Out of Control at the Hospitals

A consumer affairs TV program last week exposed a department chief at an Israeli government hospital. He charged patients thousands of shekels for shortening the waiting period for eye operations.

According to the report, those who paid were bumped to the top of the list. But he was breaking the law prohibiting fees for "extra" medical services at public hospitals in Israel.

It's no secret that black market medicine exists at Israeli hospitals. Yet we needed the good services of the media to expose the doctors scorning the law and violating the sacred principle of equality in Israeli medical care.

Why does the media have to be the one to dig? Because no one else can do it.

Israeli government hospitals employ thousands of workers, serve millions of citizens and enjoy budgets totaling NIS 5 billion in public funding - not one has an internal auditor.
Last year the State Comptroller devoted a chapter in his report to the absence of internal auditors at hospitals.
The comptroller recommended the appointment of internal auditors to hospitals, and the Civil Service Commission promised this would be done.

A year later. Shock and horror - not only have internal auditors not been appointed to the hospitals: nobody is working on promoting such appointments.

The Civil Service and mainly the Health Ministry, which is responsible for supervising government hospitals, blame the Finance Ministry. The Health Ministry claims it asked treasury for 11 positions for internal auditors: nothing happened.

The Israeli health system's annual budget is NIS 20 billion. The budget for the hospitals alone is NIS 5 billion, and the administrative department at the Health Ministry takes NIS 900 million for itself.

The health system spends NIS 700 million annually on drugs, without zero supervision or attempt to cut costs.

NIS 300 million in debts to the hospitals, owed by people who received treatment in emergency rooms and never paid, were declared lost, but nobody tried to collect them.

No budget could be found, however, for the 11 internal auditor positions at the hospitals, and this of course is the treasury's fault.

In the absence of internal auditors, the person responsible for supervising events at the 11 government hospitals is the Health Ministry's comptroller, Arieh Paz.

Paz, who is considered one of the most successful comptrollers at the government ministries, can indeed be credited for exposing a number of cases of corruption at Israeli hospitals - including the affair that led to the conviction and seven-year jail term for Vladimir Yakirevich, director of the cardiac department at Tel Aviv's Ichilov Hospital.

But Paz says he doesn't have the staff to conduct frequent and thorough reviews of the hospitals. The budget, like the human resources allocations at Paz?s disposal, are undoubtedly under the exclusive authority of the Health Ministry. The treasury has no access there. The budget allocated by the Health Ministry to Paz, who is supposed to oversee thousands of workers and the tens of billions of shekels that power the health system, consists of five employees and NIS 100,000 a year for hiring the services of external auditors.

For years the ministry has also been maintaining an office to handle the incorporation of the hospitals − a process that is still beyond the horizon − at an annual cost of NIS 1 million.

'Does the Health Ministry think it reasonable that a division of five workers can supervise the entire health system?' we asked the ministry?s spokesperson. 'The Health Ministry gives priority to allocating positions for treating patients,' came the reply.

In practice, the budget received by the Health Ministry's comptroller does not enable him to conduct effective audits, not in the Health Ministry itself, and certainly not at the 11 government hospitals.

De facto, the government's interest in safeguarding public health and the funds invested there has been abandoned.

This reality is worth pondering when examining the ministers' enthusiastic vote this week, regarding tenders.

Until now the Finance Ministry has been responsible for government tenders at all ministries: it has had the sole power to grant exemptions from the duty to issue tenders for contracts, too. 

Accountant General Yaron Zelekha warned that without treasury supervision, corruption at the ministries could run rampant, as ministers grant overpriced contracts with a wink and nod to their second cousins once removed. Yet the ministers gleefully voted themselves all power over tenders.

Moroever, the ministers voted to raise the bar for the duty to publish a tender, from NIS 0.7 million to NIS 4 million.

The ministers claimed that usurping ths power from the treasury would make their ministries more . Nobody happened to mention that the ministries are already operating without supervision, and there is no one capable of reviewing the dozens of financial undertakings to be conducted without a tender.