Medical Services That Widen the Gap Between Rich and Poor

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'Come to me and I’ll do the operation tomorrow morning.'Credit: Getty Images

The coming days will be critical for public medicine in Israel. A special committee is about to issue recommendations, including for sharap services; sharap is an acronym for private medical services at public hospitals.

Hospital directors and senior doctors are lobbying for the sharap system. But is this in the public interest? Won’t these private services further widen the disparity between rich and poor? Three issues linked to the sharap system have been in the news recently: the long wait for private services at Hadassah Medical Center, the long wait for surgery and so-called medical tourism.

A new study by the Hebrew University found that the average wait for a doctor in Hadassah’s public track is two months, while a patient who paid for private services can obtain medical care in less than a week. This is exactly what will happen in the medical system as a whole if it moves to the sharap system. Hadassah’s collapse showed us that doctors will be blinded by money; salaries of hundreds of thousands of shekels a month at public expense.

For every 1,000 shekels ($290) that Hadassah took in from sharap, 840 went to doctors (a little also went to nurses). The hospital kept only 160 shekels, which meant it took a loss, since 16 percent does not cover the cost of an operating room, tests and equipment.

The numbers on medical tourism, recently examined by Accountant General Michal Abadi-Boiangiu, are also shocking. Rich patients from Russia have paid hospitals and doctors large sums (sometimes off the books) to receive much greater priority over Israeli citizens.

Russian tourists could obtain an appointment for surgery within a few days with the department head of their choice, in most cases with the surgery scheduled for the morning – hours when doctors are supposed to be devoting all their time to citizens of this country. That’s what they’re paid for.

But while medical tourists jumped to the head of the line, Israeli citizens waited 366 days for a knee replacement, 191 days for surgery to correct a deviated septum, 102 days for surgery to treat an aortic aneurysm and 61 days for bypass surgery. Could anything be more scandalous?

Health Minister Yael German, the head of the special committee, needs to understand that once there are sharap services, a department head will say to patients: You have two options – wait six months, with a good chance the surgery will be done by an inexperienced junior doctor, or come to me via sharap and I’ll do the operation tomorrow morning.

It’s obvious what patients will choose – if they have money. It’s also obvious that the sharap money will make hundreds of doctors millionaires as we all effectively pay a new health tax.

If we want to improve the pay of star doctors to keep them from fleeing to private medicine, we could have them working a second shift at the hospital for higher pay. Anyone who wants to earn a half million shekels a month can work at the private Assouta Medical Center in Tel Aviv, but without being able to run a department at a public hospital. Let’s see who comes to him for surgery then.

The sad part of the sharap story is that we have many excellent doctors who dedicate themselves entirely to their patients and the public hospitals regardless of the financial compensation. They’re being hurt by the same greedy doctors who are hurting the image of doctors as a whole.

German has to understand that sharap services will destroy the health system (as it destroyed Hadassah), make medical care more expensive, and widen the gaps between rich and poor. Is that what she wants?

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