Report: 27% Rise in Justified Complaints Against Israeli Health Maintenance Organizations

Annual Health Ministry report shows Leumit HMO suffers from greatest increase in justified complaints.

The number of legitimate public complaints against Israel's health maintenance organizations rose steeply in 2012.

An annual Health Ministry report states that 1,279 of the complaints filed last year were found to be justified, a 27 percent increase over 2011.

The figures were released Sunday in the annual report of the Public Complaints Commission under the National Health Insurance Law. All told, the Commission found that 26 percent of all complaints were justified.

The Leumit HMO showed the greatest increase in the number of legitimate complaints, with a 48 percent rise and 163 justified complaints last year. The figure for Clalit, meanwhile, was a 30 percent rise, to 652 justified complaints, and Maccabi saw a 28 percent increase.

Only Meuhedet saw its number of justified complaints remain stable.

Leumit also had the distinction of having the most complaints per member - 2.31 per 10,000 insured members - as well as having the highest rate of total complaints, justified or not.

Clalit had the least complaints per member, replacing Maccabi, which had been the leader until 2010.

The greatest number of complaints filed with the Health Ministry against the HMOs concerned treatments that are included in the state-subsidized health basket that the HMOs had refused to provide to members.

Eighteen percent of complaints related to the quality of services provided, and 6 percent concerned the various supplemental insurance programs offered by the HMOs. Five percent dealt with patient choice of those providing the subsidized services.

Health Ministry Director General Prof. Ronni Gamzu asked the public to file complaints over any service that does not meet the standards of the National Health Insurance Law, whether they are services from the HMOs, their supplementary insurance programs, state hospitals or the ministry itself.

Gamzu called the complaints about the public health-care system "a right and an opportunity. A complaint that we can learn from, or [something] missing in the system, is an opportunity to fix and improve services," he said, on publication of the report.

Leumit said in response that in recent years it has invested efforts and resources to improve its connection with members in a number of ways, and its own surveys showed a high level of satisfaction. The HMO said it would study the report, reach conclusions and continue to improve service in coming years.

Limor Edrey