ERs require emergency care

Comptroller's report addresses Health Ministry supervision inadequacies.

By JUDY SIEGEL-ITZKOVICH
Inadequate Health Ministry supervision of hospital emergency departments was prominent among the shortcomings published in the chapter on the ministry, which has not ensured that an adequate complement of personnel and beds are available.
The relatively short, low-key chapter did not mention the issue regarded as one one the ministry’s biggest failure in the past year – its purchase of 7.2 million doses of H1N1 flu vaccine at a cost of some NIS 700 million and its failure to persuade the majority of Israelis to get vaccinated.
Asked about this, the comptroller’s spokesman said that the comptroller decided to deal with this issue in “a future report that will be part of a comprehensive examination of Health Ministry readiness for health emergencies.” Emergency rooms are affected by the availability of urgent care centers – both public and private – in the community to handle urgent medical cases from fractures to chest pains. But the ministry has failed to set a national policy about these centers and – amazingly – does not supervise their functioning or insist that they be licensed (although its doctors are licensed), unlike private surgical clinics.
In the emergency rooms themselves, there is no standard of service. A newly minted intern without any experience can discharge emergency room patients.
The comptroller also found that the health fund rules vary, with some paying more for emergency visits that don’t end in hospitalization and other paying less. Patients have no clue what they are bound to pay, he declared.
Many emergency departments are very crowded, but the ministry has not taken action to minimize excessive numbers of patients and long queues, the comptroller said. Even when there are urgent-care centers in the community, the ministry hasn’t taken action to use these for systematic reduction of pressure on emergency rooms in the same area.
Because of long queues in emergency rooms and hospital departments, many patients who require inpatient care are instead kept in emergency rooms; this is unacceptable, the comptroller stated.
The ministry must also set maximum waiting times in emergency rooms. Itshould also consider having emergency medicine specialists on duty atall times, not just have them called in when urgently needed.
The health funds have special agreements with hospitals, and somepatients are required to travel longer distances for treatment in amedical center that has an agreement with their insurers. Thecomptroller calls on the ministry to encourage more flexibility so thatpatients will not be penalized because of these agreements.
The comptroller reiterated that the ministry supplies psychiatricservices inadequately and inequitably around the country, instead ofimplementing the recommendation of a state judicial commission fromover 20 years ago to transfer responsibility for mental health servicesto the health funds.
As a result, the queues for outpatient care in ministry-owned clinicsare too long, and those who need urgent help seek it privately or gowithout.