Medical conferences are usually closed to the general public, with admission of
specialists in the field dependent on paying considerable participation fees
covered by employers. The layman rarely has the opportunity to encounter leading
hospital administrators, department heads and other senior physicians and
researchers and hear lectures directly from the horses’ mouths rather than
consultations from the other side of a desk in a clinic.
But once every
summer since 2007, the Hadassah Medical Organization (HMO) opens the doors of
Jerusalem’s International Convention Center for a day-long Israel Medical
Conference open free to the public.
This time its sponsors included the
city’s Alyn Hospital for pediatric and adolescent rehabilitation and Haifa’s
Bnai Zion Medical Center. Over 1,000 pre-registered people attended the event,
which focused mostly on infectious diseases and equity and the division of
resources in medical care.
“When I was director-general of Maccabi Health
Services,” said HMO’s new directorgeneral Prof. Ehud Kokia, I said that the
perdiem compensation for patient care [payments by the health funds to
hospitals] should be lower. Now that I’m at Hadassah, I say that the per-diem
payment should be higher. Both statements were correct.”
Jerusalem-born and -trained obstetrician/ gynecologist but a longtime medical
administrator, thus indicated that one’s hat determines one’s point of view.
“The health funds want only a 1 percent increase, the hospitals want a 10% hike,
and them committees reach a compromise. There is very heavy government
regulation, and the health budget is a very short blanket that is pulled from
one side to the next.”
He bemoaned the fact that last year’s huge
Trajtenberg Report on social and economic reforms included less than two pages
on healthcare (“I guess we are not interesting”) and that the Health Ministry
has long been the least-desired of them all when coalitions are cobbled
Public health expenditures don’t keep up with population growth
and the aging of the population, Kokia said, “so the Treasury demands more
efficiency, causing the gap to grow. There is a shortfall of NIS 9 billion in
the healthcare system, according to experts, but there are protests over NIS 30
million or NIS 300m. If it were injected with at least NIS 2b., everything would
look different.” Kokia added that in 1995, when the National Health Insurance
Law was implemented, the state spent NIS 3,500 on each resident, and today it
has dropped to only NIS 2,500. Private expenditure for health has risen to 43%
of health expenditures.
When he was a child, Israel legitimately boasted
having one of the best educational systems in the world, something that the
country can no longer do. He hoped that the same will not be said about the
Israeli healthcare system, “which is still good and can be saved,” in the years
to come. “You can’t function if you aren’t optimistic. The bottom line is not
with the Health Ministry but with the government, the Knesset and the
HMO’S ISRAEL Medical Conference has each year given the floor to
a different political leader, and after Labor Party chairman Shelly Yechimovich
said she was unable to come, the slot was offered to unelected Yesh Atid party
head and longtime journalist and publicist Yair Lapid, who took advantage of the
opportunity. He was dressed characteristically only in black and spoke without
notes for about 40 minutes.
“Something is not OK in Israel’s health
system,” he began. “Israel is No. 1 among OECD countries in the number of
patients hospitalized in a single year in a single bed.
It’s like the
Third World,” he said. Politics is an integral part of this “game,” Lapid
charged, and accused Deputy Health Minister Ya’acov Litzman, Construction and
Housing Minister Ariel Atias and Science Minister Daniel Herschkowitz of acting
on issues that specially affect their constituencies – a charge the ministers
“Litzman should have turned over every stone to stop the
privatization of the School Health Service and the weakening of Tipat Halav
[family health centers],” Lapid said.
As for the suggested draft of
haredim, the Yesh Atid politician said that many of them should perform national
“Let them go to work in hospitals, in the police and in
homes of Holocaust survivors.
They can wash their dishes, bring back
medications for them, hear their stories, write them down, take the the elderly
people to a park. Is this not observance of the commandments?” Iconoclast
economist Shlomo Maoz, who spoke with irony through most of his speech,
suggested that hotels should learn from hospitals about profitmaking, as the
country’s public medical centers have 96.6% occupancy throughout the year.
Hotels, he said, would be hugely profitable if they could do the same. He also
derided the Health Ministry and the government for allocating only 0.6% of
budgets for preventive medicine. Inadequate primary health care in the periphery
forces many patients to go to hospitals – at much higher public expense –
because untreated conditions get worse.
Maoz said it was unfortunate that
in this country, “being health minister is not an honorable post. Abroad, it is
one of the most desirable cabinet jobs... The Health Ministry needs to become
much stronger as a regulator.”
He also advocated charging medical
students who study and do internship in the center of the country much higher
tuition, as abroad, and reducing the costs of those who study and work in the
periphery of the country. Those who get their medical education at rock-bottom
prices in Israel and then emigrate should have to pay back the real costs of
their studies, Maoz concluded.
As medical centers here find it
increasingly difficult to raise money for development and state institutions
receive less and less funding from the Health Ministry, medical tourism is
becoming increasingly important to pay for new facilities. Ofer Gat, deputy
director-general of El Al, said that the world market for medical tourism –
undergoing surgery, consultations and treatments in another country – totals
$100b. a year. In Israel, the figure for all relevant hospitals was NIS 160m. in
2011. These include Hadassah University Medical Centers, (the private) Assuta,
Tel Aviv Sourasky, Sheba Medical Center, (the private) Herzliya Medical Center,
Rabin Medical Center and Rambam Medical Center. Most of the foreign patients
seek care in the fields of oncology, cardiology and orthopedics or undergo
The average medical expenditure per patient is
$10,000 to $15,000, and that doesn’t include hotel expenses of the recovering
patients and those of family members and other accompanying persons.
noted that El Al brings many medical tourists from Russia, Ukraine and other
relatively nearby locations and as far away as North America. There are also
arrangements for medical care for foreign embassy personnel here. Last year, the
airline brought to Israel and back (or vice versa) some 1,400 patients who
needed to be flown under hospital conditions, with airplane seats turned into a
“There is no other airline in the world that can do what we do in
this field,” he boasted.
The shortage of nurses in the Israel Defense
Forces’ clinics and on the frontline has induced the IDF to plan an academic
program for military nursing, similar to the Military Medicine Track at the
Hebrew University- Hadassah Medical Faculty, IDF Chief Medical Officer
Brig.-Gen. Yitzhak Kreis revealed.
Various medical faculties will compete
in the tender, and after the nurses, the IDF is going to establish a military
dental track to bring more dentists to the IDF as well.
conferences are no longer held in Israel, said International Convention Center
CEO Mira Altman. “The last one was in October 2000, before the outbreak of the
second intifada. It was a conference on diabetes attended by 10,000
participants. Security problems are always given as the main reason for
foreigners not coming, said Altman, “but there are security problems all over
the world, and it’s quieter here. Budgets are also given as an explanation. We
hope the mass medical conferences come back.
Even now, 10% of all
conferences here are on medical topics.”
DISEASES WITHOUT borders was the
theme of another panel at the conference. Hadassah- Ein Kerem pediatrics head
and infectious diseases expert Prof. Dan Engelhard noted that diseases spread
globally with great ease because of flights. “But it doesn’t always work against
us. It also helps us detect diseases with help from scientific connections,”
said Engelhard, who has gone to Africa numerous times to treat children with
He expressed his disappointment over the growing number of
Israeli parents who, out of ideology or misinformation, refuse to vaccinate
their children against childhood diseases from whooping cough (pertussis) to
measles. He strongly endorsed vaccination, saying that it clearly saves lives.
False medical “research” claiming that the MMR vaccine caused autism were
totally disproven, but some parents – and even doctors – continue to believe it,
Engelhard said. He gave as an example a girl named Riva who was born healthy and
diagnosed with pertussis at the age of six weeks. She was at Hadassah for three
weeks with pneumonia and a brain infection and was attached to a
“She almost died. We managed to save her.
have been prevented if she had been vaccinated.” In recent weeks, there has been
an outbreak of measles in Tel Aviv, mostly due to illegal migrant
“They have to be vaccinated too,” he said, “even though they
have no health insurance.”
A number of years ago, haredim from abroad
came to Jerusalem for a huge wedding, bringing measles with them and causing an
outbreak in ultra-Orthodox communities around the country.
vaccine against 13 of the most common strains of pneumococcal bacteria that
cause pneumococcal meningitis can cause severe complications, said
The future of vaccines could be plant based, such as vaccines
cultivated with potatoes.
“Just eat it, and be healthy,” he
Dr. Sagit Arbel-Allon, a senior Hadassah gynecologist who
initiated and heads its rape-victims center, Bat-Ami, strongly advocated
inclusion of the human papilloma virus vaccine for protecting both both girls
and boys against cervical cancer. The Health Ministry has not included it in the
standard basket of vaccines because of the high cost and claims that the number
of women who contract cervical cancer from the virus is “very small” (180
diagnosed cases and 70 deaths from it each year). Arbel-Allon said that parents
have to pay for it here, unlike those in many Western countries who provide it
free. “Make it an expensive bat-mitzva and bar-mitzva present,” she said. “It
The director of Alyn Hospital, Dr. Maurit Be’eri, concluded
the session with a hair-raising calculation of the medical and rehabilitation
costs until reaching adulthood of children who become paraplegics as a result of
road accidents and other preventable causes that send 182,000 children to
emergency rooms every year. The savings would build a few medical schools a
year, she concluded.