Last update - 00:00 27/09/2006
Cabinet expected to okay mental health treatment through HMOs
By Ruth Sinai, Haaretz Correspondent
Cabinet ministers are expected to approve a bill Wednesday that would make mental health treatment available through health maintenance organizations (HMOs) as of next year.
The bill is slated for a fast-track move to the Knesset, where the finance and health committees will discuss various changes requested by organizations representing people with mental disabilities.
If passed, the law will help the estimated 200,000 Israeli adults who require mental health treatment and have regular medical insurance.
Prof. Eli Shamir, chairman of Otzma, an advocacy group for the families of those with mental illness, said more than half of the estimated 4 percent of Israelis who require mental health care currently receive either partial treatment or none at all.
The bill also means that state clinics - which have waiting lists on average of three months and sometimes up to a year - will transfer responsibility for mental health treatment to the HMOs, bringing such treatment in line with all other medical care, which came under the responsibility of the HMOs in 1995.
The bill states that everyone who is insured will be eligible for treatment in accordance with a defined health basket of goods and services that will be covered. According to the bill, the HMOs will receive an additional NIS 160 million over four years to develop the necessary services, and dozens of government clinics will be phased out of operation. Hundreds of government clinic workers will be fired, while some of them will be hired by the HMOs.
An administration has already been established to supervise the transfer of services to the HMOs. The Health Ministry, HMOs and Finance Ministry have agreed to the conditions stated in the bill.
Proponents of the transition see it as making mental health care more accessible to more people, while opponents warn the new system could discriminate against the poor and those in need of long-term care.
The final obstacle preventing the bill from being approved was removed Tuesday, when the ministerial committee for legislation dismissed the treasury's attempt to link the bill with restrictions on the health basket for the mentally disabled.
Until now, mental health programs have been somewhat left in the lurch. Since the HMOs have not been legally bound to provide mental health treatment, some do not provide any such care while others provide it for a subsidized fee. The government clinics, meanwhile, have not developed new services because it appeared that the HMOs would soon be the ones to provide mental health treatment.
If the law is passed, though, the insured will be able to choose free treatment at a public, HMO-run clinic (there will be a quarterly fee, as for any doctor), or to go to an independent but HMO-affiliated psychiatrist, at a cost of NIS 94 per session for 15 sessions and NIS 142 for each additional session that patients are allowed. Although psychiatric treatment at clinics is provided for free Wednesday, the wait is very long.
Officials at mental health clinics are warning that the transition to HMO coverage will be harmful for some people, especially the poor who are currently eligible for treatment in the wake of crises in their lives such as layoff from work or divorce. Others who may be harmed by the change include those who suffer from long-term diseases such as anorexia and require unlimited treatment but will only be eligible for 30 sessions once the HMOs take charge.
But Prof. Zvi Zmishlani, director of the Geha Psychiatric Hospital in Petah Tikva, said he expects the transition to generate effective and cost-saving treatment.
"Today there are people with depression who don't get treated for three months," he said. "That's a situation that we can't live with." Although some people will get fewer treatment hours than they might have under the state-run system, he said, the sessions will be more focused.
All in all, Zmishlani said, the changes in mental health care will be similar to changes in all other areas of the medical field, involving "a compromise between resources and needs."