Coated Stents for Profit

Professor Moshe Revah, MD, was furious at this column for its attack on Health Minister Danny Naveh. He wrote to Haaretz in Naveh's defense: "What is wrong with the Health Minister's unwavering position, based on his social world view, that refuses to turn a public hospital into an institution run solely by narrow economic considerations?"
Prof. Revah is not just any doctor. He managed the Rambam hospital in Haifa for 18 years, until fairly recently. Eighteen years on the job did not suffice, it would seem, to grasp that the job of a hospital manager, of any manager, is to run the institution based on economic considerations.
It is actually little wonder that Revah, even after 18 years, didn't realize it, as the one supposed to explain what a hospital manager's job is, doesn't realize it either. In response to the Finance Ministry's attempt to make the treasurers of government hospitals subject to the Finance Ministry's accountant-general, the Health Ministry spokesman commented, "Implementing the proposal would be very bad for the patients. It would force the hospitals to operate based on narrow economic considerations."

The Health Ministry budget is NIS 27 billion, the second-largest after the defense budget. How can NIS 27 billion be managed according to something other than "economic considerations"? It can't, nor is it.

Even though the Health Ministry and the hospital managers would like to demonstrate their contempt for economic considerations, ostensibly on behalf of the patients, the truth is that every medical decision is an economic one too. The Health Ministry sharply raised the price that hospitals can charge for cardiac catheterization and the result was a steep increase in these procedures.

As a result of the manipulation of cardiac catheterizations, the number of open-heart surgeries plunged. But worry not: no hospital closed down its cardiac surgery wards. How would they support the ward managers, how could a hospital take pride in itself, without a cardiac surgery division?

In cardiac catheterizations, often a wire-mesh tubule called a stent is implanted into the patient's main arteries. There are ordinary stents, and there are stents coated with drugs that cost five times more. Until recently the health basket included only ordinary stents but a year ago the drug-coated one was added, too. Based on the doctors' estimate that drug-coated ones are needed in 40% of the cases, drug-coated ones were allocated 40% of the hospitals' budgets for stents (on top of the regular stent budget).

After a year it turned out that the hospitals' stent budget had been increased by 40%, but the number of stent implants had increased by only 28%. The hospitals kept the difference.

It would seem the hospitals do know what economic considerations are, especially when they work in their favor. One suggestion made to solve the problem of having an insufficient amount of drug-coated stent surgeries was that the hospitals be allowed to sell the excess units, privately, to patients.

Any expert on medicine knows what that would cause: a vast increase in operations involving drug-coated stents, because it would pay for the hospitals. All the doctor would have to do is recommend the operation and any patient concerned about his or her heart would buy it, at full price. Who supported that idea? The former health minister, Danny Naveh.

The Health Ministry commented that cardiac catheterization done without medical justification is negligence and the price of the stents is being rechecked.

"Given the changes in the scope of operations at the cardiac units, we shall examine the need to maintain these units," it added.