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Doctors treat internal medicine ward patients in Israeli hospital corridors.(Photo by: Courtesy)
‘Conceptual revolution’ required to end hospital ward overcrowding
By EYTAN HALON
01/19/2019
According to data provided by the Health Ministry to The Jerusalem Post last week, the nationwide average occupancy of internal medicine wards stands at approximately 114% of their capacity.
A “conceptual revolution” is required to end severe overcrowding affecting internal medicine wards across Israel’s hospitals, according to the head of the Israel Society of Internal Medicine (ISIM).

Each year, Israelis are admitted about 330,000 times to the country’s 110 internal medicine wards. While the winter weather often means the hospitalization of additional patients, wards are stretched beyond capacity throughout the year.

“You have patients lying in the corridors because there’s no room to admit them, and there are insufficient numbers of doctors and other medical staff to treat them,” Dr. Avishay Elis, head of ISIM and director of Department of Internal Medicine C at Petah Tikva’s Beilinson Hospital, told the Post. “As a result, you witness everything that is happening now: Chaos, overcrowding, lack of attention given to patients and, ultimately, inferior medical care.”

According to data provided by the Health Ministry to The Jerusalem Post last week, the nationwide average occupancy of internal medicine wards stands at approximately 114% of their capacity.
Departments at Jerusalem’s Hadassah University Medical Center in Ein Kerem reported 213.6% occupancy – the greatest across the country – constituting more than double the number of patients the wards are designed to treat. The hospital’s city neighbor, Hadassah on Mount Scopus, reported 155.6% occupancy.

Overcrowding was also reported at Hillel Yaffe Medical Center in Hadera, EMMS Nazareth Hospital, Golda-HaSharon Hospital, Laniado Medical Center, Tel Aviv’s Sourasky Medical Center and Rambam Medical Center in Haifa.

While each bed in an internal medicine ward 40 years ago supported an average of four patients per month, today each bed is used by an average of seven patients monthly, according to ISIM. In that same period of time, the number of beds per 1,000 citizens has decreased from 3.3 to just 1.8.

While internal medicine wards treat patients often suffering from multiple and the most complex medical issues, demanding coordination between a range of medical departments and disciplines, Elis accuses hospital executives of paying insufficient attention to the needs of their departments.

“These departments don’t earn the hospital money, as a hospital is financed according to procedures,” Elis said. “If you do a hip replacement or a kidney transplant, you receive money.
After a birth, the hospital receives so much money. When a patient is lying in an internal medicine ward, however, they receive a low rate and, as patient numbers grow, funding is capped and hospitals receive less and less money.”

According to Elis, even internal medicine wards operating at 100% capacity are understaffed, so when demand significantly surpasses full capacity, medical staff’s ability to deliver necessary treatment is further compromised.

An additional 300-400 senior doctors, Elis estimates, are currently required to fill existing gaps. Trainee doctors, many of whom begin gaining experience on the wards, usually progress to sub-specialties with better wages and working conditions.

The solution, he says, is to alter the mindset of hospital management – a “conceptual revolution” – and broaden the understanding that internal medicine wards are the backbone of the public health system.
“We believe the solution lies in an incentive model, as was implemented for neonatal intensive care units a few years ago,” said Elis.

The incentive model agreed upon by the Health Ministry in 2015 grades neonatal intensive care units in Israel in accordance with a list of parameters, remunerates those units with the highest scores and takes into account improvement over the years.

“We went and built a model like this for the internal medicine wards with the assistance of Prof. Gabi Bin Nun, a well-known health economist in Israel,” Elis said. “We want to put it on the table of the Health Ministry and Finance Ministry.”

In recent weeks, with the assistance of internal medicine department managers, ISIM has started to publish daily reports and photos revealing the reality of overcrowding in their wards, including images showing doctors treating dozens of patients lying in corridors.

“Internal medicine wards are one of the most prominent meeting places between the citizen, when he needs assistance most, and the state,” said Elis. “Everything starts in internal medicine and the departments are of great importance.”
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