Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
I enjoyed our series on bites and I hope you did too. Let's
begin a short series on the medical care in Israel and the
Kupot Cholim (HMOs).
Which kupah is the best? The answer is simple: none of
them! The religious sector is ten percent of the population
and all the kupot are actively recruiting this sector.
Klalit still has the best programs for people who are old and
infirm, but they are still very difficult to deal with for
gray areas.
The kupot are suffering with debt. Klalit is millions
of shekels in debt and Maccabi is not far behind. What these
kupot often do is make deals with hospitals to pay
them globally, that is pay them a lump sum for all admissions
in one year, instead of by the admission. This saves them
money but forces you to go to the hospital that they have
made the deal with -- not always the best one or the most
convenient one.
In the end, they may default on the deal they made and return
to the hospital with a new proposal -- either accept less
money or take us to court which will cost you much more. As a
result the hospitals end up losing money, so they try to
overadmit to cover this loss. This means that not all
admissions to the hospital are warranted and this is an
important fact to be aware of. The kupot then send a
person to each hospital to check if the admission is
justified and if the patient is staying too long. If an
admission is termed not justified, guess who pays the
hospital for the admission -- you!
The kupot may not give the best physicians either.
Often the best physicians are found in the clinics in the
hospital but this is expensive, so the kupah will make
you see the one that they want you to. Many poorly trained
physicians are the general physicians in kupot, and
this results in poor care, missed diagnoses, overuse of
antibiotics and overprescribing of drugs.
Poor physicians may also send to the emergency department
often, which entails long waits for service that could have
been given in the kupah. Sometimes the opposite
occurs: you may need to be in the hospital, but the physician
tells you it is nothing. If you proceed to the emergency
department it could cause you a 480 shekel bill that is not
covered by insurance.
The law does not get involved here. But by law you do not pay
for emergency services if you have a doctor's referral, get
admitted, get hurt on the job or on the way to or from work,
if you were involved in a traffic accident or your child was
hurt in school.
The following diagnoses are also paid by the kupah by
law: New fractures (how can you be sure before you go?) or
dislocations, wounds requiring suturing, foreign body in the
airway or the eye; hemophilia, CF, dialysis or cancer
treatments or complications, fever in a newborn, and females
in labor. If you get admitted this is all irrelevant, but if
you are not, the ambulance isn't paid for either. We'll speak
about beating the system next week. Write me in care of the
Yated.
Editor's Note: The writer is the head of the Emergency
Room at Ma'ayenei Hayeshua Hospital in Bnei Brak.
A message from Glaxo, sponsor of this column. Rashes
are common and may require a cream that is gentle yet
effective. A dermatologist should decide, but ask your skin
doctor about Betnovate and Eumovate -- very effective
treatments for eczema and contact dermatitis. I use them
myself!
