With a NIS 30 billion budget – the third-largest in the government, the Health Ministry is heaped with criticism in the more than 210 pages of the state comptroller’s investigation of its functioning.
Patients’ rights and their dignity have been trampled constantly by the healthcare system run and supervised by the ministry, according to the report, which also issued biting criticism of the way the ministry supervises dental services for children and adults.
The comptroller often complains that criticism he made of the ministry in his reports years ago continue to be ignored. Among the criticisms are that unqualified hospital staffers are carrying out x-rays on patients; the inadequate number of hospital social workers and other problems has forced nurses – already overburdened – to do their work for them; ; patients are exposed to excessive radiation because of the lack of low- or no-radiation scanning devices; patients’ food is often inadequate due to too few dietitians; health funds are chronically in debt because the Treasury holds the purse strings; and emergency room patients wait much too long.
The faults presented in the report are many, and there is nothing positive except that the ministry implemented a 1990 recommendation to provide basic dental care for children. But even this is implemented inadequately, the comptroller writes.
Prime Minister Benjamin Netanyahu has named United Torah Judaism MK Ya’acov Litzman to again become deputy health minister, and the ultra-Orthodox rabbi has already said he will expand his free basic dental care to children up to 18 years old from the current two to 12 years. The comptroller’s report devotes 48 pages to the ministry’s dental services department (headed by Dr. Shlomo Zusman, who, like Litzman, is unnamed in the document).
Dental care was not included when the basket of health services was created in 1994 except for cancer patients. In the past, it was subsidized by some health funds for members with supplementary health insurance policies.
Litzman, whose constituency includes large families with no money for private dental treatment, made sure in 2010 when he was deputy minister that the basket include basic care for children provided by health fund dentists. However, only about a third of children have been taken by their parents for examination and treatment under the program, which has cost hundreds of millions of shekels.
This under-use is partially due to parents’ preference of taking them to private dentists or to “inadequate ministry publicity” about the coverage, especially among Arabs and haredim.
The ministry’s National Health Council was supposed to supervise the program, but it did not hold a single meeting on the subject in more than two years. The ministry’s budget for children’s dental care has fallen below costs because it was not calculated according to the number of children in each health fund.
Prof. Jonathan Mann, former dean of the Hebrew University’s dental faculty and now head of its community dentistry department, has long been critical of the way in which the program for children has been carried out. He is often quoted in the comptroller report’s section on dentistry, but not on an essential criticism of his – that the payment to health fund dentists is only about NIS 120 per child.
“I assume that we have a major problem of over-treatment in those clinics in which reimbursement is so minimal,” Mann told The Jerusalem Post
. “They give the free basic treatment, but some dentists claim there are other problems in the children’s mouths that are not covered, and the parents pay for them.”
The comptroller notes that the ministry failed to find a way to include private dentists, including pediatric specialists, in the Litzman program.
Mann offered in 2010 that independent dental researchers in his school examine how well the free dental care is implemented, rather than leaving it to a handful of ministry supervisors. Litzman rejected the idea outright.
“I will be happy if the range of ages will increase to 18 and if the geriatric population is included,” said Mann. “But independent supervision and quality control of the program must be implemented to ensure there is no over-treatment or other abuses.”
A separate study recently found that condition of children’s teeth in the country has not improved since Litzman’s program was launched.
In addition, in what Mann called a glaring omission, the comptroller’s staff made no mention of what public health and dental experts have called the greatest dentistry catastrophe in the last two years – former health minister MK Yael German’s prohibition of fluoridation of the country’s drinking water.
The experts within and outside the ministry are eager to cancel the law she had passed to outlaw fluoridation, saying it would create a generation of poor children with rotten teeth. The experts have gone to the High Court of Justice in an effort to reverse German’s decision; ministry officials hope Litzman will agree to abolish the law soon after he takes over.
The ministry does not know how many of the 11,500 licensed dentists are actually working and how many are retired or otherwise occupied, the report says. It also lacks epidemiological data on dental health in the population, the report says. But the IDF has reported officially that 28 percent of soldiers have diseased teeth.
Dental implants have been become very popular – if expensive – in dental clinics around the country. But the comptroller found that experts in the complicated invasive procedure, which if done improperly can lead to infections and other complications – are often lacking – and sometimes dental technicians rather than licensed dentists perform them.
The ministry’s dental services do not supervise private clinics, where most patients are treated, causing the comptroller to worry that there are serious faults in some of them.
In addition, x-ray and other machines involving radiation are not supervised properly by the ministry. Despite the rapid development of technology in the field, dentists are not bound by the ministry to undergo refresher courses, and there is a serious shortage of dental specialists due to the high cost of training them.
The chapter section on medical imaging notes that 12 of the 66 computerized tomography (CT) scans in the country lack a special program that reduces the amount of radiation without lowering the quality of the scan.
Although magnetic resonance imaging scanners emit no radiation, too often scans are performed using radiating CTs instead MRIs, which cost more to operate. In addition, there is a shortage of qualified radiologists to perform and interpret x-rays, the comptroller says, and the queues are much too long. Some of those who run imaging devices lack the advanced training to use them, the comptroller writes.
Almost two decades after the Patients’ Rights Law was passed, the comptroller says, it is violated daily in general hospitals that are crowded, lack privacy, and have inadequate staffs and facilities unsuited to the needs of patients.
Because medical staff are so rushed and overburdened, the “informed consent” forms that patients are supposed to sign before undergoing surgery or other invasive procedures are not explained to them or even translated into all the necessary languages.
Few patients receive more than cursory explanations or know what they are signing.
The comptroller criticizes the fact that the lack of vacant beds in rehabilitation hospitals turns some patients after strokes or accidents into disabled people who cannot manage without nursing help. The ministry has failed to prevent medical tourism from abroad from coming at the expense of Israeli patients waiting in queues for treatment.
The Hadassah Medical Organization, a voluntary body owned by the Hadassah Women’s Zionist Organization of America, became a “supervised body” of the comptroller recently because the Treasury helped pull it out of its NIS 1.3 billion accumulated deficit with hundreds of millions of shekels in state aid. But his first discussion of the HMO crisis takes up only four pages and adds little, except to say that the Health Ministry has done a poor job supervising private medical services (SHARAP) at Hadassah and other voluntary hospitals where these exist.
Healthcare is vastly under-budgeted by the Treasury, causing public hospitals and health funds to operate on a chronic, built-in deficit; this makes proper long-term planning impossible, concludes the report. The Finance and Health ministries must work together to increase transparency and find better ways to finance healthcare, it continues.
In summation, the comptroller urges “the prime minister and the health minister to follow up closely the advance of activities to rehabilitate the health budget until it is rescued from the crisis.”
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