RX for readers: Waiting for IVF

Wouldn’t creating competition among the health funds be a goal of the ministry?

Cartoon lady 521 (photo credit: MCT)
Cartoon lady 521
(photo credit: MCT)
I am in my 30s and have two young children from in-vitro fertilization. We want another, but the health basket provided by regular health insurance does not cover expensive fertility treatments if one already has two. We have supplementary health insurance from our Kupat Holim Meuhedet (“Meuhedet See”), but there is a major impediment to getting treatment with it: It imposes a 24-month waiting period for fertility treatments for the third child onward. Where is the logic?

Waiting two years means that by the time the woman is eligible for treatment, she is older and will most likely need more and very costly treatments, with a poorer chance of eventual success. For example, a woman who joins Meuhedet See when she is 33 will be 35 by the time she starts treatment and will therefore have to have more treatments, at a greater financial cost to the health fund and emotional cost to herself. She will also, if the treatment is successful, have a high-risk pregnancy and need to undergo amniocentesis.

The health fund earns only an extra NIS 2,400 during the waiting period – less than a quarter of the cost of one treatment. Wouldn’t creating competition among the health funds so that members get the best service be a goal of the ministry? For the would-be parents, of course, the downside of the waiting period is obvious, but why is it beneficial to Meuhedet? – P.D., Tel Aviv
Dr. Yoel Lipschitz, deputy director-general of the Health Ministry who supervises the health funds, replies:
The reason for this regulation is to prevent people from “going shopping” among the health insurers regarding fertility treatments. IVF is among the most expensive treatments and may require many rounds to get pregnant. There are no real limitations for continuing treatment except for age.
The waiting period was established to protect all those involved. People should not join a health fund only to get pregnant and then, after they succeed, switch to another fund. The programs for supplementary health insurance are built on low premiums and cross-subsidization by members so they do not all pay a lot. Thus a waiting period is needed.
The regular basket of health service covers fertility treatment for the first two children. Supplementary health insurance no longer includes life-saving medications that are not in the basket, making supplementary health insurance “nice to have” [but not a matter of life and death]. Children are not a disease, so unlike with other things such as choosing one’s surgeon and various treatments, it was decided to set a waiting period for IVF.
As for competition, the health funds are permitted to reduce the waiting time. The ministry does not require 24 months for this. A health fund that wants to decide on six months, for example, can apply to us, and apparently we will agree to this, too.
Prof. Neri Laufer, chairman of the department of obstetrics and gynecology at Jerusalem’s Hadassah University Medical Center, Ein Kerem, comments:
IVF should, in general, be performed as soon as possible – especially in women aged 35 and over. From the age of 40, it is critical that it be done immediately, as age can make the difference between having a child or not, or having a healthy child or not. If the two-year waiting period is enforced, the health funds could easily have to pay a lot more for treatment under their supplementary health insurance policies.
I am middle-aged and have a number of chronic illnesses, including high blood pressure and high blood cholesterol. I also take certain vitamins and other food supplements. Some of them are so big that I have trouble swallowing them, so I cut them in half. But a pharmacist to whom I mentioned this said to abandon this practice. What’s wrong with this? Is it really harmful? – T.T., Modi’in
Judy Siegel-Itzkovich says:
The Israel Journal of Family Practice reported a few months ago on the dangers of cutting pills in two. It said a study conducted in Belgium showed that splitting pills could result not only in getting improper doses, but also in potentially toxic effects and serious consequences. A researcher from the University of Ghent explained that splitting pills usually results in different amounts of medication on each side. Geriatric institution patients with cardiac insufficiency, Parkinson’s disease and arthritis volunteered to split pills, as they are accustomed to do there. A total of 3,600 pills were cut into halves and quarters. After tests, 31 percent of the pieces were found to release too much or too little of the active ingredients in the patients; these amounts ranged from 15% to 25%. Even when the splitting was done in a very accurate way, there was an 8% difference in dosages among the pieces.
The Belgian experts called for producing more medications in liquid form for people who have difficulty swallowing them, and different dosages for those who need different amounts of active ingredients. Sometimes patients and institutions split pills even into quarters to save money.

Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to [email protected], giving your initials, age and place of residence.