Jerusalem Mayor Nir Barkat called on foreigners to come to Jerusalem as medical tourists for a variety of high-quality medical treatments - such as in-vitro fertilization - in the capital's major hospitals, saying they would cost significantly less than in their own countries. Barkat was speaking at Tuesday's opening of the Fourth International Jerusalem Conference on Health Policy, organized by the Israel National Institute for Health Policy Research (NIHP) at the city's International Convention Center (Binyanei Ha'uma). About 100 healthcare experts from abroad and twice as many from Israel are attending the triennial, three-day conference, which is focused on "Improving Health and Healthcare: Who Is Responsible? Who is Accountable?" Barkat said the city has over 100 startups in the life sciences and that medical tourism fits in nicely with his plans to make the capital a center for biomedical science and tourism, with a cluster of joint ventures being planned around Jerusalem. Institutions here are "very good in computer-guided surgery, image processing, cardiology and many other fields," he said. The city is developing infrastructure so more people from abroad can be accommodated, the mayor added. Deputy Health Minister MK Ya'acov Litzman said that "if [US President Barack] Obama wants to learn from us [about healthcare], we can teach him a few things." Obama's administration is currently fighting a difficult battle to pass a major healthcare reform bill. Also speaking was Dr. Ezekiel Emanuel, a breast oncologist who is head of the bioethics department at US National Institutes of Health. He is also the brother of White House chief of staff Rahm Emanuel, and is on leave from the NIH, serving as a special adviser for health policy to the director of the White House's Office of Management and Budget. Because support for Obama's bill is proving very tough, and only a minority of Americans have been shown in polls to support it, Emanuel declined to give interviews, present a graphic presentation with his speech or discuss the reform bill. "These are personal remarks, and I am not representing anybody," said Emanuel. "I don't want to sink ships with words." Although accountability is today a very popular and accepted term among health experts, Emanuel noted that while individuals and organizations want power, control and authority, "I don't think we want to be held accountable for what we have no responsibility and authority to control. It is a challenge to our authority and power. We like to hold others accountable." A company CEO in the US, he explained, could legitimately claim that he had little control over health insurance costs going up 6 to 8 percent a year (in the US, employers often provide health insurance plans to their workers) because others make the decisions that cause it. In a small country like Israel, where decision makers and healthcare executives all know each other and meet frequently, decision making is more personal, and executives don't want to be known as failures. But in large countries like the US, decision making is more institutional, Emanuel said. "I think we overemphasize accountability. You don't want just to point a finger and blame others, but to bring positive change... "It is widely agreed in the US that we have quantity over quality and have sick-care system, not preventive healthcare. But we have to emphasize people getting better, not just having medical tests." He recalled that people working in Starbucks making coffee and food suffer back pains from standing up all day and are sent to hospital emergency rooms, where they are sent for expensive MRI scans instead of physiotherapy. NIHP head Prof. Shlomo Mor-Yosef, who is also director-general of the Hadassah Medical Organization, said that the benefit of holding conferences since the institute was founded 14 years ago is "to bring all the stakeholders into one room" to discuss problems. The NIHP also supports research into health policy, choosing an elite 25% of proposals to fund. Despite the progress in Israeli health care, there is still a shortage of hospital beds, no dental care in the health basket, an urgent need for mental health reform, no method for comparing hospital performance, inequities and manpower shortages, said Mor-Yosef. Prof. Avi Yisraeli, a former Health Ministry director-general, said that decades ago, doctors took responsibility and were paternalistic. Today, it has gone to the other extreme, with near-total autonomy for patients who have to decide what to do after receiving explanations from their physicians on the pros and cons. Yisraeli hoped for a more balanced policy by reviving and preserving Israeli social responsibility and more incentives for high-quality medicine without encouraging doctors to send patients for tests and treatments just to protect doctors' interests.