The health system is in for major changes if Deputy Health Minister Ya'acov Litzman gets his way. The first step he will take to keep the hospitals on their toes will be to make surprise early morning visits to emergency rooms to see whether patients are being treated properly. Litzman, making his maiden speech as the man in charge of the ministry to the 100 most influential administrators and academics in the field, said at the 10th Annual Dead Sea Conference that he awakens at 3.30 a.m., prays, studies and goes to the ritual bath and is the first to arrive at the ministry. He will take advantage of his being an early riser to check the emergency rooms, he said. The two-day conference of the National Institute for Health Policy and Health Services Research, which ended on Thursday at the Daniel Hotel at Ein Bokek, focused this time on why it is so difficult to reform the health system. The United Torah Judaism MK and Gur hassid said that the main reason why it is so difficult to get reforms through is that "every year there is another health minister, but Raviv [Sobel, the powerful Treasury Budgets Division official who determines health budgets], is still here." A former twice-chairman of the Knesset Finance Committee, Litzman told the participants that he doesn't agree that observations seen from one governmental post look different from another post, but that as the man heading the complicated ministry, "I am open to persuasion. I am going to touch all kinds of things, including those that are not popular." But Litzman said he is free to make decisions, as "I am not right and not left, and I don't have to face party primaries [hassidic rabbis decide on the list of candidates]." He asserted that while some public health experts think the four health funds can be made responsible for all health services - including preventive medicine, psychiatric and geriatric care - his position is that "the health funds are not the solution for everything." He noted with humor that the insurers all agree to "provide free dental care for children aged 0 to two" when they hardly have teeth. He advocates a private member's bill that would automatically increase the basket of medical technologies by two percent every year, even though the Treasury is firmly against it. Litzman said he would very soon appoint members of this year's public committee that recommends what drugs to add to the basket, and - getting laughs from the audience - that one of the members "will be a judge, and I promise you he will not come from United Torah Judaism - as I don't know any judges from my party." While he is upset by the fact that 43% of health expenditures are covered by the public rather than by government, he has cancelled parent fees for well-baby (tipat halav) services, and this move will go into effect on October 1. Parents who refuse to vaccinate their children against infectious diseases will not receive the additional child allowance that is to be provided, he declared. Litzman is also determined to legalize and institutionalize private medical services (Sharap) in the government and health fund hospitals so that senior doctors will be on duty in the afternoons, evenings and weekends. Sharap is opposed by those health experts who fear it will be abused to the detriment of the poor and reduce the system's equity. Even though the Knesset Labor, Social Affairs and Health Committee voted down Litzman's proposal to build a fortified emergency room on the parking lot of Barzilai Medical Center in Ashkelon so bones from the Byzantine period wouldn't have to be moved, Litzman said that digging on the site will begin in the next few days to see if the alternate site is an alternative. He also hopes to push through an exemption for people aged 70 and over of copayments for medications, but for this he will have to persuade the Treasury, which doesn't like to give discounts.