BGU | MY PATH, Haim Doron, MD

CHAPTER 10

The Physicians’ Strike: Causes and Outcomes

Public Medicine and Private Medicine - the Backdrop to the Doctors’ Strike Physicians’ Salary Demands from the Public Health System Over the Years During my medical studies, I got to know the darker side of Argentine private medical practices and totally disapproved of them. I knew what an appendectomy was, whether it was warranted or not, and other such issues. 144 In the course of the history of the medical system in Israel, there were various changes that took place in regard to private practice. Public medicine in Israel was primarily developed by salaried physicians. Limitations on raises in salaries, attributed to concern about a domino effect on the rest of the economy or to overall budgetary limitations of the health system, created a series of crises in public medicine. In addition, one needs to take into account waves of mass immigration of doctors from Germany in the 1930s, of doctors from Russia at the end of the 1980s and early 1990s. In these waves of aliyah, the very matter of finding employment for all such immigrant physicians was very problematic. This was exacerbated by the fact that the Ministry of Health in Israel didn’t engage in supervision and regulation of the health system as a whole, only in the daily management of its own hospitals. The split among government hospitals and hospitals of the sick funds and other public hospitals had an impact on disparities in the wages of doctors. In the early years of the health system there were two cases of rebellion among the doctors. These involved their demanding the option to engage in private medicine. In 1920, there was a rebellion of Hadassah doctors against their director Dr. Iitzhak Rubinow, who championed comprehensive social security, including health, and fiercely opposed private medicine. 145 And, in 1946, at Beilinson Hospital, Dr. Sheba headed a rebellion of a group of doctors in favor of private medicine. It was against Clalit’s policy-makers. 146 The common denominator in the two events was the agreement of the doctors’ employers, Hadassah and Clalit, to all the wage demands except one: private practice within the public system. Historically, Clalit has always been highly sensitive to blending and mixing public medicine with private medicine. Thus, I was very sorry when Maccabi acquired a private hospital, Assuta. And I was even sorrier when Clalit acquired beds in the private Herzliya Medical Center hospital as leverage in the competition among the sick funds. In its first years, Clalit handled negotiating wage agreements with the personnel in its hospitals. On the other hand, government hospitals conducted wage agreements with the officer of wage control or “governor of wages” in the Ministry of Finance. 147 This led to much resentment on the part of government employees who staffed the government hospitals and fueled a sense of unfair discrimination compared to Clalit doctors. 144 According to Doron, under Argentine private medical practices there were doctors who removed appendixes based on economic considerations, even if from a medical standpoint this was unnecessary. 145 On the Hadassah doctors’ revolt see: Shvarts S., De Leeuw L.A., Granit S., Benbassat J., "From Socialist Principles to Motorcycle Maintenance: The Origin and the Development of the Salaried Physicians Model in Israel Public Health Services, 1918 to1998." AJPH, 89(2)248-253, 1999, https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.89.2.248 and Ran Lachman and Shlomo Noi, Ketem Shachor al Chaluk Lavan, Refu’a Shcho-rah b-Israel (A Black Stain on a White Coat: Under-the-Table Medicine in Israel), Ramot Publishers and Tel Aviv University, 1998, pp. 17-26. 146 On the doctors’ revolt at Beilinson, seen also Shvarts S., Health and Zionism, The Univ. of Rochester Press, 2008, pp.31-57, https://boydellandbrewer.com/9781580462792/health-and-zionism/ 147 The head of the Wage and Labor Accord Unit of the Ministry of Finance is an official with legal authority under the Foundations of the Budget Law 1985 to prevent changes in wages in the public sector. The Law was enacted during the period of hyperinflation in Israel.

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