Israeli healthcare complaints minimal in 2012

Only 6,382 formal complaints against medical care providers were filed with Health System Ombudsman for the year 2012.

By JUDY SIEGEL-ITZKOVICH
AN ISRAELI doctor 370 (photo credit: Baz Ratner/Reuters)
AN ISRAELI doctor 370
(photo credit: Baz Ratner/Reuters)
The Health Ministry’s Office of the Ombudsman of the Health System received just 6, 382 complaints in 2012 and 5,542 complaints from the general public in 2011, according to a report presented to Health Minister Yael German and the National Health Council in Jerusalem on Sunday.
The statistic is very small, considering the fact that all eight million Israelis are members of a health fund.
The ombudsman, Shimon Riper, is an acting ombudsman, unlike his predecessors Eti Semama, who served for five years until January 2012, and Dr. Karny Rubin-Jabotinsky, who took office in 1995 and retired in 2007.
Although the National Health Insurance Law – which created the ombudsman’s office in 1994 – required the ombudsman to produce an annual report to be presented to the Knesset speaker every year, the latest report was only the ninth during the 18 years since the position was established, and the ministry does not invite the press to cover such a presentation.
It may be that many members of the public have never heard of the post of health system ombudsman and thus have not filed complaints about the services they receive.
The offices of independent physicians working for the health funds and health fund clinics are not required to post a sign stating that health fund members who were dissatisfied by the services they received are entitled to complain to the ombudsman.
Ministry director-general Prof. Ronni Gamzu said at the beginning of the 277-page report that he saw “much importance in advancing and promoting the ombudsman’s service” because the complaints point out defects that can be corrected. A phone line, improvement of the ministry’s website and various media campaigns, he said, has made the ombudsman more prominent.
Health fund members also sent the ombudsman queries and unofficial complaints, bringing the 2012 total to 10,950, but not all of the official complaints in 2012 were resolved by the ombudsman last year.
Although Rubin-Jabotinsky entered the office without strong powers over the four public health funds, the ministry, the hospitals and other health service suppliers to implement her recommendations, the office has received more “teeth” in recent years that make it more difficult for healthcare providers to ignore them. The ombudsman can now provide his interpretation of the law and order the service provider to carry out his rulings.
Fully 27.2 percent of the official complaints were found to be justified in 2012, with 16.7% reaching a solution via the ombudsman or information provided to the individual without the complaint having been called justified.
Among the four health funds, 25.4 % of the formal complaints against Clalit Health Services were found to be justified, compared to 25.18% against Maccabi Health Services, 26.36% against Kupat Holim Meuhedet and 28.95% against Kupat Holim Leumit. A total of nearly 5,000 formal complaints were closed by the ombudsman either because they were found to be unjustified, the ombudsman had not completed the cases or they were settled without the need for a ruling.
Among the main issues in the report are the choice of a health fund (one can switch insurers up to twice a year by going to a post office or even via the website of the National Insurance Institute, which distributes health taxes collected from residents among the health funds). Another is the basket of health services that must be supplied by the health funds to all relevant patients; those who claim they did not receive all the medications and medical services in the basket are entitled to complain to the ombudsman.
Residents also complained about the quality of services they received from the providers and the services provided by supplementary health insurance sold by their health fund. Eighty percent of all residents have these policies.
Of the ministry’s services, complaints were filed on prenatal tests of the fetus; ambulance services to psychiatric institutions; reimbursements for various medical devices; and delays in getting approval for hospitalization in a geriatric institution.
Among the public hospitals, complaints dealt, among other issues, with their demands for extra payments beyond what the health funds have to supply; problems in setting appointments; and accepting a health fund’s referral slip for treatment.
Regarding the health funds themselves, the ombudsman justified complaints on, among other issues, getting the medications patients needed, which hospitals and other facilities they allowed members to go to; rehabilitation of injured patients; diagnosis of a heart patient with a complicated condition; and lack of accessible treatment for a cancer patient.