No surgery for foreign worker since 'she didn't report cyst'

Susana Radu urgently needs an ultrasound test to determine the size of a cyst found in her ovary four years ago. For several months she has suffered pain and pressure when urinating, and the cyst will probably have to be removed before it becomes malignant, if it is not already. But the Ayalon company where Radu is insured refuses to approve the test and operation, claiming that Radu did not report the growth in the health declaration she filled out for her insurance application.

Radu, 48, came to Israel in 2002 to take care of an elderly woman, and was insured at Menorah. During the period covered by her insurance she had an Xray that revealed the cyst. After her employer's death, Radu moved to another employer, and was surprised to discover that he had bought her a policy with another insurance company. The health declaration she had to fill out was in English, which she does not speak, so she asked the employer's daughter to fill out the form for her. "There was no secret, I did not conceal anything," she says.

Radu came to the clinic run by Physicians for Human Rights (PHR) after the insurance company turned down her claim application. Some 1,200 foreign workers like Radu have gone there in recent years after being denied treatment. The non-profit organization learned that the insurance company actually has a health declaration form in Romanian. It is unclear why Radu was not given this form.

The problem Radu encountered stems from the fact that migrant workers are not entitled to insurance at the country's kupot holim health service organizations. Under the Foreign Workers Law, employers must purchase an insurance policy for them from an insurance company, a situation that creates a host of problems, to the point of endangering workers' health and even lives.

Next month the Knesset will discuss a demand by PHR that Health Minister Yacov Ben Yizri exercise his authority and extend national health insurance to 102,000 legal migrant workers in Israel.

"They are here at the government's invitation and out of a clear economic interest of the state. Their treatment ought to be commensurate with that," says Ran Cohen, director of PHR's Migrant Workers, Refugees and Asylum Seekers Project. "They must be given full access to health services in the name of their basic right to life."

Currently, the employer determines which insurance policy to buy for the worker. Therefore, Cohen says, instead of vying to improve service for the insured, companies limit the type and quality of service to compete for the employer's money.

Ahuva Salzburg is a lawyer who represents dozens of foreign workers who received improper treatment because of this situation. She says one prevalent problem is the lack of follow-up after a doctor writes a prescription or sends a worker for treatment.

Radu's problem with the health declaration is fairly common. Many workers fill it out without understanding its importance. Sometimes a representative from a personnel company puts a check next to every item and the worker merely signs.

"They tell the worker, 'If you don't sign, you don't work.' Of course he'll sign. He took out a loan of $18,000 in China to come here. He must work. Afterward they deny him treatment, claiming he concealed information from the insurance company," Cohen says.

Workers who change employers frequently find themselves with no insurance coverage for the transition period. Sometimes they find this out only when they need treatment.

Language is a major obstacle. To receive treatment, be it for a cold or cancer, workers have to call the insurance company for a referral to a doctor. Service is usually in Hebrew, English and Russian, but most migrant workers do not speak these languages. They need their employers to translate, which forces them to divulge private medical matters.

PHR is certain many workers simply forgo treatment. Sometimes the problem goes away; sometimes lack of treatment makes it worse. Cohen thinks there is a better way: Instead of employers forking over NIS 200 million to private insurance companies, let them buy insurance from the kupot holim.

"It makes a lot of sense economically," he says. "We're talking about a youthful population, workers who had checkups in their countries of origin and were deemed healthy and fit for work. They are every insurer's dream."