Foreign Bodies Threaten Our Health

Medical tourism to Israel is profitable, but it raises some serious ethical issues.

The committee headed by Health Minister Yael German that’s exploring ways of strengthening the public health system will soon have to decide the fate of medical tourism in Israel. It's one of the most profitable branches of medicine, but is also the subject of bitter controversy. Its proponents highlight its profitability, which they say supports the public health system itself. Critics, though, claim preference is given to foreign tourists seeking medical care here over the medical needs of Israelis, and say this is a violation of the legal right of the country's citizens to receive public medical care worthy of the name.

The issue of foreign medical tourism cannot be considered without regard to the overall situation in the health system here. The number of hospital beds per population in Israel is among the lowest in the Western world. The occupancy rate of hospital wards is currently among the highest in the world, and the situation is getting worse. There is also a shortage of doctors, nurses and other medical support staff, and of operating rooms. Under these circumstances, the addition of patients from abroad seeking medical care here, and the facilities that must be put at their disposal, necessarily comes at the expense of Israeli patients.

Data in the most recent report on the situation by the state comptroller shows that, during a six-month period in 2009 alone, about 23,000 foreign medical tourists came to Israel. And from then until 2011, according to official Health Ministry data, revenues from medical tourism have increased by more than 200 percent.

On the assumption that per capita expenditures on medical care have not substantially changed, that would mean there has been a considerable increase in the demands on hospital facilities in this country. And it's also worth noting there are indications that the problem is even worse than official figures would indicate, because the distribution of reported revenues from medical tourists produces unreasonably low average expenditure per person. And this in turn has a negative effect on the reliability of the information the Health Ministry provides.

The medical tourism phenomenon also engenders other concerns - first and foremost the fear that attention to the country's real medical needs will be diverted elsewhere. It is certainly possible that the attention of medical personnel working in the public health system will naturally be devoted first of all to those "preferred" foreign patients who are paying for their individual care. It is also certainly possible that the medical staff would prefer to invest their time and energy in a segment of the patient population that compensates them better.

The price structure for foreign medical tourists is substantially higher than even the prices Israelis pay for private medical care (rather than relying on the public health system). And they are certainly higher than the compensation paid by the country's four nonprofit public health maintenance organizations (kupot holim, as they are known in Hebrew), for the medical care that their insured receive. This in turn creates a clear financial incentive for favoring foreign medical tourists over Israeli patients. And if that weren't enough, the growth in medical tourism causes an increase in the workload of medical staff, which in turn increases the potential and practical harm to the Israeli patient.

It should also be noted that medical care as currently provided in various segments of the public health system to patients from abroad is comparable as a practical matter to private medical service care (sharap care) - medical care that is dispensed during the doctors' private hours but at a public hospital, relying on the public institution's facilities and personnel (particularly for surgical care, oncology and cardiology). In this regard, there is no difference between this care provided to foreigners and sharap, which was the subject of a ruling by the High Court of Justice in the so-called Kiryati case.

In that 2002 case, the court and former attorney general - and now Supreme Court Justice - Elyakim Rubinstein made it clear that shortening the waiting time for medical care for one patient meant causing another patient to wait longer. All those promises about maintaining a balance within the health-care system, through oversight that would avoid harm to existing patients in favor of treatment of additional patients from the outside, are devoid of significance. And that's because of the limited resources of the system and the various incentives that tip the scales in favor of private patients. The conclusion is therefore inescapable that the extent of the damage inflicted by foreign medical tourism on patients in the public health system is greater than the economic benefits it provides the medical system and the country's economy as a whole.

The writer is the legal adviser for Hatzlaha - the Consumers' Movement for the Promotion of a Fair Society and Economy, which submitted a position paper on foreign medical tourism to Health Minister Yael German's committee.