My doctor’s receptionist tells telephone inquirers that the doctor receives “urgent or important cases” in his surgery. But she does not tell them they will have to pay 600 Shekels (about $16) for the visit, on top of their usual monthly payment to their Kupat Holim (sick-fund).
She doesn’t have to. In this fifth week of a strike by the country’s 8,500 salaried physicians in government hospitals and sick-fund clinics, patients in immediate need of medical treatment appear to be paying up without argument, albeit not too happily.
When I asked my doctor to renew prescriptions for medicines I have been taking for some time he told me: “Leave the list with my secretary and then come in again to pick up the prescription. If I see you face-to-face, I shall have to charge you the 600 Shekels.”
The strike committee’s system varies from sick-fund to sick-fund, but the special charge is country wide. In my particular sick fund, where doctors receive in their own surgeries and issue prescriptions which are filled or supplied by private pharmacies, with the patient paying 10 percent of the cost and the sick fund the balance, matters are more or less straightforward.
WORKING OF HISTADRUT CLINICS
But in the major Kupat Holim of Histadrut, to which most Israelis belong, things are more complicated. There, doctors receive mainly in the clinics. The sick-fund and the government have complained that the doctors charge extra fees for use of State-owned or Histadrut facilities.
Kupat Holim prescriptions are filled in sick-fund pharmacies which do not honor prescriptions by doctors receiving patients in emergency clinics established in hotels, against the 600 Shekel charge.
In hospital reception and emergency wards, doctors on duty are on a restricted Sabbath schedule, though emergencies, including accident cases, heart attacks and other sudden attacks, are attended to as promptly as before the strikes without advance special payment.
The extra payment demand has had one clear effect: the doctors’ work load has been drastically cut. Patients visit their doctors only when it is really necessary. Doctors report they no longer see the many patients who would come to the clinics for minor cuts or aches. Hospital emergency rooms are dealing only with bona fide emergencies.
HEALTH CARE IS NOT DETERIORATING
In general, health care does not appear to have deteriorated because of the strike. Early reports that sick people were going untreated appear to have been disproved.
An afternoon newspaper splashed over its front page an alarming report that a women, diagnosed as suffering from breast cancer, was sent home with instructions to “return after the strike ends.” It published a correction the next day, tucked away on an inside page. The correction said the doctor had diagnosed a minor cyst which did not require urgent treatment.
Medical Association sources charge such reports were being spread by Health and Finance Ministry sources to discredit the medical profession while it is locked in a dispute with the government on salary demands. They say that this is also the reason for a recent spate of reports that the income tax authorities have tightened their investigations into the tax returns of doctors.
The public, which is inconvenienced by the doctors’ strike but is not receiving faulty medical care, seems to acknowledge the fact that young doctors, in the first few years of their medical careers, are grossly underpaid and overworked by excessively long hours on duty in hospitals. But in trying to play down or discredit the doctors’ demands, the Finance Ministry has publicized the extremely large incomes of senior physicians who head departments after decades of medical practice. In Israel, as elsewhere in the world, a top surgeon is among the highest earners.
Meanwhile, the doctors and the government continue their negotiations for a reconsideration of the salary scale of publicly employed doctors. Both sides are considering suggestions of a technical committee consisting of doctors and government economists. They are trying to recast the salary scales to provide higher starting salaries for junior MDs and less killing hours.
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