A unilateral move by the Maccabi Health Insurance Fund will prevent the fund's insured from receiving treatment at Sheba Hospital, the largest in the country, starting tomorrow. The new restrictions will apply to new patients, but patients who are already being monitored in Sheba Today "it was learned that the background to this is Maccabi's request to receive a discount of tens of millions from Sheiba in the hospitalization agreement of its insured.
The Maccabi website, in the category dealing with the hospitals in the agreement with Maccabi, states that "as of February 9, 2002, Sheba Hospital will withdraw from the selection arrangements and will only be open to members of the northern and southern districts."
This means that Maccabi members will not be able to attend planned hospitalization and treatment at Sheba or outpatient clinics, such as surgeries or follow-up.
The background to the unusual move by Maccabi is related to Maccabi's demand to receive an additional discount on the hospitalization agreement it already has with the hospital.
Maccabi claims that they purchase services from Shiba in the amount of one billion shekels a year, and when they wanted to "fence" the risk and limit the number of patients or receive a discount - they were refused.
Maccabi claims that there are many other alternatives for their patients in the center (but not in the north and south, so they will be able to continue to reach Sheba).
India further acknowledged that this was an economic decision aimed at preventing harm to other services and the availability of appointments for policyholders.
Apart from that, the move was made with the knowledge and approval of the Ministry of Health.
However, a senior official in the Ministry of Health said that "this is an annoying event. It is an economic management done on the backs of Maccabi members. The hospitals cannot meet other discounts, and even if they gave discounts to Maccabi members, it could hurt and lengthen queues for all insured and other HMOs. It's greed, I have no other word. "
The source also said that "if Maccabi has a cash flow problem - they will contact the Ministry of Health and ask for assistance."
The emergency room at Sheba Hospital, Photo: Coco
"Pig demand"
Another source familiar with the details of the conflict added: "Maccabi removed Sheba from the selection arrangements so that half of the residents of Tel Aviv, Ramat Gan or Bnei Brak, who are insured with Maccabi, will not be able to receive treatment at Sheba - the largest hospital in Israel. In the freedom of choice of the hospitals for its patients, and suddenly came with a bit of a pig demand, to receive a NIS 100 million discount, in exchange for harming the insured. Maccabi already receives a 60% -40% discount in Sheba today. "They will not earn a penny but will harm patients and hospitals."
The Patient Rights Association was alarmed: "We were surprised to find out indirectly that the HMO has decided to terminate its contract with a leading hospital in the center, with the exception of its members in the north and south.
This decision directly affects many insureds, who are certainly not aware of it, despite the fund's obligation to update in advance.
This case concerns a broad problem arising from the very existence of the selection arrangements between the health funds and the hospitals.
"The reality in which HMOs restrict the possibility of choosing which institution we will receive medical care from affects many patients every day. As long as there are selection arrangements, we will continue to meet patients who are tortured from place to place, instead of focusing on recovery and recovery. ", And to work to increase competition between the hospitals, on the basis of providing quality medicine and optimal service to the general public, and not on the basis of the most attractive hospitalization agreement for the HMO."
Earlier this week, Ramat Gan Mayor Carmel Shama HaCohen and Or Yehuda Mayor Liat Shochat intervened, addressing Maccabi CEO Sigal Dadon Levy and protesting the new directive. Dadon Levy herself turned to Sheba director Prof. Itzik Kreis Maccabi wants to hold substantive negotiations on a new multi-year agreement between the fund and Sheba.
Mayor of Ramat Gan, Carmel Shama HaCohen, Photo: Moshe Shai
Maccabi stated: "Maccabi Health Services is committed to providing maximum freedom of choice to its insured. Therefore, Maccabi implemented very extensive selection arrangements, which included all government hospitals until the end of 2021. During 2021, Maccabi worked with the management of the government hospitals division in the Ministry of Health. To a new multi-year agreement for the benefit of both parties.Unfortunately, time and time again the division management has refused to conduct substantive negotiations to advance the issue.
After a year of fruitless attempts, the division led to Maccabi being required to update the fund's selection arrangements.
It should be noted that this does not affect the therapeutic sequence of the fund's insured who are already being treated at Sheba.
Maccabi policyholders will be able to choose from the 25 hospitals that are in the fund's selection arrangements. "
Mashiba said: "We continue to provide the full treatment to anyone who needs it, and we believe that in 2022 every patient has the right to choose where he will be treated."
The Ministry of Health stated: "According to the law, the fund is the one that determines the service providers on its behalf and is not obligated to provide this or that service provider - provided it provides the services with reasonable quality, distance and time to its insureds. "For hospitals that are not in the selection arrangement. The ministry will ensure that the fund provides the services to its insured at a reasonable distance and time and in an equal manner."
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