Israel’s Health Care System Seen by Many As Sick Itself

Israel once prided itself on having one of the best and most comprehensive public health care systems in the world. But the system itself is now ailing, crippled by years of labor strife.

Strikes by doctors, nurses and other health service employees have broken out periodically, usually over wages and working conditions. Hospitals have been forced to operate on reduced Sabbath schedules for days at a time. All but the sickest patients are sent home. Only emergency surgery is performed. The skeleton staffs on duty are hard pressed to feed patients, let alone clean up and provide fresh linen.

These conditions are once again in the headlines. This week, 11,000 administrative and maintenance personnel at 29 government hospitals walked off their jobs in defiance of a Jerusalem labor court’s back-to-work order. They are demanding higher wages.

Last Thursday and Friday, doctors at the same hospitals staged a 24-hour “warning strike” to protest cuts in the medical staff. Hospital nurses who have walked off their jobs at least a half dozen times during the past year are threatening to strike again.

CONFUSING HEALTH CARE SYSTEM

Many outsiders are confused by Israel’s health care system. It is not and never was a State-owned system. Even before the establishment of the State in 1948, it was based largely on a broad network of hospitals and clinics owned by Histadrut, Israel’s trade union federation, and operated by Kupat Holim, the Histadrut sick-fund.

Kupat Holim runs a dozen or more hospitals, the largest being Beilinson Hospital in Petach Tikva, and scores of clinics in virtually every city, village and kibbutz.

The government, in addition to providing large subsidies to Kupat Holim and several smaller health funds, operates 29 hospitals country-wide. Eleven of them are general hospitals, 10 are psychiatric facilities and eight are geriatric hospitals.

A number of these hospitals are maintained by the government in conjunction with the municipalities in which they are located.

Though dwarfed by Kupat Holim, there are several important smaller sick-funds. The Maccabi Sick Fund, founded by the Liberal Party but no longer affiliated with it, is second largest. Its clients largely are middle class and professionals, some of them members of Histadrut, who prefer the greater freedom of choice of doctors offered and the shorter waiting time for medical attention at clinics.

There also is the National Sick Fund, established decades ago by the Herut Party, whose members refuse to join Histadrut — a prerequisite for membership in Kupat Holim. Maccabi and the National Sick Fund do not maintain their own hospitals, but both have a wide network of clinics. Their patients needing hospitalization are sent to government facilities.

Finally, there are two or three small and quite expensive medical insurance groups which reimburse their members for visits to private doctors or stays at the country’s very few private hospitals.

Some say that the multiplicity of sick funds and private health insurance services is responsible for the plight of Israel’s health care system. The situation has prompted anti-Histadrut activists to renew their demands for a comprehensive national state health system which would take over Kupat Holim.

Histadrut is strenuously opposed to the idea, which could result in a sharp decline of its membership. It is generally acknowledged that many Israeli workers join Histadrut only because of the health benefits. Monthly Histadrut union dues cover health care by Kupat Holim.

Basically, the same problems beset the Histadrut and the government hospitals. A four-month doctors’ strike in 1982 was observed by the medical staffs of both. The same is true of the present strike by administrative and maintenance personnel. However, the 9,000 Kupat Holim workers did return to their jobs this week, but only after an impassioned radio appeal by President Chaim Herzog not to take out their grievances on the sick and helpless.

SEEK WAGE PARITY

The government hospital employees were not persuaded. They claim they are paid little more than the national minimum wage and demand wage equality with their counterparts at the Kupat Holim hospitals and clinics.

The latter obtained improved wages in direct negotiations with Histadrut which is in the position of being both employer and union. The government hospital workers say the Treasury promised them equal pay for equal work months ago but so far has not honored its word.

They were further embittered when the labor court ruled they were acting illegally and threatened stiff penalties. The court levied a 250 Shekel (about $150) an hour fine on four strike leaders arrested Monday. The fine was rescinded Tuesday when the court found that the strike leaders made a genuine though unsuccessful effort to get their colleagues back to work. The four were then dismissed by the strike committee. They still have to pay 10,000 Shekels (about $6,250) in expenses.

The labor court hinted Wednesday that all penalties might be lifted if the strikers return to work. But that seems unlikely at the moment.

If the rash of strikes and walk-outs continues, many believe a State health service will have to be established, possibly to the advantage of no one.