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After a year of heated debate, the Knesset voted Wednesday night 57-4 to pbad a bill to regulate medical tourism in Israel.
But anyone who expected a revolutionary measure that would clearly limit the scope of medical tourism and ensure a more or less equal distribution of income from all hospitals in the country would be disappointed.
The bill does not limit the number of medical tourists that can be treated in a given hospital and does not specify how much money must be spent to compensate small hospitals in remote areas that do not benefit from tourism medical.
Up to now, medical tourism, which generates hundreds of millions of shekels a year from some 30,000 visitors, has been almost totally deregulated, subject to the whims of every hospital director.
The system has been criticized for giving priority to medical tourists, for example by creating a separate and shorter waiting list for them in violation of the law. The doctors were paid for medical tourism procedures at the same time as they were paid to be on duty in the morning on their regular jobs providing services in the public health system. In some cases, doctors negotiated private agreements for medical tourists and even accepted under-paid payments. In other cases, patients would leave the country with unpaid debts.
Still, it took nine long committee sessions over the course of a year for all actors – medical tourism agents, MKs, Ministry of Health officials and hospital executives – to hear on the text of the bill.
The meetings often deteriorated into emotional screaming sessions fueled by the tension between the need to protect the interest of Israeli patients in the already overburdened health care system and the need for medical tourism revenues. Hospitals said that medical tourism revenues were used to improve health care for Israelis, but the Ministry of Health had no authority or even knowledge of where the money came from. was spent.
"The public health system needs medical tourism revenues like air to breathe in. A medical tourist brings in four times more than a regular tourist – and Israeli patients could benefit from it", said Dr. Mickey Scharf, deputy director of Clalit Health Services, at a meeting.
But the Association for Civil Rights in Israel; Adva Center, an institute for left-wing policy badysis and Physicians for Human Rights have all described the law of failure.
In a reference to overcrowded hospitals where patients often end up without a room, the groups said in a joint statement, "The Knesset threw patients out of the hallway through the window. Instead of the government investing the resources needed by the health system and helping Israeli patients, it is being ceded to external pressures from companies.
& # 39; calibrate & # 39; the profits
The new law, due to come into force in six months, does not take into account all aspects of the debate on medical tourism in Israel: although it does not limit the number of medical tourists that each hospital can treat doctors to treat medical tourists only to treat Israelis, to avoid creating an incentive to prioritize the treatment of tourists. However, the law leaves an opening for the Minister of Health to make exceptions when doctors can receive more payment to treat tourists.
The law also states that medical tourists will only be treated in the afternoons and not during normal hospital hours, except in case of emergency or other exceptions. . The penalty for the treatment of a medical tourist during the morning hours is a severe fine of 50,000 shekels ($ 13,680).
The committee members, with the support of the Ministry of Health, rejected the appeal of MK Merav Michaeli (Union Zionist), one of the sponsors of the project, to limit medical tourism to 5 % of hospital medical activity.
Instead, hospitals will have to provide the Ministry of Health with a comprehensive report on tourists treated at the hospital and the income earned in relation to income from the treatment of Israeli patients. Based on these data, the ministry may decide to limit the number of medical tourists that a hospital can accept, if this raises concerns that impact the availability of treatment for Israelis.
In 2014, a committee led by Yael German, then MP, recommended limiting medical tourism hospital revenues to between 6% and 10% of overall income and imposing a number of other restrictions. Subsequently, the Budget Division of the Ministry of Finance, citing the Committee's conclusions, attempted to impose a medical tourism income tax under the Economic Arrangements Bill, but the legislation was pbaded. been arrested in part by Yisrael Beitenu.
Medical tourism revenues come mainly from large hospitals in major cities and hardly reach outlying areas. In 2017, the Ichilov Medical Center in Tel Aviv reported 76 million shekels of medical tourism; The medical center of Sheba, Tel Hashomer earned 39 million shekels, the Rambam medical center in Haifa 27 million shekels and Assaf Harofeh 9 million shekels. But the Ziv Medical Center of Safed, Poriya to Tiberas and Bnei Zion in Haifa have not manufactured a single shekel of medical tourism.
Michaeli's appeal for a definite share of the income from medical tourism destined for hospitals in the periphery was supposed to compensate for this image, but ultimately the committee chairman MK Eli Alalouf (Kulanu) and representatives of the Ministry of Health have decided that the department "Profits to go to the periphery and report back to the committee without committing in advance to a specific amount or percentage of income.
The lack of a fixed ceiling or revenue-sharing formula for medical tourism is what most critics worry about the new law.
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The law attaches great importance to the protection of the rights of medical tourists, as a result of numerous reported cases of fraud and exploitation. Much of the law focuses on regulating the activity of medical tourism companies and their agents, which has been fertile ground for quacks.
The law states that medical tourism agents must be over 21 years of age and have no criminal record, and they will be required to register in a special register.
Agencies will be subject to certain restrictions, such as not being allowed to subordinate one service to another. Among others, the prohibition to obtain medical services when booking a hotel room through the agent allows the patient to have a contact doctors and requires patients to wear an ID card in medical facilities.
A Discipline Committee for Medical Tourism Agents, headed by a judge, will also be created and will have the power to impose penalties for violations of the law. A medical tourism agent who commits a disciplinary offense may be fined 14,000 shekels.
Industry representatives sometimes clashed strongly with MPs during hearings on the bill. In one session, Uriel Lynn, president of the Federation of Israeli Chambers of Commerce, said that "most MPs make mistaken badumptions and promote a negative image for the industry, implying that medical tourism harms the Israeli patient. , while hospitals clearly stated that the opposite is true. "
He also complained that "the committee did not allow a serious and thorough discussion and representatives of the medical tourism industry were treated with hostility and contempt".
Alalouf said the opposite. "Medical tourism will not be to the detriment of Israeli patients.In an ethical, transparent, orderly and fully controlled manner, we do not want to eliminate or harm industry, but the rights of citizens are first, "he said.
In the end, even the industry is not entirely satisfied with the law. Mark Katznelson, president of the Association of Medical Tourism Federation of Israeli Chambers of Commerce, said the organization praised the law, including sections that give priority to the Israeli patient on the medical tourist .
But he also noted serious disadvantages, most significantly the absence of any criteria set for obtaining a license to engage in medical tourism. "Unfortunately, the law only provides for the absence of registration as a criminal offense.It is an opening for freelancers to enter the company, which we regret." ", he said.
"In addition, the law will hinder the work of medical tourism companies without which this industry can not exist – for example, the responsibility for designing treatment plans will almost always go to medical institutions, even though up to the end of the year. now the companies were responsible for that.We will not be able to receive a referral before the medical facility sends us a treatment plan for that, which is absolutely nonsense, "said Katznelson.
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