'Sanctions won’t solve health system's structural problems'

BGU economist says unless an agreement is reached for comprehensive reform, the Israel Medical Association will strike every two or three years.

By JUDY SIEGEL-ITZKOVICH
doctors protest 311 (photo credit: Marc Israel Sellem)
doctors protest 311
(photo credit: Marc Israel Sellem)
The doctors’ sanctions, which began in April, will “not solve the structural problems” of the health system; unless an agreement is reached for comprehensive reform, the Israel Medical Association will strike every two or three years, senior health economist Prof. Dov Chernichovsky said on Monday.
Chernichovsky, a professor of health economics and policy at Ben-Gurion University of the Negev in Beersheba, wrote a “National Status Report” for Jerusalem’s Taub Center for Social Policy Studies that contained a chapter on the doctors’ dispute.
Chernichovsky, who frequently advises foreign governments on health systems, recommended that when the current labor dispute ends, the state should launch comprehensive reform in health services by making “corrections,” some of which have already been recommended by various public committees. He urged that the state invest significantly more money in public medical services, as it did before 1995, encourage competition and free choice of doctors in the public sector and give hospital administrators more effective tools – including higher-paying personal contracts for those doctors working only in the public sector.
The changes should be applied over a period of five to seven years, by which the state should restore public expenditure in health to 70 percent of all health costs, which is the average current level in OECD countries, compared to less than 60% in Israel today. In addition, said the BGU and Taub Center economist, health expenditures must increase to 9% of the gross domestic product instead of Israel’s current level of 8.2%.
The state, via government hospitals, should reduce its supply of health services while at the same time raising public expenditures for health.
Agreements must be reached with health workers, especially government employees in the health sector, who would get compensation for carrying out the necessary organization and management changes, Chernichovsky said.
Just raising the public-sector doctors’ wages and even increasing manpower slots in the hospitals and community services will not solve the serious structural problems, said Chernichovsky. The sources of these problems are economic and demographic and the government’s “mistaken policy” over the last 15 years, he maintained.
The health system has changed due to the ageing of the population, a rise in the standard of living and a reduction in medical services due to the decline in public-sector medical manpower, Chernichovsky told The Jerusalem Post in an interview. Instead of helping public medical services to cope with the growing gaps between supply and demand that increase demand for privately funded services, the state helps raise demand by reducing its financing of public medicine.
The gap was filled by private supplementary health insurance from the four health funds or from private insurance companies. “There is nothing like this [policy] anywhere in any health system in the world,” he declared.
As most physicians are public employees, most of excess demand for healthcare is supplied with private funding by the same doctors who also work in public hospitals and clinics; some even provide this care in government-owned facilities. He bemoaned the fact that because of high demand for care, prices for private treatment rose by 92% between 1995 and 2009, while the consumer price index has increased by only 61% during that period.
Thus those public doctors who moonlight privately are paid twice, doubling medical infrastructure in the private sector that already exists in the public sector and adopting medical technologies in an uncontrolled and wasteful way, Chernichovsky said. The amount of medical services the public received during the 15-year period has increased by only 13%, while expenditures have grown by 30%. This has resulted in relatively lower wages for medical staffers in the public sector, at the expense of those in the private sector, he said.
As a result, medical care has become less accessible to the poor, and medical care has become less efficient. The majority of those who suffer are people over the age of 65, many of whom forgo urgent treatment because they can’t pay, and those who live in the periphery, he concluded.