Medical conferences are usually closed to the general public, with admission of specialists in the field dependent on paying considerable participation fees covered by employers. The layman rarely has the opportunity to encounter leading hospital administrators, department heads and other senior physicians and researchers and hear lectures directly from the horses’ mouths rather than consultations from the other side of a desk in a clinic.But once every summer since 2007, the Hadassah Medical Organization (HMO) opens the doors of Jerusalem’s International Convention Center for a day-long Israel Medical Conference open free to the public.This time its sponsors included the city’s Alyn Hospital for pediatric and adolescent rehabilitation and Haifa’s Bnai Zion Medical Center. Over 1,000 pre-registered people attended the event, which focused mostly on infectious diseases and equity and the division of resources in medical care.“When I was director-general of Maccabi Health Services,” said HMO’s new directorgeneral Prof. Ehud Kokia, I said that the perdiem compensation for patient care [payments by the health funds to hospitals] should be lower. Now that I’m at Hadassah, I say that the per-diem payment should be higher. Both statements were correct.”Kokia, a Jerusalem-born and -trained obstetrician/ gynecologist but a longtime medical administrator, thus indicated that one’s hat determines one’s point of view. “The health funds want only a 1 percent increase, the hospitals want a 10% hike, and them committees reach a compromise. There is very heavy government regulation, and the health budget is a very short blanket that is pulled from one side to the next.”He bemoaned the fact that last year’s huge Trajtenberg Report on social and economic reforms included less than two pages on healthcare (“I guess we are not interesting”) and that the Health Ministry has long been the least-desired of them all when coalitions are cobbled together.Public health expenditures don’t keep up with population growth and the aging of the population, Kokia said, “so the Treasury demands more efficiency, causing the gap to grow. There is a shortfall of NIS 9 billion in the healthcare system, according to experts, but there are protests over NIS 30 million or NIS 300m. If it were injected with at least NIS 2b., everything would look different.” Kokia added that in 1995, when the National Health Insurance Law was implemented, the state spent NIS 3,500 on each resident, and today it has dropped to only NIS 2,500. Private expenditure for health has risen to 43% of health expenditures.When he was a child, Israel legitimately boasted having one of the best educational systems in the world, something that the country can no longer do. He hoped that the same will not be said about the Israeli healthcare system, “which is still good and can be saved,” in the years to come. “You can’t function if you aren’t optimistic. The bottom line is not with the Health Ministry but with the government, the Knesset and the public.”HMO’S ISRAEL Medical Conference has each year given the floor to a different political leader, and after Labor Party chairman Shelly Yechimovich said she was unable to come, the slot was offered to unelected Yesh Atid party head and longtime journalist and publicist Yair Lapid, who took advantage of the opportunity. He was dressed characteristically only in black and spoke without notes for about 40 minutes.“Something is not OK in Israel’s health system,” he began. “Israel is No. 1 among OECD countries in the number of patients hospitalized in a single year in a single bed.It’s like the Third World,” he said. Politics is an integral part of this “game,” Lapid charged, and accused Deputy Health Minister Ya’acov Litzman, Construction and Housing Minister Ariel Atias and Science Minister Daniel Herschkowitz of acting on issues that specially affect their constituencies – a charge the ministers have denied.“Litzman should have turned over every stone to stop the privatization of the School Health Service and the weakening of Tipat Halav [family health centers],” Lapid said.As for the suggested draft of haredim, the Yesh Atid politician said that many of them should perform national civilian service.“Let them go to work in hospitals, in the police and in homes of Holocaust survivors.They can wash their dishes, bring back medications for them, hear their stories, write them down, take the the elderly people to a park. Is this not observance of the commandments?” Iconoclast economist Shlomo Maoz, who spoke with irony through most of his speech, suggested that hotels should learn from hospitals about profitmaking, as the country’s public medical centers have 96.6% occupancy throughout the year. Hotels, he said, would be hugely profitable if they could do the same. He also derided the Health Ministry and the government for allocating only 0.6% of budgets for preventive medicine. Inadequate primary health care in the periphery forces many patients to go to hospitals – at much higher public expense – because untreated conditions get worse.Maoz said it was unfortunate that in this country, “being health minister is not an honorable post. Abroad, it is one of the most desirable cabinet jobs... The Health Ministry needs to become much stronger as a regulator.”He also advocated charging medical students who study and do internship in the center of the country much higher tuition, as abroad, and reducing the costs of those who study and work in the periphery of the country. Those who get their medical education at rock-bottom prices in Israel and then emigrate should have to pay back the real costs of their studies, Maoz concluded.As medical centers here find it increasingly difficult to raise money for development and state institutions receive less and less funding from the Health Ministry, medical tourism is becoming increasingly important to pay for new facilities. Ofer Gat, deputy director-general of El Al, said that the world market for medical tourism – undergoing surgery, consultations and treatments in another country – totals $100b. a year. In Israel, the figure for all relevant hospitals was NIS 160m. in 2011. These include Hadassah University Medical Centers, (the private) Assuta, Tel Aviv Sourasky, Sheba Medical Center, (the private) Herzliya Medical Center, Rabin Medical Center and Rambam Medical Center. Most of the foreign patients seek care in the fields of oncology, cardiology and orthopedics or undergo in-vitro fertilization.The average medical expenditure per patient is $10,000 to $15,000, and that doesn’t include hotel expenses of the recovering patients and those of family members and other accompanying persons.Gat noted that El Al brings many medical tourists from Russia, Ukraine and other relatively nearby locations and as far away as North America. There are also arrangements for medical care for foreign embassy personnel here. Last year, the airline brought to Israel and back (or vice versa) some 1,400 patients who needed to be flown under hospital conditions, with airplane seats turned into a bed.“There is no other airline in the world that can do what we do in this field,” he boasted.The shortage of nurses in the Israel Defense Forces’ clinics and on the frontline has induced the IDF to plan an academic program for military nursing, similar to the Military Medicine Track at the Hebrew University- Hadassah Medical Faculty, IDF Chief Medical Officer Brig.-Gen. Yitzhak Kreis revealed.Various medical faculties will compete in the tender, and after the nurses, the IDF is going to establish a military dental track to bring more dentists to the IDF as well.Huge medical conferences are no longer held in Israel, said International Convention Center CEO Mira Altman. “The last one was in October 2000, before the outbreak of the second intifada. It was a conference on diabetes attended by 10,000 participants. Security problems are always given as the main reason for foreigners not coming, said Altman, “but there are security problems all over the world, and it’s quieter here. Budgets are also given as an explanation. We hope the mass medical conferences come back.Even now, 10% of all conferences here are on medical topics.”DISEASES WITHOUT borders was the theme of another panel at the conference. Hadassah- Ein Kerem pediatrics head and infectious diseases expert Prof. Dan Engelhard noted that diseases spread globally with great ease because of flights. “But it doesn’t always work against us. It also helps us detect diseases with help from scientific connections,” said Engelhard, who has gone to Africa numerous times to treat children with AIDS/HIV.He expressed his disappointment over the growing number of Israeli parents who, out of ideology or misinformation, refuse to vaccinate their children against childhood diseases from whooping cough (pertussis) to measles. He strongly endorsed vaccination, saying that it clearly saves lives. False medical “research” claiming that the MMR vaccine caused autism were totally disproven, but some parents – and even doctors – continue to believe it, Engelhard said. He gave as an example a girl named Riva who was born healthy and diagnosed with pertussis at the age of six weeks. She was at Hadassah for three weeks with pneumonia and a brain infection and was attached to a ventilator.“She almost died. We managed to save her.It would have been prevented if she had been vaccinated.” In recent weeks, there has been an outbreak of measles in Tel Aviv, mostly due to illegal migrant workers.“They have to be vaccinated too,” he said, “even though they have no health insurance.”A number of years ago, haredim from abroad came to Jerusalem for a huge wedding, bringing measles with them and causing an outbreak in ultra-Orthodox communities around the country.The Prevnar vaccine against 13 of the most common strains of pneumococcal bacteria that cause pneumococcal meningitis can cause severe complications, said Engelhard.The future of vaccines could be plant based, such as vaccines cultivated with potatoes.“Just eat it, and be healthy,” he enthused.Dr. Sagit Arbel-Allon, a senior Hadassah gynecologist who initiated and heads its rape-victims center, Bat-Ami, strongly advocated inclusion of the human papilloma virus vaccine for protecting both both girls and boys against cervical cancer. The Health Ministry has not included it in the standard basket of vaccines because of the high cost and claims that the number of women who contract cervical cancer from the virus is “very small” (180 diagnosed cases and 70 deaths from it each year). Arbel-Allon said that parents have to pay for it here, unlike those in many Western countries who provide it free. “Make it an expensive bat-mitzva and bar-mitzva present,” she said. “It saves lives.”The director of Alyn Hospital, Dr. Maurit Be’eri, concluded the session with a hair-raising calculation of the medical and rehabilitation costs until reaching adulthood of children who become paraplegics as a result of road accidents and other preventable causes that send 182,000 children to emergency rooms every year. The savings would build a few medical schools a year, she concluded.