Serious accusations are directed at the largest health insurance fund in Israel:
in an outrageous way, Klalit Health Insurance is allegedly preventing hundreds of multiple sclerosis patients from receiving essential drugs, which are included in the state drug basket and are budgeted for by the state. "To the Ministry of Health Prof. Nachman Ash, and even contrary to the agreements of the fund itself with the basket committee.
Serious accusations.
The multiple sclerosis symbol, photo: GettyImages
These accusations were recently raised by the Ministry of Health itself.
Lior Barak, who is in charge of the supervision of the health insurance funds, wrote to Klalit CEO Eli Cohen in early August that the restrictions imposed by the health insurance fund on doctors in relation to providing medication to multiple sclerosis patients do not comply with the instructions of the Ministry of Health and the law, which requires the health insurance fund to provide medical treatment reasonable quality and provide medicines included in the basket.
"Hundreds of patients were affected"
The letter was written following unprecedented complaints about the severity of doctors, as well as the Israeli MS Association.
Senior doctors told "Israel Hayom" that this is the first time in the history of the state medicine basket that the health insurance fund refuses to finance medicines for hundreds of patients, even though they are fully budgeted at hundreds of millions of shekels a year.
The doctors estimate that hundreds of patients who are members of the fund have already been affected by this conduct, after delaying or not receiving essential treatment suitable for their illness.
This seriously harms the attempt to alleviate the disease and prevent its deterioration to the more severe stages.
acute complaints
Dr. Ron Milo, director of the neurology department at Barzilai Hospital in Ashkelon and one of Israel's leading multiple sclerosis practitioners, has courageously written to the Ministry of Health in recent months with sharp letters of complaint about the coffers, after it repeatedly refused to approve the medications included in the basket for many patients in his department:
"There is no limit to their attempts to save money at the expense of patients' health," he wrote in April.
"Are we forever doomed to fight with them over every patient, and they will do their own thing, without any medical logic and contrary to the instructions of the basket? How long will you allow the General to continue to abuse patients and deny them treatment?"
"There is no limit".
Dr. Ron Milo,
Multiple sclerosis is a chronic inflammatory disease that affects the central nervous system, the brain and the spine, during which the normal activity of the immune system is impaired.
It causes severe damage, such as limb weakness and instability in walking, vision impairment and speech and sleep disorders.
The 14 different medicines in the basket for sclerosis alleviate the symptoms of the disease and its progression, and are usually administered by intravenous infusion, injection or ingestion.
The conflict between the Ministry of Health and the General Assembly, revealed here for the first time, is ongoing following the decision of the basket committee to add approximately 27 million shekels to the budget for the drugs in the basket, in addition to the existing 350 million, in order to bring about flexibility in the lines of treatment.
The CEO of the Multiple Sclerosis Association, Janine Vosberg,
The basket committee's decision was made following the demand of senior neurologists in Israel, who treat MS patients.
According to estimates by senior neurologists, about 8,000 patients receive the drugs in the basket, and senior doctors estimate that Klalit's restrictions could harm thousands of patients in Israel.
reverse instructions
After the Director General of the Ministry of Health, Prof. Ash, published the new instructions for the flexibility of the administration of the drugs, at the beginning of the year, the management of the general health insurance fund issued the opposite instructions to the doctors of the health insurance fund, which stipulate "fixed lines of treatment, without adapting to the condition of the patients and without leaving room for the discretion of the health insurance fund doctors". As the Ministry of Health warned the General Administration this month.
Klalit's restrictions on giving the drugs were passed on to the doctors by the fund last February, and they are signed by Dr. Mariana Mazar and Dr. Niki Lieberman from the fund's management.
"sarcastic reference"
Following Klalit's instructions, on July 18, the heads of the Multiple Sclerosis Association wrote to the Minister of Health Nitzan Horowitz and the Ministry of Health management: "Klalit chooses not to approve the drugs included in the basket for patients, contrary to their legal entitlement. It requires doctors to follow outdated guidelines, thus preventing patients from receiving innovative and advanced treatment General conduct crosses all boundaries, and her treatment of the matter is cynical. For more than a year now, we have witnessed that she has prioritized her financial well-being, not the well-being of the patients. In fact, a situation has arisen in which there are two health baskets: one is the state basket - and the other is the basket of general".
The letter is signed by the CEO of the Multiple Sclerosis Association, Janine Vosberg, and the association's treasurer, Uri Nissen.
"Case by case"
The Ministry of Health stated in response:
"The Ministry of Health is working with the Klalit Health Insurance Fund in order to regulate the granting of entitlements to the insured according to the law."
The Klalit Hospital Fund stated in response:
"We will not withhold or withhold treatment from any MS patient who is entitled to receive it within the framework of the public health basket. We often approve treatments even beyond eligibility in the basket, and we will continue to provide the best treatment to our patients. Contrary to what is claimed in the said letters, Klalit implements the basket's guidelines On all of their points. Doctors are instructed to act flexibly in their clinical recommendations, and each case is examined and considered on its own merits. On Thursday, a joint discussion was held with leaders in the field in Israel, in order to clarify our policy. It is very unfortunate that a professional clinical discussion is presented as if treatment of patients is being avoided - on the contrary."
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