return from war with complex needs.

The current model is unsustainable. Healthcare is not only about medical excellence. It is about dignity, continuity, and trust. A system that forces its most vulnerable members to fight for basic coordination is failing in its civic responsibility.

A Start-Up Nation deserves a healthcare system worthy of its name.