Of all the figures which appear in today's Ministry of Health report, the number of MRIs best (and most painfully) exposes the dreary situation of the public health system. Behind the ludicrous number of these important scanners is the even more ridiculous method which shows who is really responsible for everyone's health: the Ministry of Finance. It turns out that to buy another MRI it is not enough that a hospital or health fund imaging center indicates a need for one, or even for the Ministry of Health to recognize the need. To buy a new MRI requires the issue of a special license stamped by the Ministry of Finance Budget Department. Yes, you heard correctly.
For years, the Ministry of Finance has objected to the issue of these licenses on the economic principle that increasing the supply will increase demand. "Even if we put an MRI in the middle of the desert, someone will find a way to use it," the ministry liked to day. After all, you too would rush to put yourself inside a dark and narrow chamber for 45 minutes if it were available and nearby, and not before being injected with iodine, wouldn't you?
In truth, just like the desert, the Ministry of Finance is drying up the system. Only after heavy pressure from former Deputy Minister of Health Yakov Litzman were new licenses added. Why do we write licenses instead of scanners? Because Israel is Israel, the joyous announcement received by several hospitals in the periphery about the new licenses did not include a check to buy them. The hospitals had to raise most of the money to buy the imaginary MRIs where else but through donations.
When it comes to healthcare, the country has to rely even more on charity.
The example of the MRIs is a drop in the ocean. It is the Ministry of Finance which determines the number of hospital beds, the number of positions, and of course the salaries of the people who fill them. Ironically, the standard-bearers of the free market when it comes to the seaports and civil aviation market do not understand that the severe shortage of nurses is because of the poor conditions caused by the workload, eroding salaries, and so on.
Just yesterday, the government published the recommendations of the Civil Service Reform Committee, which talked in high-fallutin' tones about the need for streamlining the civil service and compensating workers on the basis of performance rather than seniority. In practice, the government is a champion when it comes to reforms which save it money or are in line with its ideology to privatize government services, but it always vanishes and falls silent the issue is critical reforms which require additional resources.
The committee chaired by Minister of Health Yael German has begun its work to draw up recommendations to strengthen the public healthcare system. Except for two members, all the others are expected to support bringing private health care into government hospitals. German does not rule out this solution, but she takes an anti-nausea pill every time she admits it. Private healthcare is the easiest solution: it won't cost the government a shekel directly (private expenditure will rise because the use will grow along with insurance premiums), and hospitals will benefit from several billions of shekels.
In contrast, the hard solution would require confronting the Israel Medical Association, which has made sure about this wonderful formula whereby doctors at government hospitals can work one afternoon without restrictions at a private hospital. The hard solution would be to restrict the private practice while offering additional financial incentives to those who will work more in the healthcare system. The hard solution would be to insist that specialists carry out a reasonable number of evening shifts. The hard solution would be to demand the operation of hospitals 24/7, from imaging institutes through gastro, to the operating rooms.
Introducing private healthcare can partly do all of this, because a hospital will work overtime, especially for those who pay for it. Today, hospitals work post office hours, and this is a disservice to the Post Office.
The fact that German is a member of Minister of Finance Yair Lapid's political party is both good and bad news. It is good news because she has access to Lapid's ears and heart, but it is bad news because of Lapid's opposition to every plan which requires injecting capital into the system, which will stymie German and leave her paralyzed.
By every assessment, German understands that she cannot submit a plan which will cost the state hundreds of millions of shekels at best, which means that private healthcare is closer than ever to entering government hospitals. The Ministry of Finance will tell her that reforms are only carried out at the ports. They also cost less and and get more publicity.
Published by Globes [online], Israel business news - www.globes-online.com - on June30, 2013
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