Nahariya Hospital 224.88.
(photo credit: Ariel Jerozolimski)
The Health Ministry has done nothing to halt doctors' widespread abandonment of public hospital wards in the afternoons and on Fridays to do private work outside, even when they are paid for being on call, according to the State Comptroller's report on the ministry, released on Tuesday afternoon.
The ministry was also found negligent in supervising a wide variety of areas, such as health funds' collection of excessive and growing amounts in copayments; slow registration of new medications; possible conflict of interest by a senior geriatrician who formerly headed the National Insurance Institute (NII); and failure to close all inadequate nursing homes.
Doctors are supposed to work from 8 a.m. to 4 p.m. and Fridays from 8 a.m. to 1 p.m., with younger and senior doctors doing shifts the rest of the time - but they are not required to use time clocks.
Eighteen physicians at four hospitals were found to be doing private work in community health fund clinics, even though they hadn't reported it or received the required permission - and 5 percent of their wages had not been deducted (as required) from their paychecks.
When physicians were on call, the comptroller said, they were not to be doing other medical work, so they could return to the hospital immediately; however, many were working elsewhere, thus denying patients in their hospital immediate care.
The ministry should supervise the government hospitals to ensure that the suitable number and kinds of physicians were on duty as necessary and punish those who break the rules, the comptroller said.
In addition, patients have to finance, from their own pockets, an increasing number of medications and medical services because of reduced funding from the Treasury and "a lack of directed policy and general vision" by it and the Health Ministry. A national program to reduce individuals' copayments should be mounted immediately by the Health Ministry, the comptroller wrote, so that by 2010 they constitute just 25% of national health expenditures instead of the 33% they do today.
Some of the health funds charge too much for medications for patients with chronic diseases and give a variety of medications only as part of optional supplementary insurance, even though they are officially part of the basket of health services that all the insurers must provide, the comptroller stated. He also said the ministry's examination and registration of new medications was too slow, with 250 vital drugs still in the queue in September 2007. He demanded that drugs be approved within a year and not with the significant lag evident today.
In a study of complex nursing facilities, the comptroller found that many patients were falling between the cracks because of a multitude of authorities and responsibilities, and the health funds had no incentive to rehabilitate them. He said there were almost 50 substandard unlicensed and unsupervised nursing institutions around the country that should be closed.
Also criticized was the case of Prof. Yohanan Stessman, formerly director-general of the NII and currently district geriatrician of Clalit Health Servicesâ€š Jerusalem district, and medical director of a private nursing facility near Jerusalem and of another institution in the capital. He is also director of geriatrics at Hadassah-University Medical Center. Since in his post at Clalit he refers patients to these hospitals, the comptroller suggested that this multiplicity of functions - with no objection from the ministry - could be a conflict of interest. Stessman also did not fill out forms stating possible conflicts among these positions, even though this was required.
The comptroller also found that some patients were being fed via tubes not because they couldn't eat without help, but for the convenience of the staff or because their status and participation in financing differed depending on whether they were tube-fed or not.
Also, although obesity is a worldwide problem leading to preventable diseases that cost many billions of shekels a year to treat, the ministry has neglected to fight and prevent it. Currently 13% of teens are overweight and 6% obese, and among army draftees, the figure is 4.56% today compared to only 1.7% between 1989 to 1991. There are almost no body-mass-index tests of children. Obesity prevention strategies have not been brought to the government, and no national authoritative body has been established to coordinate a fight against obesity.
Many food companies fool the public by making false claims about their food products and hiding the fact that they may have reduced sugar but are high in dangerous fats. The ministry has not prevented the companies from targeting children for high-fat, high-salt and high-sugar junk food or from advertising such products on TV, the report said.