While Israel’s health system is largely publicly financed, private medical services (known as “SHARAP”) are available in voluntary, non-profit hospitals. Whether to permit extension of private medical services to government and other public hospitals is one of the most controversial issues in Israeli health care today. However, prior to this study, little empirical evidence was available on private care in public hospitals and its implications for the quality and efficiency of care.
This study explored a number of key dimensions of surgical care in the three public hospitals in Jerusalem in which private services are allowed. It was based on the hospitals’ computerized operating room records for 2001, which included data on over 37,000 operations, 16% of which were performed privately.
This study addressed the following:
The extent to which private care is financially accessible to different population groups.
The extent to which the most senior surgeons participate in public operations, and the degree to which their participation in public and private operations differs.
The degree to which private care is used for highly complex procedures (where the involvement of a very senior surgeon confers substantial clinical benefits).
The following are among the key findings presented in this report:
Private care is more financially accessible to the middle class than had previously been believed, in part due to the expansion of supplemental insurance coverage. Nevertheless, it remains beyond the reach of many low-income persons.
In public hospitals with a program of private medical services, the most senior (tenured) physicians participate on the surgical teams of almost all operations that involve complex procedures, whether public or private. However, choosing private care does increase the likelihood that a very senior physician will act as lead surgeon (from 74% to 97% for the most complex cases, and from 35% to 66% for moderately complex cases).
About half of all private operations are of low complexity; this reduces the impact of private care on health and equity. However, this finding may also hint at a problem of efficiency: Many patients who choose private care may lack the information they need to make an informed choice, and so use private care for operations that do not necessarily require a very senior surgeon.
This study did not assess all of the potential costs and benefits of private care. Nevertheless, its findings may inform the fundamental decision of whether to allow private services in government and public hospitals, and if so, how they should be regulated.
The study’s findings have been widely disseminated among policymakers and researchers in Israel and abroad. The study was funded in part by grants from The Maurice Falk Institute for Economic Research in Israel at The Hebrew University and by a grant from Michael Federman through The Hebrew University.