Health Ministry: Poor Get Worse Treatment From HMOs

Impoverished people are more likely to contract the flu and less likely to undergo testing for breast cancer than Israelis in a higher socioeconomic bracket, according to a Health Ministry report released yesterday.

Last year 43 percent of poor Israelis aged 65-73 got a flu shot, as compared to half of their better-off counterparts. Among those aged 74 and older, the gap becomes larger.

The report does not break the subjects down according to their health maintenance organization due to opposition from the Clalit HMO, which insures 56 percent of all Israelis. However, since 70 percent of the country's elderly are insured by Clalit, the poor clientele's inability to pay the minimal fee required for the flu shot is most clearly evident among that HMO's patients.

The findings are drawn from statistics collected from all four health maintenance organizations between 2003 and 2005, and are meant to examine whether the same health basket of medications and medical treatments actually provides all citizens with equivalent benefits. In this report, the Health Ministry has publicized, for the first time, data on socioeconomic gaps with respect to various kinds of services.

Dr. Avi Porat, the head of the steering committee for the report and direc tor of the clinical epidemiology program at Ben-Gurion University of the Negev, said the report indicates two kinds of health-care gaps: one related to illness and one to treatment.

On the illness side, the report shows that more poor people suffer from diabetes and asthma.

Poor Israelis have a diabetes rate that is five times higher than that of other Israelis who don't have financial difficulties, with the most significant gap evident among those between the ages of 35 and 65.

The report also found that women aged 52-74 are less likely to undergo a mammography to detect possible breast cancer if they are poor. While 50 percent of poor women in that age bracket undergo mammographies, 58 percent of better-off women who are the same age get tested.

This difference can significantly affect the woman's health, considering that Israeli women have a particularly high rate of breast cancer compared to other countries. Every year 4,000 women get breast cancer, and 900 die of it. According to Health Ministry statistics, a mammography reduces the morbidity rate by 30 percent for women aged 50 and above. For women aged 40-49, it reduces that rate by 17 percent.

The largest gaps between poor women and women of higher socioeconomic status, with respect to testing for breast cancer, are in the 69-74 age bracket.

The compilers of the report gave the following suggestion to reduce the gaps: "Wouldn't it be more appropriate to give the insured from the lower classes treatment that extends beyond that which equality requires - for instance, by making it easier financially, or by trying to accommodate them in terms of access to certain health services?"