Geographic Inequity in Physical Medicine and Rehabilitation Services: An Administrative Case Report of Successful Advocacy for Change

Objective: Following an injury or disease, physical medicine and rehabilitation (PM&R) services are often necessary to help patients recover function, activity, and community participation. Ten years ago, there was a significant gap between PM&R services in central Israel and those in the rural north of the country in terms of quality, quantity, and layout. The purpose of this administrative case report is to outline the gap in PM&R services between regions in Israel, as portrayed above; to describe a decade of civil action; and to describe civil action administrative approaches and actions that contributed to changes in the PM&R services now available in northern Israel. Methods: A decade of civil action to promote PM&R services is reviewed, illustrating the main administrative steps, including initiating and organizing meetings with key partners, lobbying, testifying in front of parliament and government committees, garnering media attention to promote public awareness, and filing a case with the Supreme Court of Israel. The encountered challenges and the subsequent actions are also described. Results: Awareness of the significance of PM&R services and of the inadequacy of such services in the northern part of Israel rose due to our actions, with practical field results, including a 180-bed government rehabilitation center that plans to open during 2024, and 5 daycare rehabilitation clinics and a private inpatient center that opened between 2020 and 2023. Data-driven research will aid in understanding the current gaps and tracking improvements with the opening of the new rehabilitation facility. Conclusion: When inequality is brought to light and legislation for equality exists, civil action can promote change to reduce these gaps. Impact: Others can follow the steps taken in this administrative case report to achieve success in struggles aiming to correct comparative inequality.