Israel wants to abolish private medicine in public hospitals

BMJ 1999; 319 doi: (Published 25 September 1999) Cite this as: BMJ 1999;319:803
  1. Judy Siegel-Itzkovich
  1. Jerusalem

    Israeli doctors say they will “revolt” if the treasury pushes through the Knesset (parliament) a bill to abolish private medical services in public hospitals.

    Such services, known by their Hebrew acronym Sharap, have been legally and widely used for up to 40 years in all of Jerusalem's voluntary hospitals (public hospitals that are free to patients but not owned by the government) including the two hospitals that are part of Hadassah University-Shaare Zedek Hospital and Bikur Holim Hospital The dispute is reminiscent of the row in the United Kingdom over pay beds in the 1970s when the then Labour government decided to abolish private beds in NHS hospitals, provoking anger among private surgeons and hostility from the BMA.

    Under the Sharap arrangement, patients may call the hospital for a private appointment with a senior doctor in the afternoon or evening for consultation in an outpatient clinic or diagnostic institute. They pay the hospital a set fee that is divided between the medical centre and the doctor.

    Sharap also allows patients to choose which surgeon will operate on them Hospital administrations insist they supervise Sharap to ensure that non-paying public patients whose stay in hospital is covered by their health fund are not penalised, and that private consultations and operations take place only after hours.

    A recent study at an Israeli university found that most public patients in one hospital in Jerusalem said that their medical care was as good as that given to Sharap patients in the same wards. They did, however, maintain that doctors tended to explain their treatment more and show greater personal interest in Sharap patients than in non-paying patients.

    After the introduction of the national health insurance system in 1995, which required that hospitals be run on an economic basis, medical centres owned by the government and by the largest health fund, Clalit, gradually began to introduce Sharap in various forms, but without receiving approval from the health ministry.

    Instead of a formal arrangement, patients requesting private medical services are asked to “contribute” to a hospital department research fund to get the surgeon of their choice.

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