Israeli Surgeons Illegally Demand Thousands of Dollars From Medical Tourists

Doctors demand payments for surgery on top of official fees to Tel Aviv’s Ichilov Hospital, investigative program 'Uvda’ to report.

Three leading surgeons at Tel Aviv’s Ichilov Hospital have illegally demanded thousands of dollars to perform surgery on medical tourists, the investigative program “Uvda” ("Fact") will report Monday night. The payment comes on top of the hospital’s official medical tourism fee, which is supposed to cover a surgeon’s salary.

The doctors and hospital officials strongly deny that the surgeons have done anything improper, but "Uvda" records the doctors making special requests for remuneration.   

An "Uvda" reporter visited the doctors’ offices disguised as a medical tourism agent. Speaking with Prof. Zvi Ram, head of neurosurgery, she asked about the cost of surgery and made two requests.

First, Ram would perform the surgery, a request that breaches the Health Ministry’s rules and Israeli law. Second, the procedure would take place at Ichilov, a public hospital, not Tel Aviv’s Assouta Medical Center, a private hospital where surgeons may operate privately in exchange for payment.

Ram explained how there would be one payment for the hospital and one for him. “In the biopsy, my surgeon’s fee is 8,000 euros. If we opt for surgery, the hospital cost might be around $30,000 … and about 7,000 euros for three people – that’s the staff; it’s unofficial …. If she needs surgery, it’ll be another $60,000 for the second operation.”

Prof. Shlomi Constantini, director of the children’s neurosurgery department, demanded 30,000 euros for the operation. He said only 20,000 euros would go to the hospital’s medical tourism department. Although asked repeatedly where the rest would go, he refused to explain.

The third surgeon, Dr. Yossi Paz, chairman of the Ichilov doctors’ union and a senior heart surgeon, said he would perform the surgery himself for 30,000 shekels ($8,570) and provide a receipt. This would come on top of the payment to Ichilov.

Constantini is one of a small number of internationally renowned doctors who receive a monthly salary over 100,000 shekels ($28,547) in exchange for total dedication to the hospital. Ram has a prosperous private practice alongside his hospital position.

Ram and Paz were both active in the 2011 social protests, demanding better conditions for doctors in the public health system. Paz is considered a whistle-blower, having exposed corruption at Ichilov.

“I don’t do any private business at Ichilov. That’s nonsense,” Ram said, later adding that when he charges a medical tourism fee at Ichilov it’s not for surgery but for monitoring services.

Constantini said he is not allowed to charge medical tourists for an operation at Ichilov and he does not meet with medical tourism agents at his Ichilov office. In a follow-up talk he added: “I don’t charge for surgery; my price quotes are in the general-treatment framework.”

Paz said agents only come to his clinic in the suburb of Givatayim and never to Ichilov. “I’ve never charged 30,000 shekels,” he said. “But it doesn’t matter. Even if I charged 100,000 it’s irrelevant because it’s a private market.”

In a follow-up talk Paz admitted he performs “private” operations at Ichilov but said he believed that medical tourism is an entirely private service. He added that he might do a medical tourism operation at Ichilov instead of at Assouta “so that Ichilov gets something out of it .... If this were black-market medicine I wouldn’t offer a receipt.”

Medical tourism is rapidly growing in Israel; Ichilov is one of three public hospitals where revenues are highest in this sector. The Health Ministry said in October that Ichilov’s medical tourism revenues reached 99 million shekels in 2012, a 44 percent increase over two years.

According to the state comptroller, the medical tourism industry infringes on equality in the provision of health services. If medical tourism flourishes, Israelis could face longer lines for public health services.

Israel does not yet have clear guidelines on the number of medical tourists a hospital can take in and how the money is distributed. As a result, each hospital makes its own rules, though a special committee is drafting guidelines. The panel is headed by Eugene Kandel, head of the National Economic Council in the Prime Minister’s Office.

Kobi Kalmanovitz