Text size

Some 4.5 million people, almost two-thirds of Israel's population, can't be wrong. That's the number of people with supplementary health insurance coverage supplied by Israel's health funds, the most important voluntary health insurance in Israel.

Why do these 4.5 million people believe in supplementary health insurance? Because it's cheap: It is far cheaper than the health coverage that the insurance companies supply.

Because it's accessible: The clerks at the health funds plug it routinely, every time they come into contact with a patient. The health funds' marketing machine is second only to that of the banks, by the way.

Because it's convenient: It offers the freedom to consult private doctors, because it offers dental care and the monitoring of child development. And because it insures them against medical catastrophe.

Catastrophe? Israel already has mandatory health coverage, under law, which is supposed to assure people of help in the case of a catastrophe to their health. If you have a heart attack, you will receive treatment. Yet the state health basket has a few weak points that in extreme cases can leave people helpless in the event of catastrophe.

Those weak points are the loophole through which private healthcare insurance, primarily supplementary health insurance, is marketed. The health fund clerks never neglect to mention them to members wondering why they need supplemental coverage, given their protection by law. "Think what would happen if you need a transplant abroad," they typically warn. It almost always works.

It is a great marketing ploy, but it's highly misleading. The charters of the supplementary health insurance plans at the four health funds have articles relating to three kinds of catastrophe, but just try to access the service: it's almost impossible. In fact, to a great degree, the articles are devoid of content. In short, the supplementary health plans do not really cover the three kinds of catastrophe.

For instance, the plans cover heart surgery abroad, but only if the particular operation isn't available in Israel. Since almost all surgeries are available locally, such as heart transplants, practically there is almost no ability to gain financing for surgery abroad. To prove the point, in 2001 supplementary health insurance plans paid just NIS 1.9 million for surgery outside Israel, compared with spending NIS 45 million on private doctors, consultants and surgery.

The plans left no room for doubt, adding that a long wait for surgery in Israel does not constitute cause to consider the surgery not provided here. It is perfectly well known that a major problem regarding transplants is precisely the long wait, which can be years, sometimes until it's too late, but you won't be saved by the supplementary health insurance, except in extraordinary cases.

A similar difficulty arises regarding drugs not covered in the regular health basket. The condition for receiving a drug not included in the basket is permission from the health fund's chief doctor, and obviously the chief doctor has no interest in approving a highly expensive drug costing the health fund a small fortune. Clalit, which covers 60 percent of Israel's population, even ruled that drugs outside the basket shall not include life-saving ones.

No, that is no mistake. It is declared policy at Clalit, which believes that because it covers two-thirds of Israel's population, if it allows supplementary health insurance plans to provide life-saving drugs not included in the basket - all it will accomplish is to relieve the government of pressure to add the drugs to the basket. It is a political arm-wrestling match between the state and Clalit, and meanwhile, Clalit's subscribers, who pay their hard-earned money for supplementary health insurance and can't get life-saving drugs, are paying the price.

The health funds and the Health Ministry that supervises them are aware of the situation. They don't see the problem, though. "Supplementary health insurance is very cheap, anybody can have it," they say, "and one can't expect insurance like that to provide very expensive medical care. Customers should know that supplementary health insurance is limited."

That's the problem: they don't know it. People buy supplementary health insurance partly, if not only, because of catastrophe coverage, without realizing that they're buying an invisible pig in a poke. Inclusion of the articles in the policy, together with draconian terms that make them all but impossible to exercise, is tantamount to making a false presentation. The Health Ministry is presently checking to see if that's really the situation.