Israeli State Insurance Cajoling Women to Have Four Children, Critics Say

The $2,100 in benefits would now be distributed over four pregnancies, a number most Israeli women don't reach

FILE Photo: Participants at the Nefesh B'Nefesh picnic at Park Chai in Kiryat Motzkin, August 30, 2018.
Aviva BenHaim

A Health Ministry reform for supplemental health insurance is being criticized for splitting coverage over four pregnancies, even though the average Israeli family only has three children.

The proposed change has already drawn harsh criticism online, with more than 12,000 signatories saying it makes advanced genetic testing and expert consultations available only to the rich.

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Israel’s health maintenance organizations offer their members supplemental insurance at added cost. Currently, the HMOs offer pregnant and postpartum women 8,000 shekels ($2,100) in services, to be split among up to three pregnancies, though a woman could choose to use the full sum on her first pregnancy.

The extra coverage has been provided as refunds based on receipts. The change would limit the refund for any given item, and prohibit funds from being used on items such as nursing bras and infant breathing monitors.

The Health Ministry says the supplemental insurance offers additional coverage beyond the 8,000 shekels specifically for pregnancy expenses. It says the coverage has led both women and suppliers to take advantage of the insurance.

For example, some families have used the coverage to buy covered equipment such as a breast pump, nursing bras and an infant breathing monitor. They then receive the rebate, return the items and use the store credit to buy other items such as an expensive stroller. Other people simply ask for fictitious receipts in order to cash in on the policy.

In addition, service providers such as doctors, doulas and lactation consultants have raised rates, knowing that women basically have a blank check from the HMOs, the Health Ministry says.

Revital Topper-Haver Tov, a vice president for HMO regulation at the Health Ministry, told the Knesset on Monday that if until two years ago HMOs were receiving receipts for doula services totaling 1,500 to 2,000 shekels, now these receipts sometimes top 7,000 shekels.

Likewise, the HMOs are receiving receipts between 1,200 shekels and 1,500 shekels for breast pumps worth 400 shekels, while nursing bras valued at 400 shekels are coming in at receipts for 1,000 shekels, she said.

Another trick women have discovered is using up the entire 8,000 shekels with the first pregnancy, then switching HMOs before the second pregnancy, said a source at an HMO. These costs are ultimately passed on to policyholders.

Health Ministry sources say the reform is designed to make service providers return prices to reasonable levels and let families have supplemental insurance coverage left for subsequent pregnancies, particularly as costs rise due to the mother’s advancing age.

But the question remains – why did the ministry decide to split coverage over four pregnancies when the average Israeli family has three children? With 2,000 shekels of supplemental coverage per pregnancy, families planning to have under four children are likely not to receive the full sum.

Is this a hint that a typical family has four children or more? asks Prof. Daphna Birenbaum-Carmeli of the University of Haifa, an expert on the social and political aspects of medical technology. The new policy is a way to set a standard family size, she says.

“The Health Ministry doesn’t say, ‘We’re trying to save money at patients’ expense and cut costs,’ it says they’re giving the same service in a more efficient way. There’s an implied suggestion or hint that a standard family has four children,” Birenbaum-Carmeli said.

As she put it, this is similar to the state’s policy on in vitro fertilization: Israel does not come out and call on families to have more children, it simply offers the world’s most generous funding for reproductive assistance.