BGU | MY PATH, Haim Doron, MD

People need to understand that the capabilities of private hospitals in Israel are limited. When an operation encounters complications, the patient needs to be taken immediately to a public hospital that has all the treatment options. In addition, all the public hospitals in Israel are academic and all the departments are recognized sites for specialization -- that is, they operate on a top level, medically speaking. When a patient faces a grave diagnosis, the patient will be operated on by a highly-skilled senior surgeon. In the conflict between free choice and equality, in my opinion, there is no reason to forgo striving for equality. Yes, there is some conflict. There are conferences on equality that are held, research on equality conducted, but no concrete steps are taken that bring equality closer and cancel inequalities in a systematic manner. Just the opposite -- steps are being taken that actually worsen inequalities. As a member of the health council for 17 years, all the time I argued that one can rectify injustices, such as senior citizens forced to choose between groceries and prescriptions, with minimal measures. But even this injustice remains. As previously stated, the reason, unfortunately, is that the Ministry of Finance runs the health system more than the Ministry of Health does. In my opinion, it is possible to make a number of changes that will allow choice in the public system. For instance, I don’t see any objective reason against transfering the right to a second opinion from supplementary insurance, SHABAN , to the basic basket of health services. The only reason it remains as is, is the tremendous profits of the supplementary insurance plans from this item. A second opinion as a basic entitlement would strengthen the public medical system. Nevertheless, and despite all the talk about the danger of private medicine overwhelming public medicine, this has not been done. I feel bound to note that free choice of hospital at the discretion of a patient’s primary physician was part of the 1981 agreement between Minister of Health Eliezer Shostak and Clalit. The current way – where the sick funds pay the various hospitals – stands contradictory to such free choice. Despite speeches about equality, those who could make such reforms, do the exact opposite. It is absurd that the economic factor is the only decisive one, because in the long run, it isn’t even economic We’re talking about “capping”. 154 The 1983 Doctors’ Strike The Israeli Medical Association (IMA): A Professional Scientific Society or a Union for Leveraging Salary Issues? The doctors strike between March and June of 1983 was a very painful event. I would define it as “an earthquake in the health system” that dealt a major blow to public medicine. Yes, struggles over salary levels were always part of the health system in Israel. During my period as a primary doctor in the Negev, I experienced firsthand the struggle of Clalit’s physicians. There were two facets: The first was a justified battle over wages. This emanated from the fact that during this period, the Labor Federation championed a policy of equal wages where a public bus driver and a Clalit doctor made identical wages; and the doctors revolted against this policy. Secondly, there was a struggle against the “clerks' regime” in the management of Clalit in those times. 155 The doctors viewed the clerks and administrative directors as the source of their subjugation, although this was not accurate.

154 Capping is an accounting methodology between the hospitals and the sick funds, where a consumption ceiling is set down in advance for all hospitals vis-à-vis each of the sick funds. Consumption of services beyond the ceiling is billed at a reduced rate. 155 “Clerk’s regime” is what elsewhere Doron labels “the reign of the functionaries.” This was essentially a regime by apparatchiks. See chapter 4, footnote 56.

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