Antitrust Mulls Treating Be'er Sheva Hospital as Health-care Monopoly

Soroka Medical Center, which belongs to the Clalit HMO, provides more than half of all health-care services in southern Israel.

Ofer Vaknin

The Antitrust Authority is considering declaring Be’er Sheva’s only hospital a monopoly in the field of health-care services in southern Israel.

Haaretz has learned that the authority is to launch an investigation into whether Soroka Medical Center – which belongs to the Clalit health maintenance organization and provides more than half of all health-care services in the south – gives members of Clalit priority over members of other HMOs because of a lack of competition. The authority confirmed that it has begun an investigation, but noted that it is preliminary.

If Soroka is declared a monopoly, it will be the first such instance in Israel’s health-care system. The authority will then be able to examine Soroka’s books and prohibit it from any discrimination in terms of supplies, costs and discounts to the various HMOs.

“This could be an earthquake in the health-care system, with broad implications across the board, beginning with community medicine. Ultimately, the quality and availability of health-care services in the south will be affected,” an official in the health-care system said.

Health Minister Yael German unveiled a number of recommendations in Be’er Sheva last week to strengthen public medicine in the south and the Negev. Among the proposals is the establishment of another public hospital in Be’er Sheva by 2025, with 300 beds, while also adding another 98 beds to Soroka by the end of 2016.

According to the Ministry for the Development of the Negev and Galilee, by 2025 the population of the Negev is set to reach 900,000 to 1 million, up from its current 650,000.

Soroka figured prominently in the recent Gaza war, caring for more than 2,000 wounded. It currently provides medical care for more than 1 million Israelis in the south.

According to some health-care officials, the fact that Soroka is the only large public hospital in the south allows it to charge higher rates for medical services to members of HMOs other than Clalit, and also has implications with regard to the employment of doctors living in the south.

To save money, HMOs would sometimes prefer to send their patients to distant hospitals where they have contracts guaranteeing them lower hospitalization fees. However, according to one health-care official, “It’s not logical to send a patient from Be’er Sheva to Tel Aviv, and so the HMOs are forced to purchase services from Soroka … and sometimes to pay 40 percent more compared to other hospitals, like Sheba [Medical Center, Tel Hashomer] or Ichilov [Hospital, Tel Aviv].”

Waiting periods for surgery at Soroka are longer than at most hospitals in Israel. For example, according to a Health Ministry report from last May, the average wait for a particular ear surgery at Soroka in 2013 was 120 days, as opposed to 68 days at Western Galilee Hospital, Nahariya, and Hillel Yaffeh Medical Center, Hadera; 35 days at Beilinson Hospital, Petah Tikva; 12 days at Ichilov; and 10 days at Wolfson Medical Center, Holon, and Assaf Harofeh Hospital, Tzrifin.

Clalit now provides health care for approximately 52 percent of Israel’s population. But the number of people insured by Clalit is greater in the south. In Be’er Sheva it insures 60 percent of the population; in Yeruham 70 per cent; and in the Bnei Shimon Regional Council in the northern Negev, 82 percent.

“Control is much deeper than is imagined,” a medical figure in the south said. “Soroka is also the largest employer in the region, and this is connected. Almost all Soroka employees, their relatives and pensioners, are covered by Clalit … and so it is hard to develop a market segment, and hard to hire doctors whom an HMO cannot promise an income,” he said.

However, according to a senior official in the health-care system, the idea of measuring medical services in business terms might not be the best way forward. “The evidence for this is the fact that health-care services today are not as good as in the past, although there was one dominant HMO and more bureaucracy. If there is a problem of discrimination, let’s deal with it. It is not certain that the establishment of new infrastructure and another hospital in Be’er Sheva is preferable to expanding the existing infrastructure at Soroka,” he said.

Soroka Medical Center and the Health Ministry declined to comment for this story.