Successfully reported this slideshow.

DELSA/GOV 3rd Health meeting - Arnon AFEK

475 views

Published on

This presentation by Arnon AFEK was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm

  • Be the first to comment

  • Be the first to like this

DELSA/GOV 3rd Health meeting - Arnon AFEK

  1. 1. Challenges in the wage negotiation in Israel
  2. 2. • Universal coverage by The National Health Insurance law since 1995 • Bismarckian system – 4 HMOs, capitation formula • Hospital sector includes 24 general hospitals • System is highly controlled, under-budgeted and subsidized by MOF • National health expenditure – 7.7% (stable since 1995) • Acute care beds – 1.9 (OECD avg. – 3.4), per 1,000 pop., year 2011 • Medical graduates – 4.9 (OECD avg. – 10.6), per 100,000 pop., year 2011 • Physicians – 3.3 (OECD avg. – 3.2), per 1,000 pop., year 2011 Israeli Healthcare System at a Glance
  3. 3. “Israel has established one of the most enviable health care systems among OECD countries…” OECD Reviews of Health Care Quality: Israel 2012
  4. 4. Medical Education in Israel • 5 medical schools • 700 medical students (in the past only 400) • 2 medical programs: 6 year & 4 year • Mandatory rotational internship Source: OECD DATA
  5. 5. Physicians in Israel (1) Source: OECD DATA New Licensed Physicians in Israel years 1985-2012
  6. 6. Physicians in Israel (2) Source: OECD DATA Source: MOH
  7. 7. Israeli Medical Association (IMA) • Acts as an independent, apolitical, professional organization • The official physician workers union • Negotiates with employers and signs physicians perennial collective agreements • Multiple roles:  Union  Scientific-professional (ethics)  Medical association  Advisory – Scientific board IMA’s vision: not only to act as a union, but as Israel’s medical system protector
  8. 8. Summary  In the last decade the Healthcare System resources are highly regulated and limited by the MOF in order to maintain low national health expenditures.  This led to a shortage of medical graduates, physicians, hospital beds, nurses.  Physicians are represented by a powerful union.
  9. 9. Physician’s Strikes in Israel - History • 1976 - lasted 58 days, first strike • 1983 - lasted 117 days, hunger strike, physicians left hospitals • 1994 - lasted one day • 2000 - lasted 217 days, collective agreement for 10 years • 2011 - lasted 242 days (1950 - 1990: IMA declared on 20 strikes and labor disputes)
  10. 10. Physician’s Strike in 2011 (1) • The beginning:  Expiration of labor agreement from last strike (2000)  Negotiation for a new labor agreement failed • The players :  Employers: Clalit HMO, Government, Hadassah Medical Org  Employees representative: IMA with powerful leaders, hospitals department heads, (residents?) Consultation with experts (Deloitte) • High expectations
  11. 11. Physician’s Strike in 2011 (2) • The longest strike • Acting on the edge - partial work sanction, threats to abandon hospitals • Hunger strikes • Israeli Labor Courts were highly involved • Extensive supportive media coverage • Publicized march to Jerusalem
  12. 12. The unique agreement included: • Major increase in salary (avg. increase ) • Major increase in salary of professions in need (up to 67%) • Physicians in periphery were highly recompensed (up to 67%) • Additional staff (1000) • Report to work (“clock” ; serving vs. working) • Major changes in working hours (a change of life style) • The balance between physicians in leading central Hospitals vs peripheral Hospitals. • The agreement was signed for 9 years • Hospital Directors were not a part of the agreement signed & shattered)The First Agreement
  13. 13. Orthopedics Internal General Surgery Intensive Care Center Orthopedics Internal General Surgery Intensive Care Periphery Aug Dec Salary of Young Specialist (Israel) Before the agreement (2011) vs. final step of the agreement (2018) in EUR/month
  14. 14. Residents, 2nd stage of the Strike • Shortage of medical school graduates led to a heavy burden on existing residents • Changes in the power of the leaders of the IMA (Physician guild) • Public & media support • Demonstrations, rallies • Reopening a wage agreement, first time in history • Israeli Labor Courts • During negotiation almost all residents resigned • Dead-end • Mediation
  15. 15. A new agreement for residents:  Major increase in salary  Grants with a low tax rate (150 M EUR)  Decrease of working hours - max 26 hours per shift, 72 hours per week  Short shifts  Max 6 shifts per month  Reevaluation of the agreement in 2015 Residents, 2nd stage of the Strike Results
  16. 16. Residents’ Salary (Israel) Before the agreement (2011) vs. final step of the agreement (2018) in EUR/month Orthopedics Internal General Surgery Intensive Care Center Orthopedics Internal General Surgery Intensive Care Periphery Aug Dec
  17. 17. Specialist physicians salary OECD countries (2006=100) ISRAEL Source: OECD DATA
  18. 18. ISRAEL Specialist physicians salary relative to the avg. salary (2006=100) Source: OECD DATA
  19. 19. The Agreement led to major improvements But All sides felt defeated (1) • Strengthening peripheral parts of Israel • Massive addition of beds and staff in hospital • Some physicians earn twice as much as Israel’s Prime Minister • Major benefits to residents (grants, decreased working hours) • Specialist physicians salaries were highly increased • Increase of physicians working in periphery • Increase of physicians working in professions in need
  20. 20. The Agreement led to major improvements But All sides felt defeated (2) • Discontent about having to report to work ( the clock) • Agreement signed for 9 years – No strikes! • Deficits in Healthcare budget due to high salary payment • Rising opponents against the union (IMA) • A few residents filed a spiteful lawsuit
  21. 21. The Future • A change in the leadership of the IMA • New struggle in 2015?
  22. 22. “Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling.” From the Oath of Maimonides

×