THE PUBLIC HEALTH SYSTEM
GENERAL
The public health system in Israel functions primarily through the "Kupot Cholim",
health funds, who provide their members with solutions to illness, surgery, etc.
Presently, the kupot cholim provide their members with a high standard of a range of
direct and ambulatory treatments, which previously has not been available. The
problem with this system is that the level of service provided to the insured is not on
par with the high medical standard offered by the kupa.
Over the past several years, satisfaction with the public health system has decreased.
Several factors have contributed to this feeling of frustration:
* as standards for medical care increased, the level of services decreased and so did the
need for the services. In the absence of adequate medical solutions, bottlenecks were
created which drove consumers to search for sources and financial solutions to
purchase services in a private system.
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economic uncertainty, work disagreements and strikes (doctors:1990, 1993; nurses:
1986) exacerbated the problems of continuously waiting for elective surgery.
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cut backs in government funding.
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increases in the standard of living created greater expectations in services rendered.
These factors pushed consumers to turn to a private health system for improved
medical care.
The crisis in the public health system is rooted in the existence of public and socialized
medicine. In such a system, the operating principle is, "if it’s free, why not take it?"
The right to low cost medical services generated an enormous need for services, which
frequently, were unnecessary and which strained the system,. Thus, the public health
system became increasingly bureaucratic, complicated and, of course, expensive.
Increased standards of living have also strained the public health system. For the past
twenty years, living standards have increased on the average of five years, each year.
Consequently, there are greater numbers of insurees, a high proportion of whom are
elderly. Were you aware that a 75 year old requires 7 times the amount of services as
that of a 65 year old?
The primary factor in the collapse of the health systems in Western countries is
technological development. The incredible expenses involved in the development of
new technologies are too heavy a burden to carry. Sophisticated equipment is found
today in all types of treatments, beginning from diagnostics, through laser surgery and
culminating in organ transplants and implants.
Thus, the three factors which caused the crisis in public health care in Israel are typical
of t he entire Western world today. They are:
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the great need for medical services.
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increased standards of living
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tremendous expense of technological development.
The collapse of the public health system has put the heath care system in many
developed countries in a position where they can either continue operating at huge
deficit or quit, which has paved the way for private health care systems.
Presently, there are three levels of medical coverage available to the Israeli citizen.
The first level: The Public Health Law gives every Israeli citizen the right to receive
health care in one of the kupot cholim.
Payment is through Bituach Leumi, National Insurance. It is possible for anyone to
change from health fund to another, as they see fit. Presently, the situation is such that
the public health system is inadequate, hospitals are overcrowded and the health funds
are operating at a deficit, resulting in insufficient health care services.
The kupot cholim themselves are aware that, in addition to the fact that their services
are inadequate, there are areas that are not included in Public Health Law’s basket of
services. They therefore offer supplementary insurance coverage to their members.
This second level of coverage is the supplementary coverage of the kupot cholim.
The lion’s share of supplementary coverage is in effect home care insurance, in addition to
a number of benefits which vary from kupa to kupa. The cost of this insurance is
inexpensive and coverage for all types of medical conditions is incomplete.
The following examples will clarify the problem:
1. It is difficult to obtain a list of surgeons and it is quite likely that the surgeon
selected by the insured is not affiliated with the kupa.
2. Not all supplementary insurance policies compensate for all types of surgery, so
it is possible that the required surgery may not be covered at all.
3. The insured also must pay part of the costs of surgery which an often reach
20,000 NIS. Ironically, surgery is the very reason for the supplementary insurance
policy.
The third level of supplementary coverage is provided by insurance companies for
individuals.
follows:
join the kupa of his choice and receive the complete basket of health services.
status.
unconditionally provided to all members. The government is allowed to add to the
basket of services but it may not eliminate any without the approval of the
Knesset’s Employment and Welfare Committee.
cholim. In general, people with low incomes pay less than they have in the past for
health insurance and high income earners pay more.
insurance companies belonging to the group. We believe that this specialized field of
insurance demands exceptionally high standards of expertise, which requires
centralized and supervised management. To date, 14 professionals, including 3
doctors, are employed in two departments; one which specializes in general medical
and home care insurance, and one which specializes in dental insurance.
the group. Dr. Doris Seidner, an oncologist, heads this department . Clearly, her
experience and education fit the demanding parameters which enable her to deal with
oncological claims.
treatment and who is in an uncertain state of health. The department helps the patient
choose the doctor most appropriate for his needs by using favorable connections
between the department and the medical institutions and doctors who specialize in
these cases. Thus, the insured does not have to "run around’ in order to find the doctor
and hospital most suitable for his needs.
Once it is decided which surgeon will perform the surgery, the department can
organize the following desired services for the insured: doctor appointments,
completion of the declaration of responsibility form by the institution w here the
surgery will take place, tying all loose ends and thereby eliminate all unnecessary
aggravation of the insured. All this is especially important since the patient is in a state
of fear and impaired health.
surgeon and medical establishment in order to help and be kept informed of all aspects
that affect the treatment itself , including problems and complications that could arise
after the surgery.
clear that surgery is necessary until completion of the entire course of treatment. At
this moment, it may be difficult for you to imagine the helplessness that the insured
feels when he finds out that surgery is required; yet, from our experience, we know
that there is nothing like professional medical guidance to encourage and ease this time
of crisis.
insurance agent.
agent.
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MIGDAL'S NEW MEDICAL INSURANCE