The mayor comes out in support of Tipat Halav centers.
By JUDY SIEGEL-ITZKOVICHtipat chalav 88(photo credit: )
Although the Tel Aviv Municipality has decided to forgo provision of its Tipat Halav (family health) centers and participate in a Treasury-mandated "pilot project" handing responsibility over to the four health funds, Jerusalem Mayor Uri Lupolianski vowed this week not to go along with Finance Ministry dictates.
Lupolianski admitted that his original inclination was to go along with the Treasury demands because the well-baby monitoring service costs the city NIS 4 million a year more than the Health Ministry's NIS 23 million subsidy for it. In addition, he said at City Hall on Tuesday along with members of a professional committee he appointed to investigate whether the municipality should hold on to its 31 Tipat Halav centers, the idea that a single authority takes care of residents' health from cradle to grave is logical.
But the mayor said in advance that he would implement recommendations made by the committee. The committee was headed by Prof. Jonathan Mann, chairman of community dentistry at the Hebrew University-Hadassah School of Dental Medicine, an expert on public health and the son of the late Hadassah Medical Organization Prof. Kalman Mann, who was active in the Yad Sarah organization that Lupolianski founded 30 years ago.
"I at first thought I was not qualified, as I am an expert on dentistry and not on infant monitoring," said Mann. "But the mayor said that because I was not involved in the issue, I would be objective."
Other members included Jerusalem District Health Officer Dr. Chen Zamir; City Council member Rabbi Shlomo Rosenstein; pediatrician Dr. Danny Schor; Dr. Rosa Gofin, head of the Hebrew University medical faculty's community medicine and health promotion; Sara Binyamin, chief nurse in charge of family health services; Moshe Hevroni, Kupat Holim Meuhedet's Jerusalem director; and Dr. Ada Ben-Sasson, Clalit Health Services' Jerusalem district director. All the committee members except the two health fund representatives strongly opposed the transfer of responsibility to the insurers.
The Treasury's budgets division, which is constantly interested in cutting costs, has managed to force the Health Ministry to cut its school nurses and other public health services over the past decade. Its proposal for "privatizing" Tipat Halav services has been raised periodically over the years, but only now has it offered NIS 50 million to carry out and assess the "pilot project" in Jerusalem, Tel Aviv, Modi'in and Elad.
Only for historical reasons have well-baby services in Jerusalem and Tel Aviv been supplied by the municipalities. The Hadassah Women's Zionist Organization of America launched them in Jerusalem 85 years ago at the initiative of Henrietta Szold, and later they were expanded to Tel Aviv. They have been widely praised and served as a model around the world.
But while baby monitoring and immunization is free in most developed countries, especially those with national health insurance, in Israel, it still costs parents NIS 415 for services per child from birth through age five - some large families regard it as an economic burden. The family health centers also monitor the health of pregnant women and pre-school children. Several health ministers, including the current Ya'acov Ben-Yizri, have said the fee should be canceled and the state should cover all Tipat Halav services, but no one has found the money to implement it.
Fifty percent of Israel's Tipat Halav centers are owned by the ministry, 33% by Clalit Health Services, 9% by other health funds (especially Maccabi Health Services) and 5% by the Jerusalem and Tel Aviv Municipalities. But Lupolianski said that since Jerusalem has a young population (54% are aged 0 to 23) and over 12,000 Jerusalemites are born here every year, the activities of the city's family health centers represent much more than their numbers.
The majority of the Mann Committee said that the arguments against the transfer were more powerful than those in favor. The municipality's Tipat Halav staff have special training in prevention and early diagnosis of disease in babies. Sick children and healthy children would not be treated simultaneously in the same facility, as in the health funds, which are economically minded organizations that could be tempted to make cuts at the expense of babies to save money. The health fund-owned centers also charge a higher fee than the Jerusalem Municipality.
A further concern is that while the city provides the same high-level service in all neighborhoods, the health funds could easily give less-than-optimum service to certain sectors.
Mann said that the Treasury's "pilot program" was a "waste of money" because if it wanted to study whether the municipal or health fund model were more effective and efficient, it merely had to sponsor an academic study based on the health of babies in each.
There used to be 38 Tipat Halav centers in Jerusalem, but seven have been closed as "efficiency measures." Asked to comment on Lupolianski's demand that it cover the annual NIS 4 million deficit, the Health Ministry had nothing to say, and regarding the pilot program, it noted that the issue is in the hands of a Tel Aviv court, which has frozen the Treasury's initiative for a week until a second hearing is convened.
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