Health Ministry gets failing grade in report
The State Comptroller’s annual report released on Tuesday gave the Health Ministry a failing mark in its role as a regulator of a variety of fields related to public health.
Criticism of the ministry included inadequate performance of surgeries in public medical centers, including the 11 state-owned general hospitals; long queues for surgeries; a shortage of anesthesiologists; poor provision of diagnostic and treatment for young children with developmental problems; a deficient pharmacology department; and irregularities at Hillel Yaffe Medical Center in Hadera.
“The Health Ministry does not carry out its job as regulator and as the body responsible for directing the health system; it also owns and directs the state hospitals. It has no comprehensive operating theory for surgical theaters, and it supplies only random and separate instructions,” the comptroller wrote. “It has never carried out a staff plan to set strategy for the future needs of operations according to various criteria including their geographical deployment, and it lacks a master plan for the development and equipment of operating rooms.”
Regarding elective (non-emergency) surgery, the comptroller wrote that the ministry’s shortcomings resulted in wasted money, manpower and infrastructure; caused suffering for patients and their families, including anxiety and uncertainty; and damaged public faith in the public health system, the outcome of which has been a growing preference for the private medical system.
Waiting times for non-emergency surgery can in some cases extend to a year or more; operating rooms in many public hospitals only function between 7.30 a.m. and 3 p.m., after which many surgeons rush to their private practices; staffers arrive late; there is a shortage of auxiliary workers and anesthesiologists; there is an insufficient number of recovery rooms, which delays the start of operations; the scheduling of operations for patients is very inefficient, which in some cases causes a decline in patient conditions while they await surgery.
The comptroller urged the ministry to “immediately” prepare a national program for shortening queues for surgery in an effective manner that will slow the “bleeding” of surgical services in public hospitals as it flourishes in private hospitals that performs “easier” cases at high costs.
The report also found that even though only 11% of surgical theaters are in private hospitals, these perform 23% of the operations in the country; the share of the private hospitals in performing the 20 most common types of operations rose by 58% in 2014 compared to only 19% in the public hospitals. The state-owned Wolfson Medical Center in Holon and the Rabin Medical Center-Beilinson Campus in Petah Tikva of Clalit Health Services were especially criticized for their failure to efficiently use their operating rooms; the ministry failed to set targets for the hospitals on the use of operating rooms as well.
According to the report, there is a major shortage of anesthesiologists, particularly in the periphery, whose specialty is needed not only in operating rooms but also in obstetrics departments and for many other procedures. By 2030, it is estimated that there will be a shortage of 1,000 anesthesiologists around the country. The ministry has also done little to cope with the severe shortage of academic nurses and auxiliary hospital workers, the report found.
In the section of the report focusing on Hillel Yaffe, the comptroller found that management prevented the internal comptroller from conducting investigations. He also discovered that 15% of hospital workers are related to other employees, raising the risk of conflict of interest.
Hillel Yaffe also received contributions from commercial companies, and drug and medical equipment companies also financed trips and stays of doctors for attending medical conferences abroad, all of which introduce the danger of conflict of interest, the report found.
The comptroller also faulted institutions for diagnosing and treating children with development disorders. One out of 10 children up to the age of 18 – 280,000 of them – have development disorders, and some are handled in these centers. The problems involve communications disorders, autism, cerebral palsy and cognitive disorders. But the comptroller said that many youths are prevented from receiving treatment on time due to the division of responsibility among many institutions. Most families have to wait more than the three-month maximum period for diagnosis set by the Health Ministry.
Due to financial constraints, some child development centers have been closed or in danger of closing, especially in the periphery. In addition, the Health Ministry “has done nothing to encourage doctors to specialize in pediatric neurology and child development,” the comptroller wrote. There are also too few developmental psychologists, which contributes to delays in treatment.
Regarding the ministry’s pharmacology department, the report found that due to insufficient supervision, the four public health funds do not examine and oversee taking of prescription drugs by those with chronic illness. In addition, many patients do not take the drugs they are prescribed, while others suffer from polypharmacy – taking too many types of drugs, some of them unnecessary and even dangerous. There is also a serious shortage of clinical pharmacists with advanced degrees in the hospitals and the community, and ministry supervision of unregistered prescribed drugs is also inadequate, the report found.
The pharmacology department has also failed to regulate and supervise the re-use of medical equipment that is supposed to be disposed of after a single use. At a hospital owned by Meuhedet Health Services, Misgav Ladach in Jerusalem, for example, such reuse led to the infection with the hepatitis C virus (which, untreated, could have fatal consequences) of 12 patients. The comptroller also found that many customers of health fund pharmacies wait in line for as long as 90 minutes for service.
The comptroller recommended the establishment of a professional and efficient body like the US Food and Drug Administration to take over many of the ministry’s food and drug supervision responsibilities.