BGU | MY PATH, Haim Doron, MD

of a “donation” to a departmental “research fund” or some other creative form of benefit. 152 I’m glad to say, at the community level of the health system that I was so intimately involved with for so many years, this brand of mixing of private and public medicine occurred very little. Allowing Private Medical Services in Public Hospitals There is an internal arrangement within each hospital as to the nature of its SHARAP , i.e., the private medical services that operate within the halls of public hospitals. Free choice of physician is the main principle of SHARAP . As already noted briefly, the beginning of private medical services operating within public hospitals began in 1954 at Hadassah Hospital. The arrangement was introduced by Hadassah director, Prof. Kalman Mann, and later copied by other hospitals not affiliated with the Ministry of Health or Clalit, such as Shaare Zedek in Jerusalem, Laniado in Natanya, and others. The fact that the Ministry of Health did not deal with supervision and regulation of hospitals, only their daily operations, prevented the Ministry from taking a very simple and necessary step. In my opinion, it should have been able to declare that any hospital receiving patients in the framework of the sick funds, even when health insurance was voluntary, would not be permitted to have a SHARAP . If the Ministry could have been able to make such a decision, it could have solved the problem of earning gaps that accompanied mixing, or polluting, public medicine with private practice. There were demands to establish a SHARAP at Clalit hospitals as well, but there never was a green light to do so. During my tenure, I could not conceive of such a thing as private medical services in public hospitals. I always rejected a SHARAP hands down, and I’m glad to say that to this day Clalit hospitals don’t have them. There have been Ministers of Health who were inclined to view the SHARAP as a solution to various problems, and even promised doctors such a thing in negotiations with them. That was the situation until the legal advisor to Attorney General Elyakim Rubinstein issued a clear directive to the Ministry of Health to prohibit operation of a SHARAP in a government-run hospital. I’m only sorry Rubinstein didn’t have the authority to broaden the prohibition to encompass public hospitals. Had he been allowed to do so, the entire health system would be far more homogeneous on this score. I already noted the signing of an agreement between Clalit and Shaare Zedek was held up precisely due to the presence of a SHARAP at Shaare Zedek. 153 But in the end, I had two options. I could either sign the agreement and accept the hospital’s status quo, or I could abandon the idea of joint management of the hospital. We decided to sign and accept the Shaare Zedek SHARAP . Today, in the materialistic milieu that exists and aware of all the opportunities now for private medicine, I think the Shaare Zedek’s SHARAP is probably the lesser of all evils. But I still don’t agree with it, and I still would never initiate such an arrangement at any public hospital. Those in favor of the SHARAP and private medicine in general, base their position on the argument that the patient should be allowed free choice of doctor and surgeon. They say that a person facing major surgery or a grave diagnosis will pay any sum in order to procure the best physician there is and won’t stick to lofty ideologies of public medicine. They uphold free choice above the value of equality.

152 Doron is referring to what was a widespread practice -- senior physicians taking what, in essence, were bribes or extra payments for their services. These payments then become unreported income. The patient’s objective in seeing these physicians and making the payments is either to cut queues and/or ensure that the senior physician would be the staff member performing a patient’s operation within the public health system, not someone else on staff, such as a resident. 153 This agreement is discussed in Chapter 7

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