Dr. Hezi Levy, Health Ministry medical administration head, can we stop hospitalizing patients in hallways?


Overcrowding has again become an issue in Israeli hospitals, which are reporting an unprecedented number of admissions as patients suffer complications from typical winter diseases.

By Dan Even

Jan. 4, 2011 – Overcrowding has again become an issue in Israeli hospitals, which are reporting an unprecedented number of admissions as patients suffer complications from typical winter diseases. For the Health Ministry the crisis is an ongoing one, which reached a peak last year.

According to the ministry, people hospitalized in internal medicine hallways amount to 70,000 patient-days yearly. On Sunday this week, hospitals in the country averaged 107 percent general occupancy, including 114 percent in internal medicine departments and 111 percent in children’s wards. Record high rates were documented at Jerusalem ‘s Hadassah University Hospital , Ein Karem (173 percent ) and Hadassah University Hospital , Mount Scopus (159 per cent ), Laniado Hospital in Netanya (158 per cent ), Shaare Zedek Medical Center in Jerusalem (148 per cent ), Kaplan Hospital in Rehovot (149 percent ) and Barzilai Medical Center in Ashkelon (136 per cent ). On children’s wards, records reached 188 percent at Wolfson Medical Center in Holon (175 percent ), Hadassah Ein Karem (168 percent ), Assaf Harofeh Hospital in Tzrifin, Schneider Children’s Medical Center and Shaare Zedek (all 154 percent ).

Deputy Health Minister Yaakov Litzman has reached an agreement with the treasury for the gradual addition of 960 new beds over the next six years, in an attempt to deal with the severe crowding. The increase is a dramatic one, although not all hospitals are prepared, and it is not clear whether the addition will lead to the disappearance of the practice of hospitalizing patients in hallways. We spoke to Dr. Hezi Levy, head of the Health Ministry’s medical administration, which is responsible for hospitalization nationwide, about this matter.

Dr. Levy, can we stop hospitalizing patients in hallways?

The Health Ministry convened a committee to examine the lack of hospital beds, after which the deputy minister and the director agreed to add 960 more over the next six years, including additions to internal medicine, premature baby and intensive care wards. These additional beds will be accompanied by an addition of relevant staff members. With an increase in beds and infrastructure, it is possible to deal with the phenomenon of patients hospitalized in hallways, although in winter here, as in many places in the world, we expect the crowding to continue.

The increase in beds can provide support in the short run only. At the same time we are working on a strategic plan and to establish a planning body to build up hospital infrastructures by 2020, which includes the number of beds, innovative technologies and additional personnel.

The treasury claims that the hospitals have an interest in placing patients in corridors, in order to receive more positions for workers, and also because the cost of such hospitalization is low.

Hospitals have an interest in treating patients, and not in putting them in hallways. If we look at Israel in relation to the rest of the world, we see several phenomena that contradict the treasury’s claim. The number of beds available for hospitalization in Israel stands at 1.95 for every 1,000 people – almost in last place, before Mexico , in comparison with Western countries. The average length of a hospital stay is four days – one of the shortest in the West. How does this sit with the claim that hospitals want to hospitalize patients? The director of the Health Ministry told the hospitals that he cannot cope with over 120 percent capacity, because this damages the quality of care, and he is working to bring this figure down. So it cannot be said that hospitals like Barzilai are interested in putting 56 patients in a ward built for 36. This is nonsense.

Is there sufficient infrastructure to enable the addition of beds? Where will the patients who were previously placed in hallways be hospitalized?

Some hospitals already have room to add wards. There has been construction in recent years, and we worked to build more, looking ahead to a larger population and the need to add beds in future. But it is true that some hospitals lack sufficient infrastructure. If we have to build for each bed we add, we will see results only in another three years, at the least. And so the first step is to add beds to hospitals that can use them in their existing structures.

Will the planned addition of beds lead to additional staff, or are we talking about the addition of beds alone?

Another committee at the Health Ministry, which has just completed its work, examined the existing standards for hospitals here. They are archaic, having been established more than 30 years ago, although there have been significant improvements in hospitalization conditions since. The committee recommended additional doctors, without any connection to the addition of beds. We have not yet begun negotiating with the treasury on this matter, but we will soon.

The Finance Ministry has lately been emphasizing the worldwide trend in community clinics as an answer to providing some hospital services. Are you working to provide such a solution to the diseases common in winter?

Of course the community is important too, and the Health Ministry is working to find solutions in the community to take the place of hospitalization, especially in the case of chronic illnesses. About diseases that occur in winter, I believe that family doctors located in the community are trained to recognize in which situations the patient can be treated at home with a warm blanket, chicken soup and paracetamol, and which should be hospitalized.

It was reported yesterday that at the Haemek Hospital in Afula patients waited more than a day in the emergency room due to overcrowding and a lack of beds in the internal medicine ward. Are you aware of this?

Emergency room wards have always existed, and it is possible to treat patients there. The current crowded conditions means that some patients spent more time there than planned, but it should be noted that these patients receive medical care. At the same time, of course emergency rooms do not offer the same conditions of a general hospital ward, and the addition of new beds will help to deal with this phenomenon.

How much is the negotiation over beds connected to the negotiation between the medical union and the treasury over doctors’ salaries in the public sector?

Fate would have it that they are taking place at the same time, but they are not connected. Increasing the number of beds is part of the Health Ministry’s job to treat core issues, and to organize the hospitalization system in the country. Beyond this, the ministry, as a regulator and an employer, takes part in negotiations on salaries, and some of these topics will be raised there too.

Is the current winter worse, in terms of morbidity, compared to previous ones?

The rise in hospital overcrowding reported this week is connected to the seasonal rise in winter diseases, but also, unfortunately, to the low rate of response to the flu vaccination campaign. We believe that the flu vaccine is one of the strongest means to prevent getting the flu. Among adults, there is a reasonable response [to the request that they be vaccinated], but among children under five – considered a high risk group by the ministry, which has for the second consecutive year called on parents to vaccinate them – there has been a decrease in response and less than 20 percent have been vaccinated.

In some age groups, the number of vaccinated people falls to a single digit. There was a sort of illusion that there would be no winter this year, and people were not falling ill, but now the flu is here and it is still possible to be vaccinated. The shot this year works against seasonal flu as well as swine flu.



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