'Promises to strengthen health service in periphery unkept'

Taub Center study shows gaps remain between Center and other areas.

Chernichovsky 311 (photo credit: Channel 10)
Chernichovsky 311
(photo credit: Channel 10)
The Health Ministry’s claims that it is beginning to reduce the gaps in health services between the Center and the periphery and is increasing northern and southern residents’ access to quality care are seeing no support in the field, according to a new study released for publication on Tuesday.
In the report by the Taub Center for Social Policy Research in Jerusalem, senior Taub Center and Ben- Gurion University health economist Prof. Dov Chernichovsky reached the conclusion that “what existed up to now is what will be; there has been and will be no change that will improve the periphery.”
Chernichovsky stressed that the gaps in the accessibility and quality of health services in the far-out areas of the country – including Jerusalem, where many residents are as poor as those in the periphery – are constantly getting worse, and nothing the government has promised in the field of healthcare is making the situation any better.
Starting January 1, the ministry changed the way funds should be allocated: Not only will elderly Israelis be worth more to the health funds, but more money will go to health funds with more women – who cost the health system more than men do – and to the North and South.
However, Chernichovsky, in an examination of what has happened so far and how the system is organized, told The Jerusalem Post that there seemed to be no intention of decentralizing the system of the health funds so that a total of NIS 2 billion – or 10 percent – a year would go to local districts in the periphery.
Instead, he said, the money would go to the same place – the health funds’ headquarters in Tel Aviv.
“From there, the needed money is not getting to the periphery,” he said.
Because the mechanism for actually moving the money to the periphery and inducing more doctors to work in the North and South is absent and therefore not considered serious, the major government rearrangement in healthcare is not taking place, he explained.
Chernichovsky declared that more decision-making on health and allocation of resources must be done on the district level – a bottomto- top mechanism instead of the longtime, theoretical top-to-bottom one that has left the periphery weaker and less healthy, with lower income and higher infant mortality, for example.
He added that including all areas in the South, such as wealthy suburban areas around Beersheba, in the “periphery” was not useful, as the socioeconomic condition of residents there was very different from those in the actual periphery. A real mechanism for decentralization would ensure a significant increase in hospital beds in the periphery compared to the Center, and genuine encouragement for doctors to move to the outlying regions and work for incentive pay, he said.
“Nobody is willing to pay, in the North and South, the salaries that doctors can get in Tel Aviv or Herzliya or the most expensive Jerusalem areas,” Chernichovsky said.
He also accused the government of failing to carry out significant change regarding the periphery. He included the Health Ministry, but did not name names.
“It was all much ado about nothing,” he said about the January 1 health fund disbursement change.
Although the ministry received the Taub Center information from the Post on Monday, no comment was available by press time.
Meanwhile, the Israel Medical Association released a survey showing that 15% of medical residents change their specialties over the course of their training.
In response, IMA chairman Dr. Leonid Eidelman said, a fair was held at BGU to attract residents to the periphery. More than 20 medical specialty associations, including those in neurosurgery, psychiatry, pediatrics, orthopedics, obstetrics and anesthesiology, were presented to encourage young medical school graduates to enter specialities needed in outlying areas. However, the actual number of those convinced to do so was not released.