The longstanding problem of the Health Ministry’s multiple and often conflicting roles in state general hospitals will come to an end if newly approved recommendations from a ministry subcommittee are implemented.
At present, the ministry regulates, supervises and owns the country’s 11 state general hospitals. However, Health Minister Yael German announced on Tuesday that a separate state authority would be established to run the hospitals.
The head of that authority will be a manager and administrator who is not necessarily a physician (just as many health fund directors are business experts, not doctors) and who will answer to the health minister.
German revealed the subcommittee recommendations, which her ministry has approved, at a Tel Aviv press conference. The announcement offered the first glimmer of proposals that the German Committee for the Strengthening of the Public Health System is preparing. German established the committee in June and has served as its chairman since then.
The idea of setting up a separate statutory state authority to run the government hospitals and thereby eliminate the ministry’s conflicts has come up many times. Half a dozen public committees have suggested it over the past few decades, but it has never come to fruition due to opposition in the Treasury and elsewhere.
Some of the proposals have included turning the government medical centers into independent hospital corporations, but as that would mean state employees would lose some of their job security and beneficial conditions, the workers have strongly objected to the idea.
German could not explain her success in persuading all the decision-makers this time – from Prime Minister Binyamin Netanyahu and Finance Minister Yair Lapid to the Civil Service Commission, the four public health funds, the Israel Medical Association and senior administrators. But she said that before some politicians decide to oppose the change, ground rules will be established, public tenders issued and legislation passed.
The cabinet must formally approve the establishment of the authority.
The psychiatric and geriatric hospitals that the Health Ministry owns will not be under the new authority’s control at present, and other frameworks may be necessary for those hospitals.
Though the new authority’s location has yet to be determined, it will be somewhere other than the new ministry headquarters in Jerusalem’s Romema neighborhood, behind the central bus station.
Some of the employees who have dealt with supervision of state hospitals could be transferred to the new authority, but as the ministry has had little time or energy for running these medical centers, which have therefore mostly been run by their sometimes highly independent directors-general, major personnel changes are not expected in the ministry.
Government hospital doctors, nurses, and administrative, maintenance and paramedical personnel will become employees of the new state authority rather than directly of the ministry.
The Health Ministry has been trying unsuccessfully to limit the service of state-hospital directors-general, but the Civil Service Commission is now working on proposed regulations for this issue.
Ministry Director-General Prof. Ronni Gamzu – a former director of Ichilov Hospital (part of the state/municipal Tel Aviv Sourasky Medical Center) – said he would likely now have more time for tasks other than running the hospitals, such as health promotion, disease prevention, making surprise visits and ensuring that state hospitals follow ministry directives.
Heading the subcommittee on the ministry’s “multiple hats” was Ronit Ken, formerly a Treasury official in charge of monopolies.
“The mandate I gave the subcommittee was to suggest how to deal with the ministry’s three hats, because [having] too many tasks significantly weakens the ministry’s status and harms the public health system,” German said.
“The hospitals are not capable today of running the activity for which they are responsible in a optimal way – among other reasons, due to the lack of flexibility,” she added.
The other two topics that the German Committee is examining are medical tourism, which has been controversial of late, and public health insurance. The minister is expected to present recommendations from the medical tourism subcommittee in a few weeks, and not to present the two remaining topics together.
The new authority will also supervise all the research funds, friends associations and additional bodies that have been part of the state hospitals.
Advisory committees for running the hospitals will be set up to help each hospital’s administration, and there will be internal comptrollers appointed as well. The hospitals’ directors-general will get more flexibility, as well as more responsibility in running their medical centers, Ken said.
Meanwhile, the second-largest health fund, Maccabi Health Services, has reached an agreement with the state hospitals that will give Maccabi members the right to get treatment at any government- owned medical center.
The three-year agreement – which involves Maccabi paying the Health Ministry more than NIS 6 billion – includes the 11 state general hospitals and the geriatric hospitals that the state owns. This is in addition to hospitals owned by the health funds and voluntary organizations.
The Maccabi announcement on Tuesday came out before German announced the establishment of the state hospital authority.
Maccabi director-general Ran Sa’ar said that the “distribution of our services around the country is good, so Maccabi members apply less to state hospitals than members of other health funds do. At the same time, when a Maccabi member indeed needs services available only in a state hospital, he can now get them at state medical centers in accordance with arrangements of [the health fund’s] choice.
This is an important step for the patients, Maccabi and the hospitals.”
When the Maccabi member is hospitalized in a state medical center, the health fund transfers payment to the hospital according to the period of hospitalization and the type of department or medical procedure involved, explained Sa’ar.
This is the biggest expense for the health funds, totaling about 42 percent of all their expenditures, he said.