The Management of Israeli Hospitals
The Taub Center for Social Policy Studies in Israel convened a symposium on the organization and management of the inpatient hospital system in Israel.
Participants in this special meeting, which was held at the Menachem Begin Heritage Center in Jerusalem, included professionals and policy makers in the field of health: Dr. Yitzhak Berlowitz, Director, Wolfson Medical Center; Prof. Jonathan Halevy, Director, Shaare Zedek Medical Center; Dr. Eitan Hai-Am, former Director-General, Ministry of Health and former Director, Assuta Medical Center; Prof. Eran Halperin, Director, Rabin Medical Center and Chair, the Union of Hospitals; Prof. Moshe Revach, Administrative Chair, Maccabi Healthcare; and, Yael German, MK and former Minister of Health. The discussion was chaired by Dr. Iris Ginzburg, Tel Aviv University.
The meeting opened with a presentation by the Taub Center’s Prof. Dov Chernichovsky and Hadas Fuchs on the historical background of the hospitals and the inpatient system in Israel, and shared some recent data:
- The number of inpatient beds in Israel is low relative to the US, and stands at half of the average of OECD countries.
- The number of inpatient beds in Israel’s geographic periphery is substantially lower than in the country’s center and large cities.
The discussion progressed to a review of potential alternatives for the organization and administration of inpatient services in Israel, such as incorporation of the service, the creation of an inpatient authority, and incorporation under an authority or an administrative body of the Ministry of Health. Each of the discussants spoke about patients of the system who they encounter in the course of their work.
MK Yael German, former Minister of Health, noted governance failures: “There is no regulation in government hospitals, not even at the salary level. The reach of the Ministry of Health is so extensive, that there is no managerial capacity available to oversee the government hospitals.” Prof. Moshe Revach also referred to the inability of the Ministry of Health to offer effective administration: “The Ministry of Health is also seriously handicapped in the area of corporate governance. As a hospital director, you can potentially see the Director-General only once a year. There is no directorate, there is no audit committee and no internal auditing. When the Ministry of Health is busy with 11 hospitals as well as geriatric facilities and also public health, it cannot administer appropriately, and it relies on good people in the system.” Experts also spoke about the lack of updates in the healthcare system, as Dr. Eran Halperin detailed: “No new hospitals have been established, we are working with the same number of job positions since 1977. There are no MRIs and no CTs.”
The panelists discussed the findings from various committees on the topic of the hospitalization system, as well as the Ministry of Health’s division of responsibilities including the necessary long-term conditions in terms of financing, organization and management for carrying out the various options raised. Dr. Yitzhak Berlowitz: “The Ministry of Health is like a handicapped body that cannot fulfill its legal role. The reform in the area of mental health is an example of the split personality of the Ministry: it needs to decide whether it is a regulating and planning unit that thinks about the health needs of the country, or whether it is responsible for running hospitals.”
Dr. Eran Halperin also described problems that affect the whole system and the hospitalization area in particular: “It is understandable that there are directors who will prefer not to do expensive surgeries in order to stay within their budget, or will delay certain procedures due to the expense. The subject of hospitalization has not been on the agenda the past few years because of the desire to treat people within the community. In the health fund hospitals, it is possible to cut medical procedures with the wave of a wand. Health regulation is guided by the whims of economists.”
The discussants raised the importance of finding a solution that will stabilize the system over time as well as the need to consider technological and demographic developments when examining inpatient options. Prof. Jonathan Halevy remarked: “Development of community services is the direction, whoever doesn’t need to come to the hospital – shouldn’t come. Continuity of care is important and this is what the health funds should focus on. There needs to be an investment in hospitals and in their directorates.” Dr. Eitan Hai-Am added: “The funding of the system is far from what it needs to be. There is always a deficit. The solutions must be from the perspective of a patient from Dimona without any insurance or abilities – I would make all of the supplementary insurance public.”
Prof. Moshe Revach summarized the general feeling in his statement: “I hope that the Ministry of Health will be brave enough to make health policy responsive to demographic and technological developments as well as the needs of the public.”