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