Private health insurance: a necessity!

Health Insurance

in Israel: Understanding the Issues and the Options Taking Out Private Health Insurance Of the more than 9 million inhabitants of the State of Israel, more than half have taken out health insurance, either directly or through their employer, with a private company such as Ayalon, Clal, A'hchara, Harel, Menora, Migdal, Phoenix, or others of smaller size.

Thanks to its internationally renowned surgeons, Israeli medicine is ranked fourth in the world in terms of level and quality of care, but only 36th in terms of services. The reasons for this latter ranking are numerous.

Waiting Times in the Public System In the public system, queues for surgical procedures are very long. These delays, as everywhere in the world today, have grown heavier with COVID-19. We are not talking here about life-threatening operations, which are carried out without delay of course, but about all other procedures where life is not in danger.

For example, for a colonoscopy, waiting times generally vary from two to four months depending on the Kupat Holim. For a tonsillectomy, it is similar. For a cataract procedure, one must expect six months. Records are broken in the orthopedic field, where, according to a recent Ministry of Health survey, delays sometimes exceed one year.

This explains why, of the 800,000 surgical procedures performed each year in Israel, a quarter are carried out in the private sector.

Choice of Surgeon and Diagnostic Examinations In the public system, it is not possible to choose the surgeon. It is the on-call doctor in the department on the day of the operation who performs the procedure. Yet it is essential for a patient to know who will operate on them and to feel confident.

To get an appointment for an MRI or a CT scan, one unfortunately has to wait several weeks. It is not uncommon for these appointments to be scheduled at night due to the limited number of machines available at the Kupot Holim.

Transplant Issues

and Medications Organ donations are extremely rare in Israel, which prevents access to the world bank. A patient needing a kidney, for example, must wait several years, each of which proves critical.

In Israel, only medications included in the famous "medicine basket" (sal hatroufoth) are covered. Unfortunately, many medications that can save or prolong life are not included, such as those prescribed in anti-cancer treatments Zevalin, Somavert, and Nexavar.

Every year, enormous pressure is exerted on the Ministry of Health commission to approve these treatments, but the annual budget for new medications is 350 million shekels while the need stands at one billion three hundred million.

Innovations and Treatments Abroad Innovative treatments, new technologies, and robotics are not common in the public sector due to the cost of equipment or treatments. For example, cartilage problems can be effectively treated by Orthokine injections, avoiding surgery. However, this type of treatment is not covered by the health funds, so those who are not privately insured must undergo surgery.

For varicose veins, alternative techniques can avoid surgery, but they have not yet been integrated into the public system due to lack of resources. Persons insured with private companies can benefit from these innovations.

Complementary Health Services The

various health funds in the country have put in place complementary health services, called Mouchlam and Platinium for Clalit, Maccabi Zahav and Maccabi Cheli, Meuhhedet Adif and Si, and Silver and Gold for Leumit. These supplementary plans try to improve their services and prevent the mass departure of their best doctors. However, they suffer from numerous limitations and fail to stem the constant increase in the number of Israelis who take out private health insurance for optimal coverage.

Reasons to Take Out Private Health Insurance Only 10% of the renowned specialist doctors and professors working in the private system also collaborate with the supplementary health plans of the health funds. This considerably limits the choice when one wishes to consult a specialist. The majority of these specialists can only be consulted privately, and reimbursement, at up to 80% of fees, is only possible through a private insurance policy.

Complementary insurance does not make it possible to reduce waiting times for MRIs and CT scans. A patient who has taken out insurance with a private organisation gets an appointment within 72 hours.

The waiting times of complementary insurance cannot compete with those of the private sector. In the latter, operations are generally scheduled in record time, one week on average. No advance payment is required since the insurance company sends payment authorisation directly to the hospital.

Supplementary health plans also do not allow access to transplants carried out abroad, nor to medications outside the "basket," of which there are many and which save lives. Media campaigns to raise funds for children suffering from serious illnesses bear witness to this. Had these children been privately insured, all medical costs, procedures, treatments, and travel would have been covered.

Importance of an Insurance Agent Taking out insurance directly with an insurance company is a mistake. The insurer will defend its own interests before yours. In case of need to activate the policy or in the event of a dispute, you will be an anonymous person in a mass of clients.

An insurance agent becomes your advocate when the time comes. At the time of taking out the contract, they will explain the various clauses to you in detail, clarify the points to be understood, and above all, will personally follow up with you when needed. Employees insured by their employer do not benefit from this personal relationship.

It is essential to ensure that the agent has a significant client portfolio. This will play a major role when coverage decisions are made that may require going beyond the contract or expediting reimbursements.

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