Harsh words characterized the debates at last week's Dead Sea conference on the health system. The conference, which usually consists of academic discussions, can be a bit boring, but it was quite stormy this year, focusing on the issues troubling the system's leadership: the expansion of private medicine in Israel, the supplementary insurance offered by the health maintenance organizations and the private hospitals.

For six years Sharap private medical services were offered at Ichilov, Sheba, Rambam and Assaf Harofeh hospitals, enabling supplementary health insurance policyholders to choose a surgeon. A few years ago Sharap services were canceled, after then attorney general Elyakim Rubinstein ruled that they infringed on the principle of equality. Ever since then the hospitals have been trying to get Sharap reinstated.

	Advertisement

"I fear that within five years there will be no more public health system in Israel," said Prof. Shlomo Noy, deputy director of R&D at Sheba Hospital. He was expressing the sentiments of all the public and government hospitals on the upcoming opening of the new Assuta hospital in Tel Aviv and the expected approval for a new private hospital to be built by Clalit Health Services.

Representatives of the government hospitals fear that the fancy new operating rooms at the private hospitals will result in "the skimming of the cream" - a diversion of the simpler and more profitable operations to the private hospitals, leaving the more complicated and less profitable procedures to the public hospitals, and the mass defection of doctors and nurses to the private hospitals.

"Even today we are aware that our employees are being offered 3 to 10 times what they are earning here, and we cannot match those offers due to regulatory restrictions," said Dr. Yitzhak Zaidise, deputy director at Sheba.

Representatives of Maccabi Healthcare Services (which has the controlling stake in Assuta) and Clalit reject such claims, saying that one of the reasons for the flourishing of private medicine is the high prices the public hospitals charged the HMOs for the various procedures. This made it worthwhile for the HMOs to send their insured to the private hospitals. Prof. Shuki Shemer, the outgoing director-general of Maccabi and the Assuta chair, said he felt he was facing a tribunal convened to assail Assuta, when the debate should be much wider.

The solution the public hospitals are seeking is the approval to offer Sharap services - private operations and medical procedures within the private hospitals. "Under the current conditions we cannot compete with the private hospitals because supplementary insurance policyholders cannot come to us," said Noy. "If we could offer Sharap services, we would have no problem competing with the private hospitals, even concerning prices."

Another, more radical solution proposed during the debate was to "move one step backward" - to take Assuta away from Maccabi and not to grant Clalit permits for private beds, completely separating the private hospitals and the public health service.