Medical Watchdog Says Insurance Ads Misleading Public

Committee of senior physicians says that medical insurance packages do not include proper disclosure that services and benefits offered are available to all Israeli citizens in any case.

An expert committee engaged by the nonprofit organization Public Trust, in a new report, calls advertisements of medical insurance ambiguous and misleading.

The committee of senior physicians said that medical insurance packages do not include proper disclosure that services and benefits offered are available to all Israeli citizens in the health basket.

health - Nir Keidar - November 19 2010
Nir Keidar

Although patients recovering from a heart attack or bypass surgery are eligible for care up to five recovery days, private insurance companies offer recovery days as an added benefit, without a clear explanation of what is the added value of the private service.

The HMO Clalit Health Services offers seven recovery days following a cardiac event in its extended insurance package, but the committee found these seven days include the five days available through the health basket.

This is not mentioned in Clalit's advertising of the extended coverage.

Another trend seen as misleading concerns the absence of an average price for every reimbursable service offered in an insurance package.

The Clalit and Maccabi HMOs offer percentage-based reimbursement for services in an extended insurance package, but do not specify the average cost of such services, so it is impossible to evaluate the worth of the insurance, the report says.

Medical insurance advertising also does not address the availability gaps between central Israel and the periphery. Be'er Sheva, for example, lacks a facility offering recovery services for heart patients.

Such clinics do exist in the north and center of the country and in Jerusalem. Thus, residents of the south are forced to travel a considerable distance to obtain this service - a fact that goes unmentioned in the insurance advertising.

The committee's recommendations, submitted earlier this month to Health Ministry director general Dr. Ronni Gamzo, seeks regulation of health insurance advertising, ensuring that advertised services are displayed alongside their availability in the health basket.

The report also recommends the ministry enforces the publication of price ranges for benefits offered in extended insurance, so the benefit of every package can be accurately assessed, and that the ministry introduce a minimal availability bar, with each package compelled to sponsor a patient's travel and overnight stay expenses.

Galit Avishai, chairwoman of Public Trust, who also headed the committee looking into medical insurance, said: "Health care in Israel consists of a first tier, that of the basic health services basket; a second tier, that of the extended insurance coverage offered by HMOs; and a third tier, that of private medical insurance.

When the first two tiers are offered by the same people, the HMOs, there's an inherent stimulus to create ambiguity around the availability of services, to transfer more of them to extended insurance packages and encourage clients to pay for them. We intend to resolve the absurdity this creates."

The Health Ministry said in response that as soon as the director-general receives the report, he will read it thoroughly and will respond accordingly.

The Public Trust committee included some of Israel's top medical professionals - Hadassah University Hospitals director-general Professor Shlomo Mor-Yosef; Ichilov Hospital cardiologist Professor Shmuel Banai; and Professor Gabi Bin Nun of Ben-Gurion University of the Negev, whose field is health economics. He is also a former deputy director-general of the Health Ministry.