Ombudsman: Meuhedet fund shows highest rise in justified complaints

Lifesaving drugs not in health basket to be available in supplementary insurance, Litzman says.

(photo credit: YOEL LEVI)
Many health funds members are unaware that switching to another fund can run them the risk of losing nursing-care insurance for which they have been paying for years.
Nursing care policies are provided by private insurance companies, and in the 20 years since National Health Insurance was established, the Health Ministry has failed to arrange for these policies to follow the insured from one health fund to another, an ombudsman’s report said on Wednesday.
Ironically, the loss of these benefits has become more widespread since the ministry facilitated speedier health fund registration procedures via the National Insurance Institute, the Health System’s ombudsman wrote.
The Health Ministry said it had contacted the Treasury official in charge of private insurance “over a decade ago” to reach an agreement on the issue of switching health funds and retaining nursing-care coverage, as exists in supplementary health insurance provided by the four health funds.
But “unfortunately, only during the last two years have there been discussions among the ministries to find a solution. The Health Ministry took many steps to inform the public, including publications and making it conditional for changing insurers on the Internet for users to state they are aware of it. We hope a solution will be found as soon as possible,” the ministry said.
The report was the 10th of what was initially intended as an annual summary when the procedure was implemented in 1995.
The ministry’s spokesman denied that a report had to be issued every year, although the first ombudsman, Dr. Karny Rubin-Jabotinsky, told The Jerusalem Post when she submitted her first report that it was an annual requirement. During most of her term it was indeed produced every year.
The latest report covers 2013 and 2014, and was written under the aegis of two health service ombudsmen and attorneys, Shimon Riefer (who served for three years until October 30, 2014) and Esther Ben-Haim (who succeeded him).
The 218-page report deals mostly with public complaints against the four public health funds, but it also covers criticism against the ministry, hospitals, the National Health Insurance Institute (which registers individuals for membership in health funds) and other institutions.
More than 20,000 complaints and requests for information were filed in 2013, the report found. Twenty-seven percent of 5,988 complaints were found to be justified, In 2014, 12,073 were received, and 25% of 7,481 complaints were ruled as justified.
In a trend that began in 2008, the number of formal complaints filed against the largest of the funds, Clalit Health Services, continued to decline, leaving it the insurer with the lowest rate of complaints, the report said.
Maccabi Health Services, which for years had the lowest number of complaints and justified ones, has seen a rise in both figures, but it nevertheless remained the insurer with the second-lowest rate of complaints and justified ones, the ombudsman said.
Meuhedet Health Services, the third-largest fund, had the highest rate of complaints (10 per 10,000 members) and justified ones. Leumit Health Services had the second highest number of complaints.
Asked to comment, the Meuhedet spokesman said that the report was an “important tool to promote improvement” and that management will hold in-depth discussions of the findings and prepare ways to improve the situation despite the health funds’ precarious, deficit-ridden financial status due to inadequate state budgeting.”
The Maccabi spokesman said that although more complaints were lodged against it than previously, a Brookdale-JDC-Myers Institute study has found that Maccabi members registered the highest satisfaction rate of all the funds at 96%.
More than a 10th of the complaints received by the ombudsman was about insurers refusing to reimburse members for hospital emergency room care, and insurers’ telephone services coming up short in informing clients about urgent care alternatives. The ombudsman said she had the impression the health funds were making it more difficult to get approvals for reimbursement when members went to emergency rooms without a doctor’s referral.
Another major cause of complaints was red tape and long queues for nonemergency medical problems, including elective surgery. Other topics listed included a lack of subsidies for certain drugs and medical equipment, test fees, referring members to one hospital when they preferred another, and medical staffers’ failure to respect members’ privacy.
In recent years, the insurers have been much more willing than in the past to implement the ombudman’s ruling.
In a separate development, Health Minister MK Ya’acov Litzman told the Knesset Public Complaints Committee that lifesaving drugs not in the health basket would be made available under supplementary insurance, and those beneath the poverty line would get the service free.
Litzman also said he may introduce legislation to give health funds a deadline by which to respond to issues raised by the ombudsman.
The minister also plans to propose a State Geriatric Nursing Bill within a year, in keeping with the government’s coalition agreement, he said. The measure would increase health taxes to provide for geriatric care, a step he had been working on as deputy health minister.