Hospitals, a Law Unto Themselves

Israel's ministries are not overly fond of the Finance Ministry. On the contrary, it has a reputation of belligerence, of usurping the ministries' powers and leaving them bereft of content.

We have a surprise for the ministries: the Finance monster isn't that scary after all. It is belligerent and aggressive, it does scheme to usurp almost any of their powers that come to mind. But there's no need to sweat over it: one can simply ignore its directives, even when it bares its  fangs, and it will work, too.

It certainly works for the health establishment. The Finance Ministry and its two main branches, the Budget office and accountant-general, have declared war on the health system. Yes, war. One can find no more appropriate appellation for the Finance Ministry's latest move:  it threatened to separate the hospitals' treasurers from the hospitals' managements. The treasurers wouldn't be subject to the management any more, but to the treasury's accountant-general.

The forum of 11 government hospitals, together with the entire upper echelon at the Health Ministry, managed to scuttle the proposal. "There is no authority without responsibility," is the Forum of 11 slogan. "Either we manage the hospitals, including all financial powers, or not."

The Forum accused the treasury of casting aspersions on the hospitals' managers, and added that if there is any suspicion of financial shenanigans at a specific institution, the manager of that hospital should be required to provide explanations, but that's all.

They have a point, the Forum. The attempt to extract the treasurers from the sway of the management does cast doubt on the managers of the hospitals. In fact, it demonstrates the Finance Ministry's total lack of faith in the way the government hospitals' managers run their budgets, which total NIS 5 billion a year.

Why else would the treasury try to gain control of the hospitals' budgets?

Maybe the reason is that Hezi Hai, the chairman of the Hospitals Treasurers Committee, attests that the managements threaten the treasurers to approve extraordinary costs, otherwise the managements will persecute them.

Maybe the reason is that is the legal dispute that erupted between the Wolfson Hospital treasurer and manager, after the manager informed the treasurer that she was prohibited from interfering with wages, though they comprise 70% of the hospital's costs.

Maybe the reason is the agreements the hospitals signed with the health services (kupot holim), global agreements that cost NIS 15 billion over three years, without the approval of the treasurers, though the law requires their approval.

Maybe the reason is that the managers are the undisputed rulers of the government hospitals. They compete over who runs the strongest and most important hospital. Each for instance has set up its own transplants unit: Israel is a world leader in the number of transplants per capita. It is a negative title to hold, causing waste of resources, and impairing the standards of each individual such unit.

Even the state comptroller has been questioning how the Health Ministry approved, with no professional debate, the launch of a third pediatric surgical ward at Ichilov in Tel Aviv. The decision was made while Gabi Barabash was the ministry's director-general, moments before he returned to serve as manager of Ichilov. It contravened expert opinions that there are already too many pediatric surgical wards in central Israel, and opening yet another would impair medical standards and, naturally, waste a great deal of money.

These hospital rulers are not required to account for their decisions. They are not subject to a board of directors or any other supervisor. The Health Ministry certainly does not fulfill that function. They therefore are accustomed to doing whatever they please. Only the treasurer is independent, acting based on the budget, which could ruin their hegemony.

But that hegemony is not dictated from above. Beilinson's manager doesn't have it, for instance. In fact hardly anybody has heard of Beilinson's manager, though Beilinson does not fall short in importance of Ichilov, Tel Hashomer or Wolfson, all of which serve central Israel.

That is because Beilinson belongs to the Clalit health service and its manager is subordinate to the Clalit manager, Zeev Vurmerbrand. With Vurmerbrand (and he isn't a doctor, by the way), the management hierarchy is crystal clear, and a hospital manager is not a law unto himself. Over at the Health Ministry, there is no hierarchy, no supervision, and no attempt to manage the health system, and the government hospitals.