Does the fact that the State Comptroller devoted an unprecedented 200 pages of his 1,000-page biannual report on government activities to the Health Ministry mean that the scandals are worse, or that investigators who supervised the ministry's activities were especially energetic or productive this year?
The answer is probably: Both. Shortcomings involving health services are often related to life-and-death matters, and this year is no exception. The fact that, according to this hard-hitting chapter, lives are being endangered, or even lost because of poor ministry management and supervision makes the reader sad and angry.
Radiotherapy is considered one of the most effective weapons against malignant tumors, causing the number of cancer patients seeking such treatment to grow. Although this trend has been clear for a decade and committees of experts have made recommendations and issued warnings, the Health Ministry has done nothing to expand radiotherapy facilities and increase and upgrade manpower to cope with increasing demand for high-quality radiotherapy.
In his report, the State Comptroller Micha Lindenstrauss slams the ministry for this negligence, which has resulted in long waiting lists, equipment breakdowns, a shortage of nuclear accelerators, erroneous doses of radioactivity, too-short radiotherapy sessions and too-few physicists, radiotherapy physicians and technicians.
All these shortcomings, the comptroller concludes, pose "significant concern for serious harm to the quality of treatment given to patients." His staff chose at random the radiotherapy facilities in one government hospital (Rambam Medical Center in Haifa) and one owned by Clalit Health Services (Rabin Medical Center in Petah Tikva). Only when the comptroller's investigation ended in September 2005 did the ministry suddenly ask professionals to recommend a program to ensure the quality of radiotherapy equipment. While demanding a major reorganization to suit radiotherapy to future needs, the state comptroller called on the ministry and hospitals it owns and supervises urgently to ensure that current cancer patients get the best possible radiotherapy.
Much of the chapter's criticisms were devoted to the ministry's supervision of the four public health funds. This is the job of a deputy director-general.
The comptroller does not name names but only positions; he also left out the fact that the deputy director-general in charge of health fund supervision - Michal Abadi-Boyanjo - resigned from her position at the beginning of this year to become the very well paid chief accountant of the First International Bank. The comptroller also neglects to mention that she was allowed to serve as a member of at least one board of directors of an outside organization while she held her ministry job. Moving to the bank post, she left numerous and serious failures at the ministry that are detailed by the comptroller. (Even today, months later, Abadi-Boyajo's seat has been filled only temporarily by a ministry lawyer with expertise on drug and medical equipment licensing; no permanent appointee has been named.)
Three of the four health funds - not Maccabi Health Services - used illegal incentives to try to attract new members, especially from the haredi and Arab sectors (whose large, younger families make them more profitable). By offering better ambulances, home delivery of drugs, night opening hours and free transport to and from specific clinics, the comptroller said that they thereby discriminated against other members and violated the principle of egalitarianism.
The ministry's health fund supervisor did not do anything to stop this, the state comptroller said. She also failed to ensure that residents have reliable and accurate information about their rights and the ability to get what they deserve from their insurer.
In addition, health fund managements were not consistent in their rejection of members' requests for subsidized medications. Some patients with a certain medical condition were given drugs, while other members with the same condition were not. The health funds did not offer any documented explanations, thus leaving an opening to discrimination, favoritism and potential corruption. The insurers sent letters to doctors recommending that they prescribe cheaper drugs (often generics or earlier-generation pharmaceuticals) to save money; this puts pressure on physicians not to prescribe more expensive medications that could benefit their patients more.
Although Israeli residents - all of them members of a health fund - are entitled to switch funds twice a year, only 1.1% of them actually change to another insurer, and among the elderly, the rate is less than a third of that low figure. The ministry did not take action to facilitate switching from a health fund that provides unsatisfactory care for the elderly or sick to another one that - it is hoped - would provide better care. This is largely because supplementary health insurance policies purchased by 70% of the population are available only to members of the same health fund and not others, and anyone who switches faces restrictions and must go through a waiting period.
The comptroller said the "fine print" in these policies prevented policyholders from knowing their rights and comparing the various plans.
The ministry was also strongly criticized for poor supervision of the health funds' administration of supplementary health insurance plans, which enable policyholders to choose their surgeon, for example, instead of receiving the one who is on duty at the time.
But instead of the operation being covered by the publicly funded basket of health services and the surgeon's fee being covered by supplementary health insurance, the comptroller said that Abadi-Boyanjo allowed the insurer to pay for the surgeon and the operation with money from its supplementary health insurance. This saves money for the insurers while causing "underuse" of basket funds and encouraging the Finance Ministry to allocate less for basic health services.
It puts pressure on patients to join supplementary health insurance plans and thus leads to increased "privatization" of health services at a time when government participation in health costs continues to shrink.
The ministry was also rapped for allowing unlicensed geriatric nursing homes to remain open and keep patients in substandard conditions that are liable to worsen their medical condition and for failing to set uniform standards for rehabilitation in the community.