IDF Discourages Clinics From Sending Soldiers to ER

The Israel Defense Forces discourages doctors at the privately run Bikur Rofeh medical clinics from sending off-duty soldiers to hospital emergency rooms under the contractual arrangement between the sides, according to information obtained by the Movement for Freedom of Information at the request of TheMarker.

For example, Bikur Rofeh can be charged a penalty if the number of soldiers dispatched to hospitals out of the total number of military patients arriving at the clinics exceeds an undisclosed percentage of cases. Bikur Rofeh is also entitled to undisclosed sums if the number of referrals to hospital emergency rooms falls below the specified percentage.

A senior official in the medical establishment who has seen the agreement claims the provision can potentially cause soldiers harm. "The IDF doesn't have its own independent emergency system and relies on the general hospitals," he explained. "With all due respect to the Bikur Rofeh infrastructure, it isn't always a substitute for emergency rooms. Even the health maintenance organizations understand this and allow doctors at the special medical centers to make referrals to the emergency rooms if necessary, as is often the case, without any restriction. This obstruction, therefore, doesn't make any sense. Discretion must remain in the hands of the doctors and not be dictated by various incentives."

A senior military source we spoke with, however, rejected these claims. "The agreement contains a good solution for urgent cases," he said. "Each clinic offers a nurse, blood and urine testing, x-rays, and sometimes orthopedic testing and treatment too. Most cases requiring initial emergency medical attention are covered by these clinics, and only a small percentage is referred to emergency rooms.

"In any case, we constantly subject the clinics to tight quality controls which also have a financial side," he added. "This control includes the subject of referrals to emergency rooms and proves that decisions on referrals to emergency are based on professional judgment. We haven't found any cases where soldiers weren't referred to emergency despite needing to go there. If we found that a doctor hadn't performed in accordance with required professional standards, we terminated his work."

Contrary to urban legends, however, Bikur Rofeh doctors aren't given any incentive to refrain from giving soldiers sick leave ("gimmelim" in army vernacular ). The doctors can provide a soldier with up to three days of consecutive or non-consecutive sick leave in the space of a week, plus another six non-consecutive days a month. Anything beyond that is subject to army approval.

Wait times at the clinics are also rigidly spelled out. Soldiers must be examined within 15 minutes of arrival and within an hour and a half by a doctor. In addition, every clinic must have a waiting room that can comfortably accommodate 30 soldiers and be outfitted with comfortable seating, a television set, and air conditioning or heating throughout the year.

The IDF contracted Bikur Rofeh to off-duty personnel and soldiers on leave with medical care several years ago after closing down the clinics attached to its katzin ha'ir (city security officer ) offices throughout Israel.