Although the cabinet - under pressure from the Treasury and with Health Ministry acquiescence - recently approved the establishment of a fifth health fund that would be affiliated with one or more state hospitals, the vast majority of health experts said at a Knesset conference that it was a misguided idea that would cause only harm if implemented. The all-day second annual Ariel University Center of Samaria conference on "The Face of Israeli Medicine: Private Medicine vs Public Medicine" focused on whether to establish an additional health insurer and whether to allow public hospitals to offer private medical services. It was held on thursday in the Knesset auditorium and attended by Health Minister Ya'acov Ben-Yizri and over 200 health experts, Ariel Center faculty and students. The discussion of a fifth health fund reached near unanimity by representatives of the four nonprofit public health funds, the head of the Clal Insurance commercial insurance company and others. Dr. Orit Ya'acobson, a deputy director-general of Clalit Health Services in charge of community services, said an additional health fund would attract only the young, wealthy and healthy. "Competition must be for the sick and elderly, and it could happen if health funds are given higher compensation [in the form of National Insurance Institute health taxes] for these sectors; then the funds will want more of them as members," she said. "The sick and elderly rarely want to change health funds because they are used to their doctors." Ya'acobson added that there is already a shortage of qualified medical specialists in the periphery, and if there is a fifth insurer, the situation will only worsen. "Doctors will demand higher salaries to work in the periphery, and national health expenditures will rise and go mainly for salaries." She charged that a state hospital would want to set up a health fund only to allow it to offer private medical services inside it - an arrangement that has been prohibited - and make profits. Avigdor Kaplan, CEO of Clal Insurance who years ago was Clalit director-general, said it was very unlikely that the government decision to authorize the establishment of a fifth insurer would ever be carried out. Members of a nonprofit, public health fund pay a progressive tax according to income to get a basic basket of health services. Customers of private insurance have different premiums according to risk. "We insure healthy people that will get coverage if they get sick," said Kaplan. "No private company can carry out a social law with equity for all." If a fifth health fund were to be nonprofit, there would be terrible waste because small towns and settlements, which already have four clinics, would then have to get another one from the new insurer, Kaplan said. He added that if a "virtual health fund" that purchased services from the other public insurers and hospitals were to be set up, it might succeed, but in any case, residents should be given the right to decide which hospital they want to treat them. Prof. Yehoshua Shemer, a former director-general of the Health Ministry and of Maccabi Health Services (and now Maccabi's titular head) said a fifth health fund is being pushed by vested interests that "want to put a bigger burden on the four existing insurers. A fifth would have no basis for existence. It would waste money on its own computer network, clinics, advertising and services. If I were in charge, I would prefer three, not five." He said a health fund could possibly "adopt" a hospital, because it would improve supervision, but a hospital should not become a health fund offering services only in a specific locality to a limited population. Prof. Yair Shapira, dean of the school of health sciences at the Ariel University Center and chairman of the private chain of Assuta hospitals, said a fifth health fund would be "only an adventure," harm the other health funds and "collapse within two years." Members of another panel on whether private medical services - which provide advantages including the shortening of queues and choice of surgeons and consultations by patients who pay for the privilege - should be allowed in public hospitals were largely in favor of the model that has worked well for decades at Jerusalem's Hadassah University Medical Centers, Shaare Zedek Medical Center and other hospitals in the capital. In this model, senior medical doctors are permitted to provide private medical services to paying patients in the afternoon hours, with the fee divided between the doctor and the hospital. Those who backed it said that it was inevitable that people with money would want the doctor of their choice and quick service, so that private medical services could not be prohibited. If private medical services are not provided in public hospitals, doctors will continue to leave in the afternoon to provide patients in private hospitals with care. Hadassah Medical Organization director-general Prof. Shlomo Mor-Yosef said that only about two percent of its income came from private patients, while optimizing use of facilities after hours, keeping its doctors on the premises the whole day, helping to finance its care of public patients and increasing the wages of senior doctors. "While I can't say the mechanism is perfect, it runs well," said Mor-Yosef. "For it to run properly, careful hospital supervision is vital." But Gabi Bin-Nun, outgoing Health Ministry deputy director-general for economics, said he strongly opposed private services in public hospitals because the paying customer jumps ahead in the queue, always at the expense of the patient who cannot pay. Meidad Gissin, head of Hatzvi (a patients' organization) said his group opposed private care in public hospitals unless the 20% to 30% of the public who don't hold supplementary health insurance from their health fund are given the same privileges of choice as those who do.