  July 10, 2003 Grassroots 'Health Parliament' Recommends Medical Priorities by Judy Siegel-Itzkovich, The Jerusalem Post, July 7, 2003 The "Health Parliament" an experiment in participatory democracy founded with Health Ministry encouragement earlier this year has recommended that Israelis be allowed to choose their surgeon or specialist as part of a private medical service (sharap) that should be instituted in all general hospitals around the country. This is just one of many medical questions dealt with by 120 adults around the country representing many backgrounds, educational levels, experiences, and views. Four out of six regional groups comprising the parliament said that the paid sharap service should be instituted only for choosing one's physician but not for preferential hospital treatment or shortening the queue and that such services should be available only after regular working hours so they are not at the expense of non-paying patients. In addition, the majority of parliament members called for the appointment of an external body that would supervise sharap and ensure that the hospitals meet all the regulations and criteria. Although such a system has been in effect in Jerusalem's voluntary hospitals (such as Hadassah and Shaare Zedek)for decades, the Jerusalem regional parliament ironically opposed this system. Instead, this group insisted that the public should be able to choose a specialist or surgeon but without paying any extra fee. The consensus in Jerusalem was that, due to the higher demand for more experienced specialists, the queue for these doctors would become longer. The parliament's conclusions and official recommendations were presented on Thursday at Sheba Hospital to Health Minister Dan Naveh and the National Health Council (the minister's formal policy advisory committee), but the ministry will take some time to study the recommendations before it announces which (if any) of them it will adopt. The Health Parliament was initiated by former ministry director-general and currently Sheba Hospital medical director Prof. Mordechai Shani. It was encouraged by Health Ministry Director-General Boaz Lev and organized by the Gertner Institute for Health Policy Research (of which Shani is also chairman) and Jerusalem's Zippori Center, in collaboration with Tel Aviv University researchers. An anonymous foreign donor provided funding. The members, picked at random, were exposed intensively to background information and professionally guided discussion of the issues. Although all countries struggle to ration health-care services, and various participatory groups have met in the US, Great Britain, and New Zealand, the organizers say the Israel Health Parliament is unique for its national scope and in the number of regional groups working simultaneously. While the national health insurance system, established on the principle of equal access and progressive health taxes, has ensured all residents since 1995, the growing deficits and vastly increased copayments have aroused concern both within the ministry and among social advocates over the growing gap between those who can afford better treatment and those who cannot. One difficult example of prioritization raised was whether NIS 500,000 be spent on a treatment to lengthen one person's life by four months or to prevent blindness in 100 people. In its discussions of financing health costs, the parliament recommended continuing the charging of copayments for medications and certain medical services. But it also insisted on preserving the exemptions and discounts for the needy and even to expand this to a wider group of people so that no one would be prevented for getting treatment because of income. They also put stress on the importance of disease prevention and early diagnosis of diseases that cost money in the short term but save money in the long term. Most groups agreed that the patient's age alone should not decide whether he or she should get an expensive lifesaving treatment; the quality of life of the patient was regarded as one of the most important criteria for deciding on allocating limited resources. Five of the six regional groups said that highest priority should be given to treatments that service relatively large populations that the average person could not afford himself; these would take precedence over very expensive treatments required by small groups and cheap and commonly needed treatments that patients could pay for themselves. For more information, please contact: Ila Waldman, Executive Director, Friends of Sheba: Los Angeles 1+310-843-0100 or friendsofsheba@aol.com Lauri Novick, Executive Director, Friends of Sheba - Tel Hashomer: New York 1+212-354-8484 or lnovick@shebamedical.org In Israel: Ulrike Haen at Sheba Medical Center +972-3-530-2473 or ulrike.haen@sheba.health.gov.il
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