Doctors' Proposal Will Leave Patients Paying Through the Nose, Warns Expert

'The illusion that supplementary insurance would enable patients to pay to choose their doctor throughout the public health system is baseless,' said Prof. Gabi Bin Nun.

The momentum is growing for a plan to let doctors provide private medical care in public hospitals in exchange for reducing their salary demands and ending their strike.

The idea has been brewing for weeks, and has backing from Deputy Health Minister Yaakov Litzman, the hospital managers and the doctors union. Ronni Gamzu, the ministry's director general, said yesterday that he supports the idea, which he called "a legitimate and appropriate method that the government should consider."

Barzilai Hospital, doctors strike
Ilan Asayag

But health expert Prof. Gabi Bin Nun says that contrary to what doctors' representatives say, the plan would mean thousands of patients would be paying thousands of shekels for basic surgical procedures. Bin Nun is in the department of health system management at Ben-Gurion University of the Negev.

"The illusion that supplementary insurance would enable patients to pay to choose their doctor throughout the public health system is baseless," said Bin Nun. He rejected the doctors' claims that the whole issue would be solved by having the payments covered by supplementary health insurance, which 80% of Israelis have, as opposed to patients paying out of their own pockets.

"The moment that patients can choose their doctor at any hospital, demand will increase fourfold or fivefold, and the supplementary insurance programs will need to raise their premiums fourfold or fivefold," he said.

"Worse, when choosing their doctor [at private hospitals, as is currently allowed] patients pay a down payment of 15% to 20%, which means thousands of people will be paying thousands of shekels for simple surgical procedures around the country," he said.

Meanwhile yesterday, there was no progress in the negotiations between the doctors and the government. The Finance Ministry repeated its offer to work with an arbitrator but the doctors refused, saying they would agree to do so only if the negotiations were not limited to salary and also included matters such as standards and private medical care (See story, Page 4 ).

"We consider [private medical care] the least bad solution," said Gamzu. "Maybe it's not the best solution, but the Finance Ministry is not offering giving the system another option, and is strangling it. I simply don't see other options. When I entered this post, I thought my insistence, aggressiveness and professionalism would advance the health system, but as time passes, I've learned that the Finance Ministry isn't really interested in this, but just wants to get through the storm. They're not interested in investing hundreds of millions [of shekels] to strengthen the system."

The plan would let patients choose their own doctors at public hospitals in exchange for payment made through the supplementary health insurance. Such an arrangement currently is in force only for the Jerusalem's Hadassah University Hospital and Shaare Zedek. It existed at other public hospitals until 2002 but was halted after then-Attorney General Elyakim Rubinstein and later the High Court of Justice ruled that it damaged the principle of equality.

Currently, patients may choose their own doctors only at private hospitals, plus Hadassah and Shaare Zedek.

The doctors want this system reinstated as an alternative form of compensation, and because it would let them stay at their hospitals to work in the afternoon, as opposed to leaving for their private practices.

Supporters of the plan call it a way to raise doctors' salaries without further taxing the state budget, and a way to end the strike quickly.

Litzman said that while the court had rejected this arrangement in the past, it had also said that the state had the authority to permit it legally.

Prime Minister Benjamin Netanyahu has yet to state his stance. His bureau said: "The issue of private medical care is indeed being examined, but no decisions have been made."

However, the proposal has plenty of opponents, who are finding themselves with unfamiliar bedfellows: the Finance Ministry, Knesset members, the Clalit health maintenance organization and human rights organizations.

"We have a good public system. We don't want to see different systems for the rich and for the poor," said Finance Minister Yuval Steinitz at a press conference yesterday. "We want equal service for all, more or less. We need to be very cautious with any proposal that would discriminate between different groups on such a basic matter," he said.

The treasury hinted that it would even be willing to raise the budget for top doctors who are paid to work afternoons, too. "The permit to conduct private health services would be the largest privatization process in the history of the state," said Bin Nun. "It would be scandalous to let a union decide to charge the public money as a means of solving a labor dispute."

At the moment of truth, the treasury could be tempted to support the deal, said Bin Nun.

"This would let it obtain two goals at once - it would reduce the state budget by more than NIS 1 billion by having private groups fund various medical procedures, and it could solve the labor dispute with the doctors," said Bin Nun.