doctors protest 311.
(photo credit: Marc Israel Sellem)
The doctors’ sanctions, which began in April, will “not solve the structural
problems” of the health system; unless an agreement is reached for comprehensive
reform, the Israel Medical Association will strike every two or three years,
senior health economist Prof. Dov Chernichovsky said on
Chernichovsky, a professor of health economics and policy at
Ben-Gurion University of the Negev in Beersheba, wrote a “National Status
Report” for Jerusalem’s Taub Center for Social Policy Studies that contained a
chapter on the doctors’ dispute.
Chernichovsky, who frequently advises
foreign governments on health systems, recommended that when the current labor
dispute ends, the state should launch comprehensive reform in health services by
making “corrections,” some of which have already been recommended by various
public committees. He urged that the state invest significantly more money in
public medical services, as it did before 1995, encourage competition and free
choice of doctors in the public sector and give hospital administrators more
effective tools – including higher-paying personal contracts for those doctors
working only in the public sector.
The changes should be applied over a
period of five to seven years, by which the state should restore public
expenditure in health to 70 percent of all health costs, which is the average
current level in OECD countries, compared to less than 60% in Israel today. In
addition, said the BGU and Taub Center economist, health expenditures must
increase to 9% of the gross domestic product instead of Israel’s current level
The state, via government hospitals, should reduce its supply of
health services while at the same time raising public expenditures for
Agreements must be reached with health workers, especially
government employees in the health sector, who would get compensation for
carrying out the necessary organization and management changes, Chernichovsky
Just raising the public-sector doctors’ wages and even increasing
manpower slots in the hospitals and community services will not solve the
serious structural problems, said Chernichovsky. The sources of these problems
are economic and demographic and the government’s “mistaken policy” over the
last 15 years, he maintained.
The health system has changed due to the
ageing of the population, a rise in the standard of living and a reduction in
medical services due to the decline in public-sector medical manpower,
Chernichovsky told The Jerusalem Post in an interview. Instead of helping public
medical services to cope with the growing gaps between supply and demand that
increase demand for privately funded services, the state helps raise demand by
reducing its financing of public medicine.
The gap was filled by private
supplementary health insurance from the four health funds or from private
insurance companies. “There is nothing like this [policy] anywhere in any health
system in the world,” he declared.
As most physicians are public
employees, most of excess demand for healthcare is supplied with private funding
by the same doctors who also work in public hospitals and clinics; some even
provide this care in government-owned facilities. He bemoaned the fact that
because of high demand for care, prices for private treatment rose by 92%
between 1995 and 2009, while the consumer price index has increased by only 61%
during that period.
Thus those public doctors who moonlight privately are
paid twice, doubling medical infrastructure in the private sector that already
exists in the public sector and adopting medical technologies in an uncontrolled
and wasteful way, Chernichovsky said. The amount of medical services the public
received during the 15-year period has increased by only 13%, while expenditures
have grown by 30%. This has resulted in relatively lower wages for medical
staffers in the public sector, at the expense of those in the private sector, he
As a result, medical care has become less accessible to the poor,
and medical care has become less efficient. The majority of those who suffer are
people over the age of 65, many of whom forgo urgent treatment because they
can’t pay, and those who live in the periphery, he concluded.