In an extraordinary decision, the Ministry of Health forced the management of the general health insurance fund to provide a multiple sclerosis patient with a drug that is included and budgeted for in the health basket.
The health insurance company returned and refused for five months to do so, even though the doctors treating the patient warned that the other drugs were causing him very serious and dangerous side effects.
The medicine they requested is included in the state medicine basket, and the coffers must provide it.
The new decision was made about a week ago by the Public Acceptance Commission for the State Health Insurance Law, which examines the complaints about the provision of health services by the health funds.
At the center of the complaint was a 35-year-old patient from the south of the country, who is hospitalized in the neurological department of the Barzilai government hospital in Ashkelon.
His doctors, as mentioned, determined that the medicine he received for the disease causes him damage and very serious side effects, including difficulty standing and functioning, chills and fever.
Despite this, the cash register refused to provide him with the said medicine for many months.
Janine Wesberg.
"Disrespectful treatment", photo: None
In the Public Acceptance Commission, headed by attorney Nili Dikman-Hayon, it was exceptionally determined that Klalit's restrictions on the doctors in providing the medicines for sclerosis are contrary to the provisions of the medicine basket law. , with a unique annual budget addition of about 30 million shekels for medicines (in addition to the about 300 million shekels already transferred to sclerosis), which is given to the coffers and which is intended to erase and cancel all the previous restrictions that were in the basket until then on the provision of medicines for sclerosis.
From the decision, which was implemented by the Ministry of Health, there is a sharp criticism of the drug policy of the management of Klalit, the largest coffers in Israel, which restricts the provision of drugs contrary to the provisions of the law and the government's decision.
The decision was sent to the management of the cash register as a warning.
Indeed, it was only following this that Klalit decided to approve the administration of the medicine to the patient, and he has already started receiving it.
Dr. Milo. Brave complaints,
It should be noted that if the fund continued to refuse to accept the request of the Public Acceptance Commission to provide the drug, the Ministry of Health could, according to the law, bypass the fund and finance it directly to the patient using the fund's funds in the National Insurance accounts.
Such extraordinary cases have already happened in recent years.
"Abuse of sclerosis patients"
The complaint of the patient from the south of the country has been at the center of the fight between Klalit and the Ministry of Health in recent weeks, which was revealed in Israel Hayom.
As part of the struggle, the Ministry of Health stated that Klalit is preventing hundreds of MS patients from receiving essential drugs that are included and budgeted for hundreds of millions of shekels per year in the state drug basket.
This is in complete contrast to the government's decision, which fully accepted the recommendations of the basket committee, to the State Health Insurance Law, to the instructions of the Director General of the Ministry of Health, Prof. Nachman Ash, and even contrary to the agreements of the fund itself, as given during the basket committee discussions for 2022. Serious and unprecedented accusations They were slammed by Lior Barak, who is in charge of the supervision of the health insurance funds, who already wrote on August 3 of this year to Eli Cohen, CEO of Klalit.
Multiple sclerosis is a chronic inflammatory disease that affects the central nervous system, brain and spine.
The inflammation damages the normal activity of the immune system and attacks the nerve fibers and the substance that surrounds them (myelin).
As a result, severe damage is caused to patients - including limb weakness and instability in walking, vision impairment, speech and sleep disorders, and more.
The medicines for sclerosis alleviate the symptoms of the disease and its progression to more severe stages.
The basket includes 14 medicines for the disease.
The complaint to the Ministry of Health about the multiple sclerosis patient from the south of the country was forwarded back in July of this year to the Ministry of Health and general management, by the heads of the Israeli Multiple Sclerosis Association.
"When will the abuse of the insured MS patients stop?" reads the complaint, which is signed by Janine Vosberg, CEO of the association, and Uri Nissen, MD and treasurer of the association.
"Behind every refusal is a person whose life you are destroying and putting him in existential anxiety."
One of the central doctors in the protest against Clalit is Dr. Ron Milo, director of the neurology department at the Barzilai government hospital in Ashkelon. In recent months, he has courageously written letters of sharp complaint to the Ministry of Health about Clalit - after the health fund refused to approve for many patients in his department drugs included in the multiple sclerosis basket.
Dr. Milo, together with Dr. Maroane Alkirnawi, accompanied the patient in Barzilai.
Dr. Milo wrote to the Ministry of Health that he "demands to know how long you will allow the General Assembly to continue its inappropriate policy, to dominate an interpretation that is contrary to the instructions of the basket, to continue to abuse the patients and to deny them treatment that the expert doctors decided on in accordance with the instructions of the basket?
It seems that there is no limit to the attempts of the coffers to save money at the expense of the patients' health."
"doesn't work according to the law"
The patient's wife wrote to the Israel Multiple Sclerosis Association at the beginning of September, after the general management and the southern district of Kopa returned and refused to finance the medicine, that her husband "woke up every day with new symptoms such as circumcision, dizziness, weakness, imbalance, and not to mention the depression he had recently fallen into . You make him anxious and destroy my family, and we live in the shadow of this fear and tension when he has been without treatment for four months, and I see the damage that has been caused to him. Even so, it is difficult for us to deal with and contain the patient. This situation and this situation only makes it more difficult."
Janine Vosberg, from the Multiple Sclerosis Association, told "Israel Today" following the decision: "All my wars are not capable of yielding what your one article yields. After two years of contemptuous treatment by the General Sclerosis Center towards MS patients, we are glad that it is over - In the end the Ministry of Health decided to intervene and represent the sick citizens of the country against the fund that operates illegally.
We expect the Ministry of Health to stand by the patients, and act quickly and decisively so that patients are not forced to go without treatment for six or eight months, or even up to a year and a half - something that deteriorates their physical and mental condition."
Makhlilit said in response: "The fund promotes and leads medical innovation and quality, and stands at the medical-clinical front for the benefit of its patients. This is normal conduct between the Ministry of Health and the health funds, which reflects the relationship and the professional considerations that are taken into account for the benefit of our patients. In the individual case, the treatment was approved for exceptional reasons due to his condition ".
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