Nov 17, 2011

Israel - Medical tourism is impairing care of Israelis, claims investigative show



Medical-tourist preemie infected babies with resistent bacteria, claims 'The Source'.

Is Israel's flourishing medical tourism industry coming at the expense of Israelis? The heads of Israel's health system certainly claim it is.

An investigation by Raviv Drucker on Channel 10's television show "The Source" this week revealed a series of events and internal correspondence from Schneider Children's Medical Center of Israel that seem to prove it's true: Medical tourists do divert resources from Israeli patients.

Medical tourism - which brings non-Israelis to the country not to climb Masada, but rather to go to the hospital - is a growing business. It also is a highly lucrative one for the hospitals, which usually run at a deficit.

The market leader is Sheba Medical Center at Tel Hashomer, which industry observers estimate gets NIS 80 million a year from medical tourism. Hadassah University Hospital in Jerusalem makes NIS 60 million, and Assuta isn't far behind, with income of NIS 50 million a year. Tel Aviv's Ichilov complex gets NIS 40 million, while Rambam Medical Center in Haifa and Beilinson Hospital in Petah Tikva each have to settle for NIS 30 million a year, roughly speaking.

The money is life blood to the hospitals, which get 20% to 30% more per procedure from foreign patients than for Israeli ones. Since this income isn't related to the health maintenance organizations, the hospitals have more flexibility in how they spend it.

No rules

A few months ago a commission empaneled to regulate medical tourism in Israel, headed by Sheba deputy director Prof. Arnon Afek, delivered its conclusions to the Health Ministry. The committee, which was appointed after an investigation by Haaretz, indicated that Israeli patients could be suffering because medical tourism isn't regulated ("Israel gives medical tourists perks denied to citizens" ).

Among other things, the Afek committee recommended the establishment of a mechanism to supervise the economics of medical tourism. It also advised that service to medical tourists should be handled separately from service to Israelis if the hospital has the infrastructure to provide separate care.


Six months have passed since the committee made its recommendations, but the Health Ministry has not given the hospitals any binding directives on the matter.

The Source investigation found that during June 2010, a premature baby - and medical tourist - who was infected with a bacteria resistant to antibiotics was hospitalized at the Schneider nursery for premature infants. Lab tests indicate the baby infected at least one Israeli baby at the nursery. Following that incident the procedures for accepting premature babies in the framework of medical tourism were tightened. Yet this May, the nursery accepted a baby born in the 26th week of pregnancy who also had the germ. She did not make it, but before passing on she infected a number of Israelis, not only babies, with the same drug-resistant bacterium.

The probe also discovered internal documents at Schneider in which nurses, other carers and doctors warn that mixing medical tourists with Israeli patients on the ward could be hazardous. One medical employee told Drucker that instead of patients serving as a support group for each other, they wind up pitted against one another.

Not getting proper care

Drucker also uncovered a letter by Prof. Isaac Yaniv, head of the Pediatric Hematology and Oncology Department, written to Dr. Asaf Toker, deputy director of the Schneider Children's Medical Center (as of this July ). The hospital handed down a directive not to accept patients without the advance permission of the department that would provide the care, Yaniv wrote. Yet, according to the letter, "At the end of last week a tourist with a brain tumor was accepted, without coordinating with us, and even though we explicitly stated we couldn't care for him. We wish to clarify that as things are, the oncology department cannot care for more tourists or patients from the Palestinian Authority without substantially impairing our care for Israeli patients."

The investigative show also reported on the departure of Ruth Halevy, formerly the director of the Nursing Division at Schneider Children's Medical Center, after a confrontation with its director, Prof. Joseph Press, over this very issue. Following her resignation, a number of nursing chiefs at Schneider wrote a joint letter to the director-general of Clalit Health Services, which owns the hospital, noting the significant increase in the number of medical tourists and patients from the Palestinian Authority, which they felt was impairing care for all.

Clalit responded that the concerns of Schneider nurses had been heard, and that it had reacted by revising its directives for taking in non-Israeli patients. The hospital staff would be augmented specifically to take care of these extra patients, Clalit wrote.

In any case, these events show a division between the money people at Schneider and the medical people, raising the question of whether it happens elsewhere too.

Schneider's business plan for 2011 includes NIS 2.5 million income from medical tourism, which is very low compared with the amounts other hospitals are taking in.

Less than 5% of patients are tourists
Clalit also says it has clear directives for accepting medical tourists with regard to quotas and treatment methods. Clalit added that Schneider complies with them all.

The Health Ministry said the Schneider Children's Medical Center handles cases that other hospitals cannot, and the acceptance of non-Israeli children is based on the number of beds that are available without impairing treatment of resident children.

Schneider Children's Medical Center said it complies with all the rules on accepting non-Israeli patients, who constitute fewer than 5% of its patients. In any case, as it is a nonprofit organization, any revenues from medical tourism are put to good use in buying advanced technology.

No Israeli children are refused treatment, it added.

As for the premature babies with the resistant bacteria, the hospital qualified that they were carriers of the bacteria, not ill with the disease it causes, and maintained that their acceptance had represented a humanitarian gesture of the greatest importance.

Ronny Linder-Ganz



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