BGU | MY PATH, Haim Doron, MD

internal medicine. There is an excellent model in Yerucham 48 and a model for primary pediatric medicine in Ofakim; but these are the exceptions.

When I realized the Beer Sheva medical school was not coming on board to promote community medicine on a high level, I invited myself to a meeting of the faculty’s governing council and told them: “Distinguished colleagues. Your way doesn’t lead to the development of primary medicine in the community on a high level. Only specialization of family medicine can contribute to this.” I succeeded in convincing them that it would be worthwhile to bring in a department head from the Emek hospital. Only then did they accept my argument and establish a department of family medicine that operates to this day as an independent department. The greatest waning in the community medicine concept has come from the deans who came after the first. Those deans believed the more the school would deepen the scope of its research and distance itself from the community, the more prestigious it would become. Even though I am not in any way opposed to nurturing research, this view of the deans was a mistake. In the last analysis, academic democracy as practiced at the university, whereby every few years a new dean is chosen by a majority vote, is not the best way to conduct things. The most relevant consideration in choosing a dean should be the best person for furthering the objectives of the medical school. There were deans who were excellent ‘as deans,’ but not for realizing the vision of community medicine which was among the foremost objectives of the medical school at its inception. At every meeting of the Goldman Committee, at my initiative and that of others such as Prof. Stephen C. Schoenbaum, 49 who for many years served as the Goldman Committee’s chair, and Prof. Steven Schroeder, 50 his predecessor in that post and the founding chair of the committee, we made recommendations to strengthen primary medicine in the community. But unfortunately, our recommendations had little effect. The funds were channeled to the hospital and to research – not to medicine in the community. All these processes led to a retreat from a community-oriented commitment. However, the most dramatic event having an adverse effect on channeling of resources to medicine in the community would come from elsewhere: Legislation of the National Health Insurance Law. The public still doesn’t fully appreciate how much damage was inflicted on the health system and medical education in Israel with this law. The law abolished the Parallel Tax. 51 What ensued in the wake of this move, threw Clalit into a budgetary straitjacket. Clalit, even if it was convinced that channeling budgets to medical education was right and proper, couldn’t do this under the conditions forged under the new law. This represented a pitiful philosophy of partition that dominates medicine to this day. The upshot is that the Ministry of Health deals only with medical services, and the Ministry of Education and the Council for Higher Education deal with medical education. This split delivered a death blow to the collaboration between the school of medicine and Clalit, and killed the agreement between them. Thus, cancellation of the Parallel Tax was the decisive factor striking down the original vision of BGU’s school of medicine in Beer Sheva; and the integration of medical service, medical education, and research was dealt 48 A small development town 35 km. southeast of Beer Sheva in the heart of the Negev plateau. 49 Stephen C. Schoenbaum, M.D., is the former medical director and then president of Harvard Pilgrim Health Care of New England, Providence, Rhode Island. He was an associate professor of medicine and associate professor of ambulatory medicine and prevention at Harvard Medical School. He then became Executive Vice President for Programs at The Commonwealth Fund and Executive Director of its Commission on a High-Performance Health System. He is currently Special Advisor to the President of the Josiah Macy Jr. Foundation in New York City and an adjunct professor of healthcare leadership at Brown University. 50 Steven A. Schroeder, M.D., studied medicine at Harvard, and later became director of the Division of General Medicine at the University of California San Francisco (UCSF) where he also did health services research. From 1990-2002, he was the president and CEO of the Robert Wood Johnson Foundation in Princeton New Jersy. In 1996, he became the founding chairperson of the IARC. He currently is Distinguished Professor of Health and Health Care at UCSF, where he heads the Smoking Cessation Leadership Center. 51 Parallel Tax ( Mas Makbeel , in Hebrew) - a special tax that underwrote the operations of the sick funds. A tax had been collected from employees by Israel’s National Insurance Institute, allocated to the four health funds proportionally, per capita , according to a yearly census of their memberships (whose nature has been subject to controversy). The tax was abolished in 1997 in the framework of the annual Arrangement Law. See Chapter 9 for a detailed discussion of the National Health Insurance Law, Parallel Tax, and Arrangement Law.

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