After ten years of battling for residents to get the health services they are entitled to under the National Health Insurance Law, outgoing health system ombudsman Dr. Karny Rubin urged the granting of more independence, funding, manpower and recognition for her successor, Etti Semama.
Rubin, who filled the position for the maximum two terms, presented her seventh report (for 2006) to Health Minister Ya'acov Ben-Yisri at a session of the National Health Council in Jerusalem.
For some unexplained reason, unlike in previous years, the volume was not presented to him and Knesset Speaker Dalia Itzik in her Knesset office.
During her decade in office, Rubin received more than 35,000 complaints against the health funds, the Health Ministry and other authorities, plus nearly 70,000 complaints from people who said they were transferred against their will to another insurer or were not able to join the health fund of their choice.
In 1998, most registration problems were solved by residents being able to register for a health fund (including switching from one insurer to another) in any post office. In 2006, the ombudsman was given "teeth," by which decisions were not merely recommendations, but had to be carried out by order of the Health Ministry director-general. In most cases, the health funds acceded.
At least one health fund director-general admitted that many Israelis are still unaware of the existence of the ombudsman as the address for making complaints against their health insurer.
In 2006, Rubin received 4,523 complaints about failure to get medical services and medications and about payment arrangements and choice of doctors and medical institutions.
Twenty-two percent of those dealt with were ruled justified, with 20% unjustified and 19% relevant but unable to be granted. The rest were either beyond the bounds of the ombudsman's responsibility or had not been resolved.
Rubin also handled some 3,700 complaints about health fund membership in 2006, and all of them were resolved, she wrote in her 85-page report.
Among Rubin's recommendations were that any ombudsman in the future be a physician who has worked as a clinician for at least five years in the public health system (Rubin did, as a psychiatrist, but Semama, as a Health Ministry official, has not); and that the ombudsman's office be given a budget independent of the ministry budget so it is able to consult with outside experts and get the manpower it needs.
The ombudsman's office has suffered chronically from a staffing shortage. Even with thousands of complaints it has only 15 staff members - five of which are offcial manpower slots. In addition, the ministry did not supply suitable computer software for registering these complaints complaints.
She also urged that health funds be required to reimburse members quickly for money they spent that is regarded by the ombudsman as covered by national health insurance, and that the insurers be forced to present their side in a dispute without delay.
Meanwhile, in the report Maccabi Health Services came out looking best, among the four health funds. Its share per 10,000 members of complaints was the lowest, and the number of justified complaints was also fourth out of the four. Complaints against the largest insurer, Clalit Health Services, were most numerous, but a growing number of complaints against Kupat Holim Meuhedet were registered by the ombudsman's office.
Ben-Yizri and ministry director general Prof. Avi Yisraeli praised Rubin for her contribution to protecting the rights of health fund members and said they wanted to strengthen the ombudsman's office. Yisraeli noted with frustration, however, that even though he is responsible for a budget of many billions of shekels, he lacks the power to add "even a quarter of a manpower slot" without Treasury permission.
Maccabi director-general Prof. Yehoshua Shemer, who recently announced he will retire and become unpaid president of the health fund, recommended that a copy of every member's complaint to the ombudsman be forwarded to the head of every insurer so they could keep their finger on the pulse.