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A run-of-the-mill pedestrian who is insured by one of the health maintenance organizations and who needs a drug is at the mercy of the health-care maintenance organizations and the insurance companies. But for one group of former Very Important Persons, things are different. They pay for their medicines out of their own pocket - be it Viagra, diapers or other health items - and hand the bill over to the state for reimbursement.

That's how things are when you belong to the "VIP Heath Club" made up of about 600 former state officials and employees and their partners, including presidents, prime ministers, ministers, Knesset members, judges and retired chief executives.

The arrangement covers former office holders who were appointed or retired by 1986, and older judges who were appointed or retired by 1995, some of whom still preside in courts.

The state reimburses these luminaries for their health-care expenses, including some treatments that are not and never were included in the health basket. All they have to do is submit the bill to the Health Ministry, though sometimes, their claims are rejected.

One former VIP recently sought reimbursement for his Viagra pills. The elderly gentleman, who uses a walking stick, argued that he is entitled to reimbursement since the drug is a medicine for improving sex life and is licensed in Israel. The Health Ministry agreed.

In another case, an elderly VIP demanded that the state cover the cost of what adds up to a few thousand shekels a year for diapers for incontinent adults. The state showers him with cash as well.

One former VIP demanded reimbursement for the cost of a nose job, arguing that the operation was for improvement of her health and airways. A second claimed the cost of a trip to Germany for so-called thermal therapy, and a third sought public funding for an orthopedic bed with an adjustable mattress, costing tens of thousands of shekels.

The latter three claims were rejected by Dr. Michael Dor, who heads the Health Ministry's General Medicine Department. The financing is meant to cover treatments in Israel, not overseas, and a sophisticated orthopedic bed is not medical equipment, but a piece of furniture, he ruled.

Dor came to the rescue of the public coffers because former office holders are flooding the Health Ministry with demands. A former judge has submitted receipts for the purchase of preventive homeopathic medicines like Propolis and Hizukit. Another wanted the taxpayer to cover homeopathic treatments, and some have sought state funding for cosmetic treatments and massages.

The Health Ministry sent them home empty-handed. State compensation has been denied for vitamins and Chinese teas. There is no reimbursement for massages unless performed by a licensed professional such a physiotherapist.

Some of the treatments demanded by the former VIPs are entirely outside recognized medical care and are not performed by licensed professionals but by "specialists" who have taken a course of study, sometimes a spiritually-oriented one, in India or China.

In one instance, a former senior official submitted receipts for malaria medicine used by travelers to the Far East. As the official in question is very elderly and in no condition to fly around the world, ministry officials wondered why he needed the medicine. The claim was finally rejected after suspicions arose that the medicine was meant for his grandson.

An aging club

The recipients covered in this special arrangement are aging so their medical expenses are growing. The cost of nursing home care for a former VIP reaches NIS 10,000 per month or more. The Finance Ministry has capped the amount reimbursable for this. TheMarker has learned that last week the Health Ministry sought a 25% increase the NIS 12 million budget for reimbursement of former VIP health costs, to NIS 15 million in 2010.

About 70% of the annual medical costs are spent on nursing, an expense that is likely to grow over time. In addition, as they age, recipients also require more medicines that are not included in the health basket.

Nevertheless, in the long term, expenses attributable to VIP club members are likely to fall as they die, and they are not replaced by additional members. The cost of financing medical expenses for this group is expected to add up to NIS 200 million-NIS 300 million over the next 15-20 years. And it seems there's plenty of budget resources for these entitled ones.