The Bottom Line / The hospitals and the `Law of Lines'
When people see a long line at a public institution, they often think that the problem stems from too few clerks and insufficient funds, and that the government should solve the problem by transferring more money to the institution.
When people see a long line at a public institution, they often think that the problem stems from too few clerks and insufficient funds, and that the government should solve the problem by transferring more money to the institution. If you think that, you have fallen into the trap of the "Law of Lines." This law states that if a public institution wants to obtain more funding, the best way to do so is by creating long lines.
Many of us still remember the long lines for obtaining a telephone - lines that numbered up to 200,000 people and produced a wait of seven years. At that time, the Postal Ministry was responsible for supplying telephone service, and in order to obtain larger budgets, it created an endless line. But the minute Bezeq was established, the line disappeared - because Bezeq did not receive its funding from the government.
The doctors used the "Law of Lines" in the early 1990s, creating a long and threatening line for heart operations. The press back then was full of stories about people who died while waiting for their operations, and the lines created heavy public pressure for a solution. But the solution that was found has no parallel in any other public institution: The doctors work in the public hospitals in the morning and earn their first salary, and then, from 4 P.M. onward (and some say even earlier), they work for a "health corporation" run by that very same hospital, with the same operating rooms and the same administration, and there they do exactly what they did in the morning - and this is called "shortening the lines." But of course, they receive a second salary from their "health corporation" - and miracle of miracles, the lines disappeared, because their purpose had been achieved: a significant increase in the doctors' salaries and an additional budget for the hospital administrations, a kind of slush fund that the administrators can use as they please.
Though the corporations make full use of the hospitals' expensive infrastructure, they pay the hospitals only 20 percent of their revenues, while 50 percent of revenues go to pay the salaries of the doctors and the other staff. This is a completely unreasonable proportion that cannot be justified by any economic standard. And if it were changed, so that the hospitals received 30 percent while the doctors and staff received only 40 percent, the bulk of the hospitals' crisis would be solved.
The entire system is problematic. It causes operations to be moved from the mornings to the afternoons, because in the afternoons, doctors are paid per operation, while in the mornings, they receive a fixed salary. Furthermore, the creation of a link between the number of operations and the doctor's salary encourages the doctors to perform more operations, some of which are unnecessary. And the doctors have for years been refusing to punch a time clock, as it would then become clear that the "afternoon" work (in the corporations and the private clinics) actually begins long before 4 P.M.
The hospital administrations also need a "new disk." Some of them spend "according to need" throughout the year, without taking revenues or budgetary constraints into account, and then they suddenly hit a situation in which they claim that there are no medicines, no catheters and patients are liable to die - and the government panics and gives them more money. Some administrations open new units and unnecessary wards for reasons of "prestige" and run their hospitals inefficiently.
Why should the director of a hospital not be responsible for staying within his budget, just as the head of every other organization is?