"Strengthen hospitals, not patient choice"

Prof. Alik Aviram: If you fly first class, you don't get to choose the pilot.

Instead of confronting insurance companies and changing the way of the world in health insurance, including abolishing underwriting of basic medical policies, as recommended by the Yael German Committee, it would be better to abolish the healthcare funds' supplementary insurance in favor of improving publicly-funded healthcare services Israel National Institute for Health Policy Research scientific director Prof. Alexander (Alik) Aviram told "Globes" in an interview. He previously served as medical director at Maccabi Healthcare Services and CEO of Assuta Medical Center Ltd.

"If we're trying to put things in order and setting new rules for health insurance, why is supplementary insurance needed?" Aviram asks. He says that the launch of supplementary insurance in the late 1990s created the spiraling in health insurance, and the German Committee was an opportunity to make real change in the matter. "It's almost superfluous, in my opinion, to buy insurance beyond the state insurance, but it's the right of every individual to buy this insurance and the right of these policies to exist," he says.

In general, Aviram criticizes what has become a near consensus, even among the biggest opponents of allowing private health services at public hospitals, over the public's need to choose a surgeon. The German Committee members generally agree that this is necessary, and the disagreement is only over financing: allow the choice of a doctor at a public hospital through health insurance, or through government funding via the hospitals.

"When you fly first class, spending a lot of your own money, you'll get great food and cloth napkins, but you never choose the pilot," says Aviram. "It's the same at private schools. You can choose the school, but not the teacher of your children."

Aviram says that the emphasis in the health system should have been on strengthening the hospitals, so that the public would know that in choosing a good hospital, they get good doctors. As for cancelling supplementary insurance and blocking the right to choose a doctor, he proposes allowing, through government financing, the obtaining of a second opinion - an item that currently amounts to 13% of the medical expenses of supplementary insurance (the choice of surgeon amounts to more than 40%).

Aviram also criticizes the German Committee's proposal under which public hospitals will allow "choice of team" instead of choice of doctor. In other words, the patient will be promised (by activating additional insurance or through government funding) that the person who will carry out the surgery will be one of the experts on a list. "I already hardly dare speak about the ethical aspect, God help us, but what will the resident doctor do? Or the junior doctor? It's bizarre and difficult for me to believe that a doctor or person with administrative experience is behind such an idea," he says.

Aviram says that supporters of private healthcare practice believe in a myth that doctors at public hospitals are "fleeing" to private practice. He says that most doctors cannot allow themselves to leave public medicine because it creates the reputation that is the basis for their "outside" income. He says that it is the responsibility of hospital administrators to ensure that their doctors are at the hospital when they are most needed, regardless of the number of hours or the extent of the position. "If a senior doctor trying to establish his private practice leaves his job at a public hospital, his income will fall by four levels of seniority. He won't starve of course, but people won't be waiting in line for him either," he claims.

Published by Globes [online], Israel business news - www.globes-online.com - on April 24, 2014

© Copyright of Globes Publisher Itonut (1983) Ltd. 2014

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