Ministry Accuses HMOs of Forcing Some Patients to Travel Far for Healthcare

A Health Ministry report shows that patients are often referred for medical check-ups or other treatment to facilities that are far from their homes, sometimes requiring hours of commuting. The report, by the ministry's ombudsman, Eti Samama, who deals with implementation of the National Health Insurance Law, reveals a problematic situation whereby patients are told to seek treatment in distant locations by their health maintainence organization, due to various selection criteria, and financial and other considerations.

According to data for 2008, the ombudsman received 371 complaints concerning patients sent for treatment at locations far from their homes or contrary to their wishes. Of these cases, 124 involved hospitalization and 247 involved treatment in clinics or health institutes.

The Clalit HMO is leading the pack with 7.3 complaints for every 100,000 members, three times more than Leumit HMO (2.7 complaints), Maccabi (2 complaints) and Meuhedet (1 complaint) per 100,000 members. Complaints concerning the location of treatment constituted about 10 percent of the total number of complaints against all HMOs last year. The vast majority of complaints, some 70 percent, focused on the health basket - i.e., on the services and medicines covered by the HMOs under the national insurance law.

In response, Clalit says that it has an "agreement with all government and public hospitals ... Diverting patients to a particular institution is done based on medical assessments, geography and considerations involving the area of residence."

In statements made during a speech at before the Association for Patients' Rights a week ago, Samama stressed that "prior to the National Health Insurance Law, medical services were provided on the basis of medical assessment and were of reasonable quality. They were provided within a reasonable time frame, and at a reasonable distance [from home], in accordance with the funding available to the HMO."

In one case, a 20-year-old patient from Nahariya, suffering from infection of the intestines, was told by the HMO that she could go for specialized treatment either to Meir Hospital in Kfar Sava or to Beilinson Hospital in Petah Tikva.

According to the law, an HMO can select the medical center to which its members will be sent for treatment, and can thus select a facility that it owns, or treatment in a community medical center rather than more costly hospitalization.

In view of the ombudsman's findings, a decision was made at the Health Ministry that in the near future, HMOs will be required to have prior authorization before making such arrangements with medical institutions. Moreover, it was decided that the period of treatment also has to be defined, so that patients requiring ongoing care, such as dialysis, will not have to change treatment centers.

Adina Marks, head of the Association for Patients' Rights, said that "the minute a patient will be able to select the location of medical treatment, it will bolster his or her faith in the system. The Health Ministry needs to intervene in the so-called selection arrangements of the HMOs, because at present decisions involving patient referrals for care are forced on them. Many people would not seek private medicine or 'black market' medicine if they could choose where they will be hospitalized."