The exposure on Channel 2’s investigative program Uvda of three senior surgeons at Tel Aviv’s Ichilov Hospital who demanded direct payment from medical tourists undergoing surgery in public hospitals, brought to light some of the maladies of Israel’s medical system. The surgeons caught on film in their misdeeds – Prof. Zvi Ram, Prof. Shlomo Constantini and Dr. Yossi Paz – are among the most senior surgeons in the country. The norms underlying this kind of behavior should concern every person in Israel.
The most disconcerting distortion uncovered in the report is the automatic use by senior physicians – who obtained their experience and their reputations in the public medical system and earn good money there – of public infrastructure to make private profits. This blurring of the boundaries between public and private is symptomatic of a managerial and moral deterioration, as well as of corrupt organizational conduct along the lines of the behavior at the Ashdod Port, where powerful employees take advantage of public resources for their own purposes.
Another distortion involves the attitude toward medical tourism, which has been a source of significant income for public hospitals. Medical tourism produces important income, but the lack of a clear policy leads to a “whatever the market will bear” approach, which ultimately harms the Israeli patients who are trumped by the medical tourists.
The healthcare system has been at a crossroads in recent years. Alongside attempts by public medicine to attract private sources of income, medical insurance and private medical services have created two tiers – those who can afford to choose a physician, receive expedited treatment and be reimbursed, and those who are cared for according to the conditions of public medicine. The main task facing Health Minister Yael German and the committee she heads, which is currently discussing ways to strengthen public medicine, is not to find the right combination of public and private medicine, but to separate the two and strengthen the public system, which is still the system that serves most Israelis.
A strong public medical system will contribute to the training of doctors, significant research and, first and foremost, to professional efficiency, according to which treatment will be based on medical priorities and not the economic wherewithal of the patient.
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