Report: The highest number of justified admissions per capita in 2020 - against Leumit | Israel Today

Increase in justified complaints against HMOs:

1,264 complaints filed by patients in 2020 were found to be justified and HMOs were required to provide them with medication, treatment or testing.

This emerges from the annual report of the Commissioner of Public Admissibility in the Ministry of Health, for 2020. The report also shows that in the last four years, the rate of justified complaints has increased from 27.6% in 2017 to 35% in 2020.

A total of 1,823 admissions were filed against Clalit, 973 against Maccabi, 435 against Meuhedet and 381 against Leumit.

When the highest justified acceptance rate was against Maccabi (37.2%), followed by Clalit (35.5%), Meuhedet (30.4%) and Leumit (30.4%), but the number of complaints is affected by the relative size of the funds.

Calculated according to a standardized number of persons in the fund, it appears that the number of justified admissions per capita was the highest in Leumit (1.59 justified admissions per 10,000 insured), followed by Maccabi (1.45), Clalit (1.27) and Meuhedet (1.18).

"The HMOs 'interpretation of the scope of patients' rights may be rigid"

The commissioner, Adv. Nili Hayun Dickman, notes that "Leumit has more than 30% admissibility per capita from the next fund, and this is a result that has been repeated in previous years."

On the increase in the number of justified admissions, Adv. Hayun Dickman notes: "There is a concern that the implementation of the basket of services by the funds is done in a way that reduces the scope of services included in it and that their interpretation of patients' rights is rigid."

In 2020 there was a certain decrease in the number of admissions submitted due to the corona, mainly in the months of March to September.

Thus, for example, in one case a patient who did not receive a response due to the corona and needed an urgent injection, received the service privately.

Thanks to the commissioner's intervention, he received a refund from the fund.

The director general of the Ministry of Health, Prof. Nachman Ash, said of the fact that 35% of the admissions were found to be justified because "it can sometimes be seen that the health insurance companies give a rigid interpretation of the scope of existing medical rights."

Clalit Executive Headquarters in Tel Aviv, Photo: Yehoshua Yosef

Leumit responded: "It can be seen that we have the lowest justified acceptance rate compared to the other funds, with only 30% of justified referrals. Moreover, the number of complaints in 2020 has decreased compared to 2019, and we will continue this trend in the coming years. At the same time, we will study the report and draw lessons from it. "

Clalit said: "We have the lowest relative acceptance rate among the funds for the tenth year in a row."

Maccabi stated: "We have reduced the number of admissions by 12% compared to the previous year. The report expresses the satisfaction of the insured in the field of drug treatment and in the administrative field.

We will study the report.