Physicians Protest HMO Takeover of Well-baby Clinics

Doctors groups petitioned the High Court of Justice yesterday against plans to transfer management of well-baby clinics from the state to health maintenance organizations. The 2007 draft budget includes a NIS 50 million trial to transfer many of the clinics, which the Israeli Medical Association and the state doctors' union call privatization of the clinics.

The HMOs already run about 20 percent of the country's well-baby clinics, but the doctors groups oppose any expansion of the plan, saying the state health law disagrees with removing well-baby clinics from state hands. The groups said the Finance Ministry move, "made without proper authority and in the name of fiscal savings, amounts to contempt of the Knesset."

At an Israel Medical Association press conference in Tel Aviv yesterday, the organization presented a detailed report on the "Danger to Public Health" - transfer of the clinics to the HMOs. Well-baby clinics provide preventive medicine services to children through age five, including instructions for parents, monitoring development and vaccinations.

The IMA report details the vehement opposition to restructuring the clinics expressed by public committees, various Knesset committees, and former health ministers Danny Naveh and Nissim Dahan.

IMA chairman Yoram Blachar said yesterday that transfering the well-baby clinics to the HMOs would harm weaker populations, which cannot pay HMO deductibles for the services. The report warns against allowing preventive medicine becoming "health for the wealthy."

The report says the HMOs are concentrated in well-off urban areas and would close clinics in outlying areas, which serve a weaker population. In addition, doctors are concerned fewer children would receive early childhood vaccinations. "Pediatric medical experts are concerned that preventive medicine budgets would get swallowed up by the general HMO budgets and would face cutbacks," the report said.

The doctors say Israel is considered a leader in vaccination coverage with 97 percent of children under 12 months immunized against diphtheria, tetanus and whooping cough. In addition, 98 percent of children are vaccinated against hepatitis B and 93 percent against polio.

However, the IMA said the agreement between the health and finance ministries and the HMOs stipulates that in order to receive funding under the pilot program, "an HMO must reach 75 percent vaccination."

Instead, the IMA is demanding that the state adopt a four-year-old public health report determining "it is not clear transfering the service to the HMOs would create fiscal savings... Taking responsibility for preventive medicine from the well-baby clinics would endanger a vital service whose contribution to public health in Israel is indisputable."

The Health Ministry said in response it "believes the quality of service at the well-baby clinics is deteriorating since the budget is not updated to reflect population changes. The ministry agreed to transfer some of the clinics to HMOs so the ministry's budget and personnel would be freed to better serve the public."