Katz pushes ‘Cap Law,’ leaving hospitals angry over ‘budgetary neglect’

Part of the Arrangements Law, dictates how health care providers and hospitals secure payments • suggested mental health, “payment-per-bed" reforms spark anger

By HAGAY HACOHEN
Updated: DECEMBER 13, 2020 22:00
Foreign Minister Israel Katz attends a cabinet meeting, December 2019. (photo credit: MARC ISRAEL SELLEM)
Foreign Minister Israel Katz attends a cabinet meeting, December 2019.
(photo credit: MARC ISRAEL SELLEM)
Finance Minister Israel Katz is pushing the so-called Cap Law as part of the up-and-coming Arrangements Law, despite protests from hospital directors that the planned reform spells “budgetary neglect” during a pandemic with severe mental health fallout.
The Cap Law outlines how health care providers such as Maccabi and Clalit are to pay hospitals and vice-versa. The caps limit payment, which, if exceeded, will reduce further state funding. For example, health care providers pay hospitals, which are run by the state, for each patient who is taking up a hospital bed for the duration of their stay.
How can hospitals be prevented from extending people’s stay to collect more money?
The Cap Law states that, after X number of days, the healthcare providers pay very little or nothing at all. Just as there is a cap, there is also a floor: a basic sum that must be paid even if, during one year, nobody needs that service.
The agreement used to be valid for a three-year period and binds 24 hospitals and four healthcare providers across the nation. The new Cap Law, if approved, will be valid for five years.
What does the new Cap Law contain? The concept of a global sum paid to each hospital wing based on its numbers of beds. If a patient stays in one bed beyond the cap, the healthcare providers will pay full price. This money won’t go to the hospital but rather to a fund. The sums collected will be given to hospitals that can show they became more efficient by meeting objective standards.
Healthcare providers could also get that money if they can point to steps taken to offer better service, for example, when the issue is looking after the health of the elderly. The lump sum for days spent in hospitals across the country was NIS 23.4 billion in other Cap Laws approved in previous years, TheMarker reported.
The Cap Law also includes a limitation on health services the hospital offers “on the side.” Since state-owned hospitals can’t sell their services, Israel witnessed the creation of “Health Services” that can raise funds, reward medical doctors and purchase new equipment. Such firms pass 40% of their earnings to the hospitals they work with.
The new Cap Law places a limit on that. If the growth of the firm is 130% more than the hospital it is meant to serve, all the money (not 40%) would go to the hospital directly.
The new budget would remove a mental health cap so that healthcare providers will not be given discounts for sending patients to the psychiatric ward, where they take up beds. The money is meant to encourage the pursuit of other options for looking after mental health patients within their communities.
“The new Cap Law cements all the bad things that led us to the situation we faced with COVID-19,” head of the Forum of Government Hospitals Dr. Miki Halbertel said during a Sunday protest against the new payments scheme. The situation was described as “budgetary neglect.”
He claimed that the Health Ministry supports the forum on this issue and that “the Finance [Ministry] level must understand they can’t separate authority from responsibility,” Walla reported.
The Finance Ministry gave hospitals until Tuesday morning to respond to its proposal.
“It’s time to stop the chronic starvation of the Health System and the endless wrestling between [different] actors [in it],” the forum said, “it’s best to continue with the existing [cap] law with additional [funds] and enter marathon discussions about a new method of calculation that will benefit all citizens.”


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