hospital - Moran Mayan - December 6 2010
Patients in the hallways at Haifa’s Rambam Medical Center. Photo by Moran Mayan
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Deputy Health Minister Yaakov Litzman has compiled a plan to address overcrowding and bed shortages in public hospitals across the country, Haaretz has learned. A key element of the plan, which Litzman is already pushing toward implementation, involves setting up emergency rooms in towns and cities that lack full hospitals which would provide basic medical services, including blood tests and X-rays.

According to the model prepared by the Health Ministry, a third of the project's cost will be covered by the ministry itself, a third by the local authority, and a third by the health maintenance organization chosen to run each particular facility, pending cooperation agreements with competing HMOs.

The plan currently calls for 10 new emergency rooms, starting with five to be set up in Umm al-Fahm, Arad, Taibeh, Kiryat Shmona and Yeruham.

Litzman told Haaretz that emergency room lines are extremely long, and that he believes the new ERs would solve that problem. Since taking office, the deputy health minister has conducted surprise inspections of emergency rooms across the country and has gathered data on how long people usually wait to receive medical attention.

The Health Ministry does not regularly collect such data, but surveys conducted by various medical associations indicate that the ER waiting time does appear to be an issue.

A survey carried out by the Israeli Neurological Association in 28 hospitals and released this week put the average wait time for a stroke patient to enter a CAT scan at 1.8 hours. A Cardiologists Association survey found that those seeking treatment for clogged blood vessels wait an average of 1.5 hours, although one hospital had an average wait time of over 2 hours.

Litzman also said he will soon instruct the ambulance service to place an intensive care ambulance in every large town in Israel that does not currently have a hospital or emergency room, in a bid to increase medical responsiveness in an emergency. Large towns are not legally required to have an intensive care ambulance, and many today make do with a regular ambulance.

600 more beds

Meanwhile, the health and finance ministries have reached an agreement to add another 600 hospital beds over the next six years, a move also aimed at reducing the overcrowding of Israeli hospitals.

"This is a historical agreement," said Litzman, referring to the decade-long freeze on the number of hospital beds. The freeze resulted in Israel placing very low among developed nations in terms of the relative number of hospital beds, with 1.93 hospital beds per 1,000 people. This number is much lower than the relative rates seen in the United Kingdom (2.6 beds per 1,000 people ), the United States (2.7 ), France (3.6 ), Germany (5.7 ) and Japan (8.2 ).

The Finance Ministry and the Israel Medical Association are also currently negotiating new salary arrangements for physicians in the public sector, and senior health care officials told Haaretz that the agreement on hospital beds resulted from the treasury's desire to remove that specific demand from its negotiations with physicians.

Litzman said the first beds supplied through the agreement will be placed in emergency rooms. He also said he would intervene in the negotiations between physicians and the treasury in a bid to raise the earnings of physicians working in the periphery.

"It's important to give better wages to those physicians working in the periphery as well as over the weekend," Litzman said. He also told a conference at Haifa University this week that he intends to encourage private medical services in public hospitals on weekends - at an extra cost - to embolden doctors to stay in public facilities and not defect en mass to private ones.

Seeking lower co-payments

The deputy health minister is also seeking to reduce the amount patients must pay for medication. A ministry committee appointed to examine the difference between the prices of drugs purchased by HMOS from pharmaceutical companies and patient co-payments will conclude its findings shortly. Litzman said the panel had found "very large gaps between the prices."

Publication of the results is expected to draw strong protests from the HMOs, who until now treated price agreements between themselves and the pharmaceutical companies as a commercial secret.

"It's not that the HMOs are putting money in their own pockets, because they use the money they make from low drug prices to improve medical treatments," Litzman explained. "But still, it's possible to reduce co-payments related to the purchase of medicine, especially for underprivileged families."

In February, Haaretz reported on a plan for the gradual reduction of co-payments, written by the committee head and chief of the ministry's community medicine department, Dr. Dror Guberman. The full report was never published and in October Physicians for Human Rights, the Association for Civil Rights in Israel and the Adva Center wrote to Litzman, requesting that the report be released.