Advanced Search
MyIDEAS: Login

Selecting your Surgeon: the Private--Public Mix in Public Hospitals in Jerusalem; Considerations of Efficiency and Equity

Contents:

Author Info

  • Gur Ofer
  • Miriam Greenstein
  • Bruce Rosen
Registered author(s):

    Abstract

    The question of whether to permit private medical services (dubbed SHARAP) in government hospitals is one of the most controversial issues in Israeli health care today, with parallels in European countries. Under the Israeli National Health Insurance Law, all residents that are entitled to free medical care included in a defined "basket" of services. This basket excludes the choice of surgeon for hospital services, such as surgical operations. However, people can pay for this choice out-of-pocket or through supplementary insurance. Such surgical procedures can take place in private facilities, often by publicly employed surgeons during their after work hours. Most of the public hospitals in Israel forbid such "private" operations on their premises. However, in three Jerusalem public, non-profit hospitals, choice of surgeons is allowed under long-standing SHARAP programs. This study explores the functioning of surgical care in these hospitals, in order to contribute empirically based evidence to the above mentioned debate. The study is based on administrative data of the three hospitals on about 37 000 operations carried out in the year 2001, 16 percent of which were in the SHARAP program. The study analyzes and discusses the implications of SHARAP for equity, efficiency and freedom of choice. It finds, first, that most SHARAP activity is for relatively routine procedures. Second, that despite SHARAP, nearly all the public complex operations are performed by teams that include very senior surgeons. Finally, the study finds that the costs to the majority of patients for most operations are reasonable, especially when covered by supplementary insurance, which most people hold. On the other hand, SHARAP appears to continue to be beyond the reach of most low-income persons. Moreover, by opting for SHARAP, patients do increase the likelihood that a very senior surgeon will be the surgeon-of-record, and this does have implications for health care equity. (JEL classification: I18, I32) Copyright 2006, Oxford University Press.

    Download Info

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
    File URL: http://hdl.handle.net/10.1093/cesifo/ifl008
    Download Restriction: Access to full text is restricted to subscribers.

    As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.

    Bibliographic Info

    Article provided by CESifo in its journal CESifo Economic Studies.

    Volume (Year): 52 (2006)
    Issue (Month): 3 (September)
    Pages: 513-547

    as in new window
    Handle: RePEc:oup:cesifo:v:52:y:2006:i:3:p:513-547

    Contact details of provider:
    Postal: Oxford University Press, Great Clarendon Street, Oxford OX2 6DP, UK
    Phone: +49 (89) 9224-0
    Fax: 01865 267 985
    Email:
    Web page: http://cesifo.oxfordjournals.org/
    More information through EDIRC

    Order Information:
    Web: http://www.oup.co.uk/journals

    Related research

    Keywords:

    Find related papers by JEL classification:

    References

    No references listed on IDEAS
    You can help add them by filling out this form.

    Citations

    Lists

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    Statistics

    Access and download statistics

    Corrections

    When requesting a correction, please mention this item's handle: RePEc:oup:cesifo:v:52:y:2006:i:3:p:513-547. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Oxford University Press) or (Christopher F. Baum).

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.