The Bottom Line / News on Back Pages, Beds on Back Burner

It turns out that geriatric nursing space is a major item. The state spends about NIS 1.3 billion a year on nursing-care beds for impoverished elderly people.

Not even the press bothered much with the appointment of the Pensioners' Party representative, Yaakov Ben Yizri, as health minister. It made the back pages at best. The papers did bother to note that Ben Yizri continues to demand (in vain) that the number of geriatric beds at state institutions be increased.

Dull stuff, isn't it. But that's just the thing, it isn't. Big money is at stake and emotions are running high. For the first time, too, the treasury is facing outright rebellion.

Look at the story from another angle. A few months ago the Antitrust Authority conducted a raid and caught 27 geriatric institution managers red-handed, secretly meeting in Petah Tikva to coordinate bids for a government tender.

What was the tender for? You got it: geriatric hospital space in that city.

It turns out that geriatric nursing space is a major item. The state spends about NIS 1.3 billion a year on nursing-care beds for impoverished elderly people. The money goes to hundreds of institutions around Israel.

A person is entitled to partial or full coverage depending on his financial status, and gets to choose an institution from a list. The coverage is managed through "geriatric formulas."

About half the 30,000 geriatric beds in Israel are paid through such formulas, which makes the Health Ministry a major player in the geriatric sphere. So far it has been a very accommodating partner: It chose the institutions with which it would work, and mainly determined how much it would pay each institution for each day an old person is hospitalized, based on extremely vague criteria. Vague enough to engender complaints that the geriatric institutions run by Likud apparatchiks get higher rates, and vice versa.

Because of the complaints, and the long wait for a geriatric formula, the Health Ministry decided on reform. It would clear up the criteria for choosing geriatric institutions, and narrow the gaps between the rates each facility gets.

The reform was ready to roll when the Finance Ministry ambled along with a new idea. The ministry, or rather its accountant general, demanded to know why the Health Ministry was spending a stunning NIS 1.3 billion a year without issuing tenders.

The Finance Ministry took the price structure suggested in the reform, lowered it by 4 percent in the name of efficiency, set that as the maximum price a facility could get, and issued a tender. The pilot tender was for the Petah Tikva area.

But meanwhile the tender is essentially a fiction. The 27 institutions in the Petah Tikva area joined forces, as we explained, to circumvent it.

Even the sector players who didn't collude have nothing but complaints about the tender. One unhappy party is Mishan, the biggest company in Israel for geriatric healthcare.

Mishan manager Shimon Cohen says that at the maximum price the treasury set, he won't even bother to bid. "The price is too low. It would impair the quality of service," he says. "At that price they'll get old people whose diapers get changed once a day instead of four times a day, as is our practice, but the treasury doesn't care. They want to save money at the expense of the aged."

The treasury insists that all it did is introduce a 4-percent efficiency factor into the Health Ministry price, and that the tender includes criteria governing service quality. The unit supervising care at geriatric institutions was enhanced, the treasury adds, and in general, the geriatric formula budget is closed.

"Any savings achieved by the tender will be returned to the Health Ministry so more formulas can be handed out," the Finance Ministry promised. "Mishan is just angry because it was far more convenient for it to get public money without a tender."

Mishan was unconvinced and announced it would boycott the tender. Most of the other institutions in Petah Tikva are doing the same: Only six bought the tender papers. The treasury is firm that public money won't be handed out without a tender and is threatening that institutions boycotting the tender will lose all the beds paid for based on formulas. If that happens, the people cared for at those institutions will find themselves migrating based on how the tender develops.

Nothing like this has ever happened with a treasury tender before, including tenders in which some of Israel's biggest corporations took part.

As said, the geriatric care sector is packed with action. The new health minister faces an interesting time.