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Clalit presents: Basket care - but no funding for cancer patient Israel today

2022-03-03T21:13:18.337Z


Clalit Health Insurance Fund refused to fund urgent treatment, which is included in the basket of drugs for breast cancer patients at Haemek Hospital • Only after the intervention of "Israel Today" - it was agreed to approve the amount


Clalit Health Insurance Fund refused to fund a 40-year-old cancer patient with the necessary treatment, which is included in the drug basket, which she was supposed to undergo at the Valley Hospital.

It was only following "Israel Today"'s appeal to the fund that it was decided to finance its urgent treatment.

The same woman from the Jezreel Valley had breast cancer, which had already sent metastases to the liver.

Doctors have recommended special and urgent treatment that is performed only in hospitals and includes the insertion of particles of radioactive material into the liver through catheterization.



Clalit Health Insurance Fund, Archive, Photo: Dudu Greenspan

The treatment was supposed to take place at Haemek Hospital in Afula, but Clalit Health Fund, of which the patient is a member, refused for weeks to finance the urgent treatment.

This is despite the fact that treatment is included in the state-of-the-art drug basket.

Israel Today has learned that following the HMO's outright refusal and the Valley Hospital's announcement that it will not perform the essential treatment for the patient, the Commissioner of Public Admissibility to the State Health Insurance Law in the Ministry of Health, Adv. Nili Dickman, ruled that the HMO must fund The treatment.

The commissioner noted that the purpose of the law regulating the provision of health services in Israel is "to provide adequate medical service to insureds and the fund's obligation to meet acceptable standards of reasonableness", and that sometimes "this is the only rescue treatment that may extend the life of breast cancer patients ".



Treatment is included in the drug basket, Photo: Getty Images

Despite this, Clalit continued to vehemently refuse to fund the treatment, and the patient, who lives in the Jezreel Valley, was forced to begin procedures to receive treatment at Hadassah Ein Kerem Hospital in Jerusalem.

This, with special funding that will be made by the Ministry of Health transferring the financing to Hadassah for treatment through funds that the Ministry of Health will collect directly from Clalit's account in the National Insurance funds.

By law, the Ministry of Health may do so in those cases where the HMOs insist and refuse to fund treatment included in the drug basket.

Yesterday there was a development in the affair, after a request from "Israel Today" for a response to an article from the fund's CEO, Ruth Ralbag, the fund informed the cancer patient that it had been decided to finance her treatment. In the north of the country, which rejected it again and again.

Complaints about the way in which Clalit manages and budgets the Valley Hospital, including that of the special action committee of the department heads, which raised serious allegations of discrimination, neglect and ongoing discrimination, were recently exposed in "Israel Today".

There were serious complaints from 30 doctors about the risk to children's lives due to extreme workloads, complaints from doctors in the intensive care unit that patients in critical condition die due to lack of care and respiratory patients fall out of beds, and complaints from department heads that the conduct of one of the medical institutes Indifference to harm to patients. "

Clalit stated that "this is a very exceptional case. In light of these special circumstances, we will respect the position of the Ministry of Health and approve the treatment."

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Source: israelhayom

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