Senior Health Ministry officials, including heads of state-owned hospitals, are publicly criticizing ministry decisions they say could cause irrevocable damage to the country's public health system.

Their criticism also argets the ministry's approval of expanding the supplemental insurance programs of the Clalit and Maccabi health maintenance organizations to include drugs for cancer and other serious illnesses that are not part of the basic basket of goods and services.

A joint finance and health ministry team has been created to set policy for creating the facility envisioned by Clalit. Maccabi is currently the only HMO to own private hospitals (its Assuta hospital chain has 300 inpatient beds).

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Prof. Gabi Barabash, director of Tel Aviv's municipal-national Ichilov Hospital, wrote on February 22 to Health Ministry Director General Prof. Avi Israeli and treasury budgets director Kobi Haber that allowing Clalit to operate a private hospital "spells disaster for the public hospitalization system."

Barabash called for a total separation of the HMOs from hospital ownership or operation, and asked Israeli and Haber to suspend progress on Clalit's plan until a "comprehensive and exhaustive discussion" is held.

Barabash also requested a comprehensive discussion be held on a detailed document by Ichilov deputy director Dr. Ronni Gamzu, advocating for dramatic legal and budgetary changes to the operation and monitoring of the HMOs' supplemental insurance programs and private hospitals.

Gamzu's document provoked strong reactions throughout the country's health system. Among other changes, Gamzu proposed forcing Maccabi to relinquish ownership of the Assuta hospitals and blocking Clalit from establishing a private hospital. "These measures weaken the public inpatient system," he said.

"We will not be able to deny our responsibility in the future, when [the full implication of] these measures is realized and the public health system is blighted. Who will then explain to the public why it can obtain the services of top surgeons only at private hospitals, upon payment?"

A senior official in the Health Ministry's budget department, Ruth Ralbag, last week joined the fray, arguing in a letter to Israeli that the incentives for opening private hospitals lead to a decline in the public health system and the division of health consumers into rich and poor.

Prof. Rafael Beyar, CEO and director general of Rambam Medical Center in Haifa, warned Israeli, "The current situation threatens Israel's public and academic health and the standing of the country's health establishment ... and could lead to irrevocable damage."

Dr. Meir Oren, director of the government-owned Hillel Yaffe Hospital in Hadera, wrote to Israeli, "There is no doubt that the writing is on the wall - the destruction of public health in Israel, the growth and cultivation of private medicine with public funds and at a much higher cost to the public, and reduced access for the public at large. This is imitating the American model, which should be avoided at all costs."

Neither Health Minister Yacov Ben-Yizri nor his ministry responded by press time.