סיום מאכזב ל"24/7 - הדור הבא" - 13.7% רייטינג לגמר

By Haim Shadmi

In recent years, the health system has been working in a competitive environment. Soroka Hospital is not only a hospital that provides medical services to residents of the south, but it is also a hospital owned by the Clalit health maintenance organization. In order to prevent senior doctors leaving for other hospitals, particularly those in the center of the country, Clalit has to offer them a really fat pay check.

Alternatively, it has to lure other senior physicians to Soroka, or other hospitals under Clalit's wing. One such way is to offer them handsome pay. Prof. Azai Appelbaum, head of Soroka's cardiovascular department, brought from Hadassah Hospital nine years ago, and who was the highest-paid person in the public sector in 2001, according to the report released yesterday, is proof of this trend.

The HMOs have fought tooth and nail for years to prevent being included in the treasury's annual report. They held to one reasonable claim: As state hospitals are not required to report salaries, there is no justification for the HMOs to file. The High Court of Justice rejected this argument a year ago, and ruled that they were state-supported, and therefore subject to examination by the treasury's wage director. Data from the Health Ministry and the HMOs show that the burden of payments by the citizen has grown, and an increasing number of patients cannot afford to buy medicines or receive treatment due to lack of funding. The data also demonstrate that the state's funding of health is continually shrinking, while the citizen's share of paying for health services is growing. And all the while, the HMOs rack up vast budget deficits.

Now, particularly in light of the high wages being paid to the most senior posts in the health organizations, it becomes clear it is the citizen who is not profiting from the fruits of competition between the health service providers. In the name of that same competition, the HMOs, so far successfully, have kept from the public knowledge of the true prices HMOs pay for the components of the health service basket. The HMOs also refuse to let the Health Ministry - the government body responsible for supervising the country's health coverage - know what prices they pay. The HMOs buy medicines according to prices agreed in secret negotiations and according to the number of insured with each HMO. They claim these are trade secrets.

The problem lies in the fact that the HMOs are budgeted according to the prices that the Health Ministry has determined for each medicine in the basket, which is always higher than the actual price paid. In many cases, the HMOs save millions, but these monies are not plowed back into offering more comprehensive health services.

In a year in which the government decided not to expand the health basket, a decision that will reverberate for many sufferers, one has an uncomfortable feeling regarding the manner in which the HMOs have been using their monies saved. The number of doctors appearing in the top slots of the public sector "high earners" table only goes to strengthen this feeling.