The Health Ministry has walked back on its plan to improve public health care in Palestinian neighborhoods of East Jerusalem by scrapping the current system in which the country’s four health maintenance organizations work with licensees that run public health clinics in the neighborhoods.
The plan would have had the HMOs operate the public clinics themselves instead, as is the practice in the rest of the country.
In the Palestinian neighborhoods, the licensees open the clinics and employ the doctors and administrative staff who work there.
The system has prompted complaints for many years from Palestinians in the eastern part of the city as well as from human rights groups that have claimed that the care provided has been substandard and not up to the level in Jewish West Jerusalem.
In 2018, the Israeli cabinet approved a comprehensive plan to bridge social disparities between Jewish and Palestinian neighborhoods in Jerusalem. The plan, which received more than 2 billion shekels ($600 million) of government funding, was designed to deal with a range of issues including education, infrastructure, employment and health care.
In the field of public health, the plan called on the Health Ministry to scrap the system of licensees and to have the HMOs run the public health clinics in East Jerusalem themselves. The Health Ministry received 30 million shekels in government funding to make the transition.
Two years later, the ministry reported that of the four HMOs, Leumit Health Care was the only one to do so – directly operating five clinics in East Jerusalem and getting government funding to take the step. And in 2021, the ministry issued an update that expressed reservations about the plan.
“Following conversations with the HMOs, there won’t be additional moves to the direct operating model on the part of the HMOs in the coming years, other than Maccabi [Heathcare Services], which intends to open [a large clinic] in 2022,” the statement said.
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About two weeks ago, the ministry issued a draft proposal that would permit the licensees to continue to operate in East Jerusalem and would reduce the financial incentives for the HMOs to operate clinics there directly. The ministry issued a statement saying that the plan to have the HMOs operate the clinics “has run into various difficulties stemming from the complicated reality in East Jerusalem.” Sources in the field said that the difficulties relate in part to the fact that the licensees have considerable influence.
The Health Ministry said in response to this article that when it saw that the transition was not progressing satisfactorily, it decided that in addition to permitting the HMOs to directly operate clinics, it made an option for them to place their own medical staff at the licensees’ clinics as a condition for funding.
“In light of the unique needs in East Jerusalem, the ministry is currently working on a plan that includes improving the health situation there. The plan is at its initial stages and the ministry expects to include it in the next five-year plan for the east of the city of Jerusalem,” the ministry said.
One major problem with the current system is that the doctors employed by the licensees are not recognized by the ministry. Most of them studied medicine in Arab countries and did not take Israeli medical licensing exams. To overcome the issue, the licensees employ one doctor with an Israeli medical license at each clinic and the others get that doctor’s stamp of approval, sources said.
“You can’t ensure the same level of services, particularly if the licensee wants to save money,” a doctor who worked at one of the clinics told Haaretz.
East Jerusalem health care advocates have collected complaints from residents who could not get a referral to a specialist or an examination other than at their clinic, who were sold medications at inflated prices or who even came to clinics with emergency medical conditions and were turned away because they had not gone to the right location. There were also reports of patients being hesitant to go to hospital emergency rooms.
Erez Venger of the Jerusalem branch of the Maan workers’ rights organization said the situation is more serious in Palestinian neighborhoods that are within the city limits of Jerusalem but are on the West Bank side of the Israeli security barrier.
“People prefer to travel to the Palestinian Authority to receive medical services there for a fee, because they aren’t managing to receive the services from the HMOs. It’s something that I’m encountering more and more.”
Dr. Yael Assor, the coordinator of an umbrella group of civil society groups seeking to narrow health care disparities, said the Health Ministry’s stance was ironic in light of the fact that the current health minister, Nitzan Horowitz, is the leader of Meretz, a political party that has purportedly made equality between Jews and Arabs a priority.