Lupolianski vows not to give up family health centers

Demands Health Ministry pay the annual NIS 4m. the city spends on tipat halav services, which are run with 100 nurses and 11 doctors.

By JUDY SIEGEL
Jerusalem Mayor Uri Lupolianski voiced his opposition Monday to the Treasury's plan to transfer responsibility for the municipality's 30 family health (tipat halav) centers to the four public health funds as an "efficiency measure." Lupolianski said at a press conference at City Hall that his natural inclination had been to agree to the transfer of responsibility to the health funds, as it would relieve the fiscal burden of a service the municipality subsidizes even though the Health Ministry has responsibility for providing well-baby services in most of the country. Lupolianski also demanded that the Health Ministry pay the municipality the NIS 4 million a year that the city has to spend on tipat halav services, which are run with 100 nurses' and 11 doctors' slots. The ministry covers only NIS 23 million of the NIS 27 million in basic costs; the municipality also pays for maintenance of the centers, courses and other costs. Asked to comment on Lupolianski's demand, the Health Ministry had nothing to say, and noted regarding the Treasury's "pilot program" that the issue was in the hands of the court. The "program", which was to begin soon in Jerusalem, Tel Aviv, Elad and Modi'in, was frozen until next week by the Tel Aviv District Labor Court after the Union of Public Health Nurses threatened to shut down all activity starting last Sunday. The labor sanctions were postponed pending the next court hearing. For historical reasons - including the launching of the first tipat halav service in Jerusalem in 1921 by the Hadassah Women's Zionist Organization and later another in Tel Aviv - family health center services in these two cities are provided by their municipalities. The Tel Aviv Municipality has already agreed to forgo responsibility for its well-baby services. Fifty percent of Israel's tipat halav centers are owned by the ministry, 33% by Clalit Health Services, 9% by other health funds (especially Maccabi Health Services) and 5% by the Jerusalem and Tel Aviv Municipalities. But Lupolianski said that, since Jerusalem has a youthful population (54% are aged 0 to 23) and over 12,000 Jerusalemites are born here every year, the activities of the city's family health centers represent much more than their numbers. He changed his mind, he said, after receiving an 80-page report released by a professional committee he appointed to look into the Treasury plan. The committee was headed by Prof. Jonathan Mann, longtime head of the Hebrew University-Hadassah School of Dental Medicine and a public health expert, and included representatives of the ministry, academic researchers and two health funds (Meuhedet and Clalit Health Services). Mann and the other members interviewed Finance Ministry budget officials, Health Ministry public health officials and others before reaching their conclusions. Ten of the 12 members supported the final recommendation against the Treasury's transfer plan, while the two health fund representatives supported the idea. The committee said that transfer of responsibility to the health funds could have been beneficial because it would mean continuous care for members from birth through death and because the Health Ministry should own its centers as well as regulate them. The arguments against the transfer, however, were more powerful: the municipality's well-baby services have been praised here and abroad; its staff have special training in prevention and early diagnosis of disease in babies; sick children and healthy children would not be treated simultaneously in the same facility; health funds are economically minded organizations that could be tempted to make cuts at the expense of babies' health to save money; the health fundowned centers charge a higher fee than the Jerusalem Municipality does; and the city provides the same high-level service in all neighborhoods, while the health funds could easily give less-than-optimum service to certain sectors. Mann said that the Treasury's pilot program was a "waste of money" because, if it wanted to study whether the municipal or health fund model were more effective and efficient, it merely had to sponsor an academic study based on the health of babies in each. The National Council for the Child praised the Mann Committee for its conclusions and called on the government to reject the Treasury's plan. It said the Treasury's ongoing efforts to privatize health and social services were a disaster. Recent research has found that Israeli government expenditure on school health services was the lowest compared to 11 other Western countries, it said.