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ERs require emergency care
Comptroller's report addresses Health Ministry supervision inadequacies.
Inadequate Health Ministry supervision of hospital emergency departments was prominent among the shortcomings published in the chapter on the ministry, which has not ensured that an adequate complement of personnel and beds are available.

The relatively short, low-key chapter did not mention the issue regarded as one one the ministry’s biggest failure in the past year – its purchase of 7.2 million doses of H1N1 flu vaccine at a cost of some NIS 700 million and its failure to persuade the majority of Israelis to get vaccinated.

Asked about this, the comptroller’s spokesman said that the comptroller decided to deal with this issue in “a future report that will be part of a comprehensive examination of Health Ministry readiness for health emergencies.” Emergency rooms are affected by the availability of urgent care centers – both public and private – in the community to handle urgent medical cases from fractures to chest pains. But the ministry has failed to set a national policy about these centers and – amazingly – does not supervise their functioning or insist that they be licensed (although its doctors are licensed), unlike private surgical clinics.

In the emergency rooms themselves, there is no standard of service. A newly minted intern without any experience can discharge emergency room patients.

The comptroller also found that the health fund rules vary, with some paying more for emergency visits that don’t end in hospitalization and other paying less. Patients have no clue what they are bound to pay, he declared.

Many emergency departments are very crowded, but the ministry has not taken action to minimize excessive numbers of patients and long queues, the comptroller said. Even when there are urgent-care centers in the community, the ministry hasn’t taken action to use these for systematic reduction of pressure on emergency rooms in the same area.

Because of long queues in emergency rooms and hospital departments, many patients who require inpatient care are instead kept in emergency rooms; this is unacceptable, the comptroller stated.

The ministry must also set maximum waiting times in emergency rooms. It should also consider having emergency medicine specialists on duty at all times, not just have them called in when urgently needed.

The health funds have special agreements with hospitals, and some patients are required to travel longer distances for treatment in a medical center that has an agreement with their insurers. The comptroller calls on the ministry to encourage more flexibility so that patients will not be penalized because of these agreements.

The comptroller reiterated that the ministry supplies psychiatric services inadequately and inequitably around the country, instead of implementing the recommendation of a state judicial commission from over 20 years ago to transfer responsibility for mental health services to the health funds.

As a result, the queues for outpatient care in ministry-owned clinics are too long, and those who need urgent help seek it privately or go without.
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