There isn’t a family in Israel that hasn’t been caught up in the sticky threads of bureaucracy. Whether it involves getting disability payments from the National Insurance Institute, a subsidized treatment from a health fund, income supplements for the poor, help for Holocaust survivors, information on employee protection, aid for single parents, old-age pensions, immigrant benefits or assistance to minority groups, getting information and assistance can be a struggle against red tape.

A conference on improving accessibility to patients’ rights and information was held recently in the auditorium of Hadassah University Medical Center on Jerusalem’s Mount Scopus and attended by a few hundred people.

It was organized by the voluntary organization Kol Zchut, the Hadassah Medical Organization, the Israel Medical Association (IMA) and the Academic College in Rishon Lezion.

Facing worries, fears, lost work days, extra expenses and other pressures, individuals facing illness are especially dependent on getting necessary information and assistance in a hurry. The plethora of private companies that charge for helping patients retrieve financial benefits in recent years shows there is a problem, said Dr. Osnat Levtzion-Korach, the new director-general of the Mount Scopus hospital.

“These companies have jumped into the vacuum for profit. Patients today have many rights and privileges, but they have to be made accessible,” she said.

“Patients as well as doctors, nurses, social workers and others in the healthcare system have to know their rights. Life will be better, healthier and more convenient when people become familiar with what is coming to them. It’s a new world of an information revolution, but with rights are responsibilities,” said Dr. Leonid Eidelman, director-general of the IMA.

There are two possible policies regarding the distribution of state benefits, said Prof.

Momi Dahan, head of the Hebrew University’s School of Public Policy and Government, who addressed the audience.

“There is universal entitlement in which everyone in a certain situation gets a benefit, such as child allotments, and there is selectivity, in which only some – such as low socioeconomic groups – qualify.”

The decision whether to use a universal or selective policy, said Dahan, is “very complex.

It’s very complex to award benefits to everyone without using a means test. As a result, everybody gets less. But the alternative is not simple at all. The government office has to set up a mechanism to decide who deserves to get the mechanism. This is a very expensive process. And then, people will have to apply for the allotment and take off work to file for it. Another problem is that if a person who receives an allotment begins to earn more – even one shekel beyond the limit – he will lose his entitlement. They immediately lose their incentive to work.”

THEORETICALLY, DAHAN continued, “anyone entitled to a benefit demands it. But in fact, large number of people don’t apply for benefits. This is a serious dilemma in deciding between a selective and universal policy because of the differences in taking advantage of the benefits. Not everybody who is entitled actually gets it.”

It’s strange that people don’t always take advantage of benefits to which they’re entitled, said Dahan, especially in a country where people love to take advantage of bonuses, free gifts and other seeming bargains.

“Money is being offered but many people don’t pick it up. It’s odd, but many people who are entitled are ashamed.

There is the stigma of being needy. It is a mark of Cain, like being poor or having some kind of defect.”

The Hebrew University researcher said the US model is generally selective, while Scandinavia and Western Europe use the universal model, adding that “Israel has generally moved from the universal system to the selective one.”

The relatively low “uptake rate” depends on the community. Haredi (ultra-Orthodox) Jews, for example, are usually well aware of benefits, and the synagogue-based social fabric that serves as a means of communication even without the benefit of the Internet or email means the people are very interconnected. But new immigrants, for example, are often left out because of lack of experience, veteran Israeli friends to advise them and the language barrier.

“When we decide on a selective model, we must be aware that there is a price. It can take a human toll on the poor that doesn’t occur if there is a universal system,” said Dahan, who added that he opposed the bestowing of food packages on the poor and hungry who have queued up instead of giving them gift certificates or smart cards.

Because the disadvantaged – economically, culturally or educationally – feel overwhelmed by red tape, many seek out commercial go-betweens who promise to obtain benefits for them while charging significant fees for the service. So government health or welfare agencies are not really giving a certain sum to the needy and sick but a significant chunk to the go-between, Dahan said.

The saddest reason that the needy don’t take what they deserve is that they lack information.

“This eliminates the heart of social policy. If the disadvantaged or needy person doesn’t get the benefits, we have compromised the principle of the selective model – that we give help to those who most need it.”

Dahan showed a list of various US government programs such as food stamps, Aid to Families With Dependent Children, Supplementary Security Income of Social Security, noting that the takeup rates there range from 41 percent to 76%.

“This is shocking!” said Dahan.

As for Israel, “we know much less about rates of how many entitled people actually receive benefits. We have studied the ‘negative income tax’ program. Only 45% of those eligible actually receive it even though a lot of effort was put into it.”

Regarding the program for water subsidies for the elderly, the takeup rate is higher, but fewer poor people receive benefits because they don’t know about it. According to a study carried out at HU, the takeup rate for subsidized water for low-income Jerusalem families, said Dahan, was at 87%, very high, among haredim, 74% among pensioners, 61% among east Jerusalem Arabs and only 38% for new immigrants.

Language barriers clearly reduce takeup rates, but there are other factors. To help people get the assistance they deserve, it costs money to establish focused assistance programs, institutional reorganization and others. While government offices usually mean well, not helping all those who deserve help is also a policy tool, “as the Treasury’s budget division wants to reduce costs. That means setting up complicated red tape, as in the negative income tax program, so not everybody applies for it. They want to protect the public purse. It depends on whether an institution has a high or low ethos. The Israel Tax Authority and the the National Insurance Institute have a different ethos in taking and giving.”

THE NON-PROFIT Kol Zchut organization founded and headed by Amitay Korn three years ago has a huge potential in helping people get what they deserve. Korn’s friend Erez Perlmutter urged him to do so. It took a year for it to be approved as a non-profit, but hundreds of thousands of people still don’t know about it. The organization has a staff of 10 and a public council headed by Prof.

Yitzhak Zamir, a former attorney-general of Israel and justice on the Supreme Court.

Kol Zchut functions primarily though its website (www.kolzchut.org.il) as a database for supplying information on entitlements and assistance in a wide variety of fields.

Korn, who worked in computer software and established companies in the north, is devoted to the project, which is dependent on volunteers and donations.

“We deal with human situations,” Korn said at the conference. “Some are major, and some are relatively small, but they are important to the needy person. For example, an independent woman suffering from breast cancer lives in a city some distance away from the hospital where she is rated.

She is employed and not recognized by the NII for disability payment. Her health fund will pay for her travel expenses to the hospital and back, but she wanted to be exempt from paying parking fees there. Such things happen often.”

Click on cystic fibrosis and find help for CF children in kindergarten and in school, genetic tests, inhalation equipment, health tax discounts, vocational assistance.

“We try to make information accessible and simple to understand – without all the legalese,” Korn said.

A growing amount of data is available on the Hebrew-language site, which is free and runs no advertisements.

“It’s a system that deals with the rights of people regarding health, allotments, Holocaust allocations, unemployment benefits, help to autistic children, the blind, homeless and so on. We bring all the subjects together in one website. We provide information on how to receive a health fund referral for hospitalization, who pays for the ambulance and emergency room, outpatient clinics, borrowing medical equipment and on and on. We list medical conditions, even ‘orphan diseases’ that affect a small number of people.

Although the whole site is in Hebrew, some of the text has been translated into Arabic and English, but not enough to empower patients who speak these languages, not to mention Amharic and Russian. We hope to translate more.”

So far, it has 2,100 entries, and 70,000 people visited the site last month. But despite holding seminars for social workers and representatives of a variety of voluntary organizations, hundreds of thousands of people who need the information the organization supplies never heard about it (including this health journalist, who did not even once receive publicity material from the organization).

“We are all volunteers,” Korn signed. “We don’t have the money to promote ourselves,” he said, but after being informed, he began to send information to The Jerusalem Post.

Health Ministry director-general Prof. Ronni Gamzu, who spoke briefly during the conference, said: “We try to help patients learn of their rights, but there are still many who are uninformed. We have tried using the media to spread information; we used a media campaign for spreading the word that patients who feel they have not received what they deserve can file a complaint with our ombudsman’s office. We even received letters from health funds who didn’t like the idea of highlighting the ombudsman, perhaps because more people would demand rights,” Gamzu said.

“It isn’t impossible to get patients informed. It can be done. People have a right to get what they are entitled to from the National Health Insurance Law, not just medications but also information about procedures and processes. I commit myself to putting on the Health Ministry website within six months all the information we have on rights from the National Health Insurance Law.”

Eti Semama, who has completed her service as the health system’s ombudsman, said that of the complaints she received almost seven in 10 dealt with the basket of health services, 19% with the quality of care, 5% with the choice of providers and other topics. In 2010, 50.4% of the complaints were rejected because there was no basis for entitlement in the law, but the rest were justified.

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