Subscribe to Print Edition | Thu., November 20, 2008 Cheshvan 22, 5769 | | Israel Time: 03:10 (EST+7)   Back to Homepage web haaretz.com Haaretz Toolbar Diplomacy Defense Jewish World Opinion National Print Edition Car Rental Books Haaretz Magazine Business Real Estate GA 2008 Travel Week's End Anglo File

Patients wrongly charged for 'experimental' treatments By Ran Reznick Tags: hospitals, medical treatments  May 2005 was a difficult month for Ehud Hoch. The 54-year-old from the Haifa suburb of Kiryat Haim was diagnosed with leukemia and received radiation treatment to his brain. The procedure led to radiation poisoning, which only worsened with time, harming his balance and vision. When the medications he was taking to counteract the radiation proved ineffective, doctors recommended a series of oxygen treatments in a hyperbaric oxygen chamber - where he would breathe oxygen at a higher than atmospheric pressure for several hours. The procedure worked. Hoch's neurological problems disappeared, and he returned to work at a security-related factory in the north of the country. Hoch spent 40 two-hour sessions in the chamber, running up a bill of NIS 30,000, which he paid for out of pocket. Advertisement The Clalit Health Maintenance Organization, of which he is a member, refused to fund the treatment, claiming it was not included in the health basket it is required to provide its members under the National Health Law. Hoch is not alone. Haaretz has learned that about 800 other patients - among them heart patients, cancer patients and disabled people - did not receive funding for medication and essential treatments at the four major HMOs in 2007-2008, even though the Health Ministry determined these treatments were part of the health basket. Hoch remained persistent and petitioned the Health Ministry over Clalit's decision. In September 2006, Dr. Karny Rubin-Jabotinsky, then the Health Ministry official in charge of overseeing the application of the National Health Insurance Law, ruled that the oxygen treatment is indeed included in the health basket. She stated that such treatment is common for treating brain damage, and is likely the only therapy that could have helped Hoch under the circumstances. In October 2006, the HMO filed a lawsuit against Hoch at Haifa's regional labor court, the first time an HMO sued a private patient under the terms of the National Health Insurance Law. Clalit demanded the court issue a declarative order stating the commissioner's ruling was "fundamentally flawed." The HMO claimed the treatment was experimental, and is not included in the health basket. It also stated that while the basket does provide for soft tissue treatment, the brain does not fall under this category based on the HMO's criteria. Clalit stated that including the treatment without increasing funding would place Israel's health services in "real danger." "[Funding coverage] has implications for the wider patient public, which may find itself entitled to coverage within the health basket," a Clalit official said. Hoch's attorney, Dori Spivak, responded that the Human Rights Clinic at Tel Aviv University's Faculty of Law determined that the law authorizes Rubin-Jabotinsky to order the HMO to fund the oxygen treatment. Judge Michal Freiman is expected to rule on the case soon. As in Hoch's case, Rubin-Jabotinsky, aided by a panel of officials, was the go-to official when disputes erupted between patients and HMOs. She has since been replaced by Eti Samama. Health Ministry officials said that in recent years it has received 500 to 800 complaints from patients annually over disputes regarding health basket coverage. The officials said that while the majority of the complainants ultimately received coverage for the treatments they required, the cases that reach the ministry are only the "tip of the iceberg," as many chronically ill, poor, and elderly patients, as well as Arab citizens and new immigrants, are not aware of their rights to file a complaint if denied coverage they believe they are due. Rubin-Jabotinsky said that for every justified complaint her office received, another 25 patients did not file a complaint against their HMOs. Ministry officials added that even after a decision has been made that the HMOs must cover the treatments in question, they often continue to refuse. Moreover, Hoch's case is not the only one involving Clalit, the country's largest HMO with an annual turnover of NIS 18 billion Dr. Yehudit Elitzur, an 80-year-old cancer patient from Jerusalem, has been battling the disease for 23 years and has been forced to pay more than NIS 3,000 a month since July 2007 for cancer medication. Elitzur wrote to Clalit demanding coverage, and received a response from Dr. Nicki Lieberman stating that the medication's coverage falls under the "experimental" category, and is not included by law in the health basket. This year, Samama ruled that Elitzur was entitled to receive coverage for the medication. A senior ministry official told Haaretz that the HMO's conduct "presents a legal problem but beyond that, this is a very difficult moral problem." A Clalit official responded, "These are two complex cases, in which there is a dispute between Clalit and the ministry official who oversees application of the National Health Insurance Law." Professor Gabi Ben Nun of the department for health system management at Ben-Gurion University in Be'er Sheva called the HMOs' behavior a "scandal." "The dispute over the criteria of the health basket must not come at the expense of the patient," Ben Nun said. "The HMOs must provide treatment to the patient, and only afterward continue their argument with the ministry." The Health Ministry said in a statement, "The ministry has various officials who are authorized to supervise HMOs and to provide guidance regarding ministry decisions, including the director-general, the unit for supervising HMOs, the legal office, and the health system ombudsman." Bookmark to del.icio.us   The King is dead Archeologists find new evidence for King Herod's tomb site. Al-Hasbara Israel launches Arabic YouTube channel to bypass Arab media.

Read & React Bradley Burston: Dividing Jerusalem, one wall at a time Responses: 42 Peres: Obama told me he was 'very impressed' with Arab peace plan Responses: 75 VIDEO / Peres speech at Oxford University disrupted by anti-Israel protesters Responses: 104 Settler rabbi: The State of Israel is an enemy of the people Responses: 69 Hamas: We're prepared to end cease-fire and confront Israel Responses: 49 More Headlines 22:25 IAEA: Syria site bombed by Israel bore features of nuclear reactor 22:05 Israel to boycott 'Durban II' anti-racism conference 21:40 Assad: Israel never asked Syria to cut ties with Hezbollah, Iran 21:42 PA negotiator: Obama told Abbas he'd spare no effort to see Mideast peace 19:26 Israel launches Arabic YouTube channel to bypass Arab media 22:02 Jewish Republican representative elected to top deputy spot in Congress 01:36 Archaeologists find new evidence for King Herod's tomb site 23:06 GA special report / Satisfied participants bid farewell to Jerusalem 00:44 U.S. FAA downgrades Israel's aviation safety ranking 19:04 Dividing Jerusalem, one wall at a time 02:09 Al-Qaida No. 2: Obama guilty of betraying Muslim roots in backing Israel 00:42 Peres speech at Oxford University disrupted by anti-Israel protesters 02:07 Warsaw completes restoration project marking Jewish Ghetto boundaries 01:50 Court sentences Boaz Yona to 7 years, doubles damages he must pay 02:40 Report: 90% of schools offer auxiliary programs not monitored by Education Min. Previous Editions Select Day 19 nov 18 nov 17 nov 16 nov 14 nov 13 nov 12 nov 11 nov 10 nov 09 nov 07 nov 06 nov

Special Offers Advertisement Living in Israel Studying in English Click & Meet our students from all around the world Dan Boutique Jerusalem New Dan Hotel in Jerusalem Young, Fun & Distinctively Dan Book Now Online! Fattal Hotel Chain Perfectly located hotels on best resorts of Israel. Car rental in Israel Shlomo Sixt Receive $15.00 from our low rates. Dial 013 for your long-distance calls and get all your money back US CITIZENS Vote for real change. Request your ballot today! Eldan Rent a Car Israel's leading car rental company offers you a 20% discount on all online reservations Jewish Singles Personal Ads Find the love of your life on JDate.com Israel's Premier Real Estate Website www. israel-property.com Hebrew Summer courses From $39.95 Junkyard Junk a car - get free towing nationwide and a tax-deductible receipt

Home | TV | Print Edition | Diplomacy | Opinion | Arts & Leisure | Sports | Jewish World | Underground | Site rules |

Real Estate in Israel | Travel to Israel with Haaretz | Hotels Israel | Restaurants Israel | Tourist attractions Israel | Shops Israel

birthright Israel | Search engine marketing

Haaretz.com, the online edition of Haaretz Newspaper in Israel, offers real-time breaking news, opinions and analysis from Israel and the Middle East. Haaretz.com provides extensive and in-depth coverage of Israel, the Jewish World and the Middle East, including defense, diplomacy, the Arab-Israeli conflict, the peace process, Israeli politics, Jerusalem affairs, international relations, Iran, Iraq, Syria, Lebanon, the Palestinian Authority, the West Bank and the Gaza Strip, the Israeli business world and Jewish life in Israel and the Diaspora.

© Copyright  Haaretz. All rights reserved