Subscribe to Print Edition | Fri., November 21, 2008 Cheshvan 23, 5769 | | Israel Time: 02:52 (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

HMOs exploiting their members By Haaretz Editorial Tags: Israel News, healthcare  The suit filed by the Clalit Health Maintenance Organization (HMO) against leukemia patient Ehud Hoch, an HMO member (Ran Reznick, Haaretz November 19), illustrates a very extreme and disturbing practice that too-often characterizes all four of the nation's HMOs. Every year, all of them evade paying for or providing medication, treatments and examinations for hundreds of patients. The medication and treatments in question are part of the health services specified by the State Health Insurance Law of 1994, and have been prescribed for HMO members suffering from serious illnesses. The HMO and Health Ministry are embroiled in an argument over the medical and legal interpretations of administering these medicines and treatments and their suitability to certain patients. H Advertisement owever, the HMOs' conduct is dishonest at best and cunningly cynical at worst. In all the cases reported in the expos?, the argument ended with an examination by the Health Ministry's State Health Insurance ombudsman. The accumulated grievances in the ombudsman's office show that every year hundreds of patients - disabled people, cancer, heart and other patients - complain that they did not get the medication and treatments they deserved. Even after the ombudsman ruled, on the basis of professional opinions, that the HMOs are obliged to provide or finance the medication or treatment, the HMOs tried to shirk their duty. This involves 500 to 800 cases a year. This conduct is a blatant infraction of the State Health Insurance Law and demonstrates the HMOs' immoral contempt for their patients. For every patient who dares to complain about his HMO there are hundreds, perhaps thousands of others who are incapable of doing so. These include the chronically ill, poor and elderly patients, as well as new immigrants and Arab citizens who are not aware of their rights to file a complaint and are not familiar with the bureaucratic labyrinth. These complaints won't even reach the stage of receiving a hearing in the ombudsman's office. Nor will these thousands be able to pay from their own pockets, as the hundreds who complained to the ombudsman did, for their treatments and medication while waiting for their case to be heard. The cost of these services usually exceeds the average wages of a middle-income earner. There is a clear impression that the HMOs have developed a scandalous way to take advantage of the weakness of their members at their most vulnerable time of need. The state already budgets the HMOs' expenses according to their expected use of the health basket, and yet they also contrive to make money off the backs of the patients, and then boast of their economic cleverness. The HMOs argue that they are acting within their legal rights, including the absurd suit against Hoch, and that consenting to the patients' demands would lead to their "collapse." This is a distorted interpretation of the State Health Insurance Law. Professor Gabi Ben Nun, formerly the Health Ministry's deputy director for economics and health insurance, is right in stating that "the HMOs are obliged to provide the treatment, and only afterward settle accounts with the ministry." The Health Ministry must ensure full transparency and expose the extent of this practice in each HMO to its members. It must also take action against the HMO officials and managers who are responsible for this practice. 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.

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