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Increase in justified admissibility, most of them - against the National Health Insurance Fund: Report of the Public Admissibility Commission
After Leumit come the descending order of the Maccabi, Meuhedet and Clalit HMOs.
Leumit "leads" a fund with 30% more admissibility per capita than the next fund - the same as in previous years. 20,194 applications were received by the Admissions Commission, 35% of which were decided as justified. Leumit: "We will study the report and draw lessons from it"
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Ministry of Health
HMOs
Meirav Cohen
Wednesday, November 17, 2021, 6 p.m.
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There has been an increase in the number of justified admissions against the health funds, Leumit has absorbed the highest amount of admissions - this is what the Public Admissibility Commission's report for 2020 published by the Ministry of Health revealed this morning (Wednesday).
After Leumit come in descending order Maccabi, Meuhedet and Clalit HMOs.
Leumit HMO "leads" by 30% more per capita admissibility than the next HMO - a result that was repeated in previous years.
Admissibility ratio per capita (Photo: Official website, Ministry of Health)
In 2020, the investigation of 20,194 applications received by the Commission ended - a decrease in the number of admissions per capita compared to all HMOs.
The decrease in the submission of admissibility is explained by the fact that in recent times, due to the corona plague, the slowdown in routine medicine is being reflected.
The largest decrease in the number of admissions submitted last year was in relation to the United Health Insurance Fund.
However, from the initial data of 2021 we see a return to the extent of admissibility submitted in previous years.
Along with the decrease in the number of admissions received, there is a significant increase in the amount of justified admissions, when in 2020 35% of admissions were declared justified admissions, and at the end of the admissibility inquiry and the Commission intervention, the requested medical service was approved for the applicant.
An analysis of the admissibility data in recent years shows that there is a constant trend of an increase in the number of justified admissions, with more than a third of the admissions submitted to the Commission being found to be justified after clarification.
In these data, too, the National Health Insurance Fund is at the top of the table, with the highest justified admissibility ratio per capita recorded.
The lowest justified acceptance ratio per capita is found in the United Health Insurance Fund.
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"Leads" by 30% more per capita admissibility than the fund after it.
Leumit (Photo: Official website, Leumit Health Fund)
The year 2020 was mainly characterized by the medical crisis of the corona plague, which flooded unique issues that do not characterize routine conditions, such as complex basket labels in relation to various drugs or treatments, and the difficulty in their actual implementation;
Use of the Commission's powers to ensure that new medicines and treatments included in the basket of services reach their destination and are accessible to patients;
Issues relating to the field of dentistry and the need to strengthen these services;
Supply of oxygen generators to the insured who need them, and the extent of entitlement to receive them;
The child development reform, which came into force in September 2020, and the waiting times for child development services.
Leumit Health Fund stated that "from the data it can be clearly seen that Leumit has the lowest percentage of justified admissions compared to other funds when Leumit has only 30% of justifications, at Meuhedet 31%, Maccabi 37% and Clalit 35.5%. The year is 2019 and we will work to continue this trend in the coming years as well, when at the same time we will study the report and draw lessons from it. "
Percentage of justified admissibility (Photo: Official website, Ministry of Health)
Minister of Health Nitzan Horowitz responded to the publication of the report: "Expand and add. The health system must strive for continuous improvement in order to improve medical services to the public."
Director General of the Ministry of Health Prof. Nachman Ash said that “Raising public awareness of the possibility of applying to the Commission and submitting admissibility for clarification, serves the principles of the law, promotes the exercise of the rights of insureds under the law, and contributes to ensuring equal and broad health services.
I sincerely hope that this report will be used by all of us to learn and learn lessons in order to provide a better service to the public. "
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