IMA blames Treasury ‘spin’ for strike focus on 'Sharap'

Doctors say the conflict involves much bigger issues than instituting private medical services (Sharap) in public-sector hospitals and forcing physicians to punch time clocks.

By JUDY SIEGEL-ITZKOVICH
Hadassah hospital 311 (photo credit: Marc Israel Sellem)
Hadassah hospital 311
(photo credit: Marc Israel Sellem)
The Israel Medical Association’s two-day warning strike ended on Wednesday evening with maneuvering by the Finance Ministry, Deputy Health Minister Ya’acov Litzman and even the Prime Minister’s Office, but the 20,000 doctors said the conflict involves much bigger issues than instituting private medical services (Sharap) in public-sector hospitals and forcing physicians to punch time clocks.
“We certainly didn’t ask for Sharap; we didn’t put it on our list,” IMA spokeswoman Ronit Schwartz Ben-David said. “This is disinformation. However, being required to punch clocks – as demanded by the Treasury – to prove you are in the hospital during your work hours is a side issue but an important one. Doctors have to perform supervision and consultation from home after hours, go elsewhere for meetings and other work when they are not in the building. A physician is not like other professionals who must be on the premises at all time when working and don’t mind punching clocks,” she said.
While members of the IMA executive committee were in yet more meetings with Treasury wage and budget officials on Thursday, and would not disclose plans for more sanctions or a future general strike, Schwartz Ben-David attacked the amount of “spin” in the media – and behind it political and other influences claiming that the IMA is willing to reach a compromise and lower wage demands if Sharap is allowed in the public hospitals. This system has been functioning for some 50 years in the three largest medical centers in Jerusalem – Hadassah (at two centers), Shaare Zedek and Bikur Cholim – because they are owned and run by voluntary organizations and been well accepted by the capital’s population. But the Treasury and others have long opposed Sharap in government hospitals and those owned by Clalit Health Services. A doctor has to spend many years in a specialty before being allowed by the Jerusalem hospital Sharap arrangement, after regular work hours and with strict supervision, to become a wellpaid consultant.
Officially, Sharap means being able to choose which physician will consult on your medical problem, give you treatment or perform your operation instead of you taking the person on the duty roster.
But abuses would mean that paying patients would get ahead in the queue and also receive much better, thoughtful and personalized care than those who don’t pay.
The IMA has opposed Sharap for years out of concern that it would create more inequity in healthcare, and even further weaken it in the periphery – and would pit the IMA’s younger doctors against its senior ones who would benefit from it. The majority of young, overworked and underpaid interns, residents and some older doctors don’t have the seniority and “names” that attract paying customers.
Sharap is paid partially out of pocket and partly through the four public health funds’ supplementary health insurance policies – which 80 percent of the population pay for to some degree.
The push for Sharap has not come behind the scenes from the Treasury, even though its officials – and former finance minister and now Prime Minister Binyamin Binyamin Netanyahu – favor privatization in many parts of the public sector. The Finance Minister fears that if Sharap is introduced, public demand for more health services will rise along with more public expenditure on health, which it has tried to squeeze since 1995, when the National Health Insurance Law went into effort. And there is the perceived risk that if senior doctors get the right to provide Sharap, nurses and other medical staffers will demand it as well.
Litzman, who in the last few weeks has been pushing for Sharap as a “solution” for the health system’s ills to keep doctors in the public hospitals until evenings and nights and allow them to earn more, has been pro-Sharap since he took his job. He visited emergency rooms in the middle of the night and saw only junior physicians on duty – making him furious and demanding that senior doctors work shifts as well. He cooled down his enthusiasm somewhat on Wednesday after some of the Hebrew media made it appear that privatization in public hospitals would bring an end to the conflict and has not received wide backing.
In a statement on Wednesday, the Health Ministry said that following reports in the media about Sharap and Litzman’s advocacy of this possibility, he recalled that “the Supreme Court declared [during an IMA suit about Sharap] that for it to be introduced in the government hospitals, the cabinet has to arrange regulations.
The choosing of a doctor who would be paid by patients for his services in the state hospitals can be done with proper regulations through health service companies” operating in the hospitals rather than the public institutions themselves.”
Litzman added that Attorney- General Yehuda Weinstein had given his opinion to the cabinet, which then instructed the health and finance ministers to prepare such regulations – but then a decision was taken in which the Treasury canceled Sharap arrangement plans.
Another Treasury-IMA session is expected on Thursday, which will be followed by the convening of IMA management.