Health funds have surpluses from optional policies

Health fund members used their supplementary policies for dental care, medications, vaccinations and for getting a second opinion from another specialist.

April 2, 2018 00:29
2 minute read.
mental health

A team of doctors discuss mental health (Illustrative). (photo credit: INGIMAGE)

The supplementary health insurance programs of the four public health funds – Clalit, Maccabi, Meuhedet and Leumit – showed a cumulative surplus of NIS 186 million in 2016, representing some 4% of membership fees, according to a report issued by the Health Ministry on Monday. Supplementary plans provide more benefits that those in the basic basket of health services and are held by 74.4% of the public.

In 2016, Clalit supplementary plans had a surplus of about NIS 59.5m., about 2.8% of the money it took in for supplementary health insurance; Maccabi Health Services had an excess of NIS 98m., or 6.8% of monies received for supplementary plans; and Meuhedet had an NIS 38m. excess (6.6%). Only Leumit showed a deficit, amounting to some NIS 7m., about 2% of income from supplementary plan fees.

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The ministry said it was “difficult to draw clear conclusions at this stage, and it seems that additional time will be required to stabilize the various processes related to the implementation of the provisions of the new legislation relating to supplementary health insurance, as well as of commercial insurance policies and various initiatives they involve.”

A ministry program that extended work shifts in public hospitals to allow more operations in the late afternoons and early evenings has reduced the number of operations performed under supplementary health insurance for all four health funds, which want more operations to be performed by public rather than private medical facilities. But as these declines varied significantly among the health funds, it was difficult to reach conclusions about the effects of the program to shorten queues, the report said.

Women are a bit more likely to take out supplementary health insurance policies than men. People living in the periphery, who generally have lower incomes than those in the center of the country, are significantly less likely to pay for supplementary health insurance than those in the center of the country. In addition, Israeli Arabs are significantly less likely to take out the extra policies compared to the Jewish population.

The four health funds collectively took in NIS 4.446b. from supplementary plans in 2016, compared to NIS 4.248b. in the previous year. Each person with supplementary insurance paid an average of NIS 716 annually – a rise of 2.9% compared to the average of NIS 696 in 2015.

In addition to surgery, health fund members used their supplementary policies for dental care, medications and vaccinations not in the regular basket of health services and for getting a second opinion from another specialist. Marketing, administrative and other costs were highest at Leumit, and lower (in this order) in Meuhedet, Maccabi and Clalit.

Jerusalemites were mostly likely to use their supplementary policies to choose their own surgeon, while residents of the North and in the center of the country were least likely to use them for this purpose. Tel Aviv residents were most likely to use the policies for getting a second opinion, followed by residents of Jerusalem and the country’s center. Tel Avivians were most likely to want special pregnancy and obstetrics services from their policies and Jerusalemites the least.

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