The state comptroller gave the Health Ministry failing marks for several important functions for which it is responsible, from not preventing the near-collapse of the Hadassah Medical Organization (HMO) or properly supervising its financial recovery to highly inadequate handling of rehabilitation of the mentally ill, of abortions and of medical labs.
The chapter in the comptroller’s report is among the most critical of the ministry in years.
The HMO, with its two university hospitals, has 1,149 beds and employs 5,000 doctors, nurses, paramedical staff and administrative and maintenance workers. It also runs professional schools.
Its accumulated deficit reached NIS 1.3 billion in 2014, after chronic sanctions by staffers, threats of a shutdown, Knesset committee deliberations, interventions by the owners (the Hadassah Women’s Zionist Organization of America) and a torrent of bad publicity.
The Health Ministry and the Treasury forced it to enter a recovery plan in exchange for NIS 1.4 billion from its coffers.
Between 2011 and October 2015, HMO had five directors- general, three of them only acting managers. The comptroller noted that HMO accountants noted that by the fall of last year, the recovery plan had still not been completed, raising doubts whether the institution could survive.
Health Minister Ya’acov Litzman pushed through the appointment of former Sheba Medical Center director-general Prof. Zeev Rotstein as permanent director-general in June 2015, but he took over the reins only a few months ago.
Among the factors causing the deficit were a chronic hands-off policy of the government.
Years of delays in moving the Ein Kerem medical center to its new hospital tower and finding economic uses for its old facilities, excessive pay for some doctors and other professionals, improper running of private medical services during morning and afternoon shifts, major health fund debts to HMO, excessive HMO discounts to health funds for its services, and excessive costs of the medical school and other professional schools led to the shortfall.
In addition, numerous workers of all kinds were given special bonuses for work that they did not perform, the comptroller wrote.
The ministry had set down regulations that senior Hadassah professors be limited in giving Sharap (private medical service) services and that the vast majority of procedures be carried out in the afternoon and early evening, but many of them performed simple operations paid for privately instead of leaving them for more junior, non-Sharap surgeons.
For some senior doctors, Sharap constituted 90 percent of their treatments, with the rest performed for public patients covered by National Health Insurance.
This occurred even though no doctor was to spend more than a quarter of his time on Sharap patients.
Up to 14% of HMO activities involved Sharap, but the hospitals did not take in enough to prevent it from losing money (while doctors earned significant amounts).
From January to June of last year, of 169 senior doctors allowed Sharap privileges, the private work of 28% of them constituted more than half of their HMO work.
Only a minority of Sharap procedures (mostly emergencies) should have been performed in the mornings, so as not to come at the expense of public patients, the comptroller wrote, but in reality, many were carried out then, “raising the concern” that treating private patients was unjustified.
This, he continued, occurred as a “gross violation” of the recovery agreement as the Health and Finance Ministries failed to intervene, just as they “ignored warning lights” about HMO’s insolvency for a long period.
The Health Ministry has a NIS 750 million annual budget to rehabilitate the emotionally disabled who suffer from 40% or higher disability and there are as many as 120,000 Israelis entitled to such help.
But the comptroller found that only 21,000 (or 17%) of them get such assistance through the ministry, even though the acceptable rate worldwide is 25%.
The report found that the ministry never bothered to find out why so many were left helpless or to proactively try to help them; instead, it just responded to queries.
The ministry lacked information on the individual patients’ problems, which included not only psychiatric disorders but also dementias, addictions, cognitive deficits and others.
Working with private suppliers of services, the ministry failed to ensure the privacy of data about some patients.
A total of 19,300 legal abortions (approved by public abortion committees) are carried out each year, with some 95% of women’s applications approved.
But even though there are 39 medical institutions with such committees, only 52% are public; the rest of the abortions are carried out in private hospitals and clinics.
In 2014, 602 Israel Defense Force soldiers in regular service underwent abortions at state expense.
For almost 17% it was not their first abortion. The ministry was criticized for not ensuring that the hospitals and clinics that performed the abortions provide information on safe sex that could have prevented repeat abortions, the comptroller wrote.
The ministry is responsible for supervising all medical labs in public institutions, including hospitals and health funds. High-quality and accurate results are vital for identifying disease and treating it, as well as preventing superfluous tests.
Accurate diagnosis of cancer, for example, can prevent unnecessary interventions and suffering.
But the ministry did not set time limits for tests to be performed, assess the efficacy of centralization of many health fund labs, set mandatory lab hours, ensure uniform quality, or check the reliability of foreign labs when tests could not be performed here.
Although half of all lab workers in public hospitals are over the age of 55, the ministry has not prepared a program for hiring and training young replacements in the future.