THINGS ARE DIFFERENT IN ISRAEL, at least for an ex-pat American.
An aside: Because transliteration is never perfect, this scrivener prefers to write the English-language word in Latin letters followed by the Hebrew word in Hebrew letters: thus > ככה
SINCE ARRIVING (THIS TIME) I have spent entirely too much time in a hospital or getting medical tests.
It turns out I have a small malignancy in my left ureter. Eventually it will be removed and, hopefully, that will be the end of my hospital stays and visits.
Over the course of the processes, I have been seen by doctors who work for my insurance company (Macabbi – מכבי) and by doctors who are employed by a hospital.
USA way
IN THE U.S. with a Medicare Part “C” all-inclusive or “advantage” plan, my primary care physician (PCP) would refer me to a specialist.
If the insurance carrier got involved, that involvement was between the carrier and my PCP.
PCP to me: I’m referring you to a specialist.
PCP to insurer: Insurance company, my patient needs a specialist; this one is on your providers’ list; send a referral to the patient.
Sometimes, the insurance company sent the referral to the PCP and the PCP forwarded it to me.The PCP usually alerted the specialist to expect me to call for an appointment.
- In one case I was delayed in making an appointment. The provider called me: When are you coming in?
The Israel way
Here, the PCP determines there is a need for specialist intervention, same as in the States.
The patient makes an appointment with the provider.
If the provider is employed by the insurance carrier, the PCP makes a referral and the patient sees the specialist. It’s all in the family.
BUT, if the specialist belongs to a state-funded hospital, the patient needs a referral AND a code on a Form 17 that basically states the insurance company (kupat holim – קופת חולים) will pay the bill.
Two of the first things a new comer learns in Israel are:
- 1. Savlanute (patience – סבלנות)
2. Form 17 (טופס 17)
Before the specialist outside of the kupat holim can see the patient — more accurately, before the hospital can be paid for the specialist’s time — the patient must have a Form 17 code from the insurer.
Lacking the Form 17, the patient might be billed for the hospital employee’s services
Lacking a Form 17 will not preclude medical care, but it may cause the patient to pay a fee that will be reimbursed by the kupat holim.
Just what is ‘FORM 17”
Form 17 is a Financial Obligation Form
The best description I found of Form 17 and its use at on the Anglo-List.com (https://tinyurl.com/xxtjvz4m).
It actually takes things step-by-step.
The Shira Pransky Project (https://tinyurl.com/3au6e4kx) offers 5 Things To Know About Your Kupat Cholim. While it is not “Form 17 specific,” the information is well worth reading.
Emergency care will not be denied for lack of a Form 17.
Once admitted to the hospital, Form 17 goes away for all intra-hospital procedures; e.g., if the hospital doctor determines a CT scan is needed and the hospital has the facility, the patient is scanned with only the doctor’s order; no supplemental Form 17 needed until the patient is discharged.
On the other hand, all “out patient” procedures require a separate Form 17 with the “code” from the kupat holim for each procedure or interview.
Need an MRI? Get a Form 17.
Need to meet with a radiologist? Form 17.
Telephone interview with a cardiologist? Form 17.
Meet with anesthesiologist? Form 17.
Bureaucracy vs. efficiency
Bureaucracy wins.
Perhaps because Israel is a nation of clerks — the government employs more people than other industries — bureaucracy is safe and always will prevail over efficiency.
It would be, IMO, more efficient to have a family doctor refer to a service. The fact that the doctor, an employee of the kupat holim ordered the service should guarantee that the service will be paid by the kupah.
The patient should never be bothered to run around to get a Form 17.
Israel is an “SMS” nation, a country that expects everyone to have a mobile phone with Short Message Service (SMS or text messaging).
SMS is the primary form of communication between the kupah and the subscriber (patient) and between the non-kupah vendor (hospital, diagnostic center) and the patient.
Fortunately, if the patient’s Form 17 code failed to arrive before the patient arrives for the service, an SMS message with the code satisfies the vendor.
It sounds efficient, but compared to the U.S. process that normally does not require patient input, it is sorely lacking.
Admittedly, when I had a referral in the States, I printed out the insurance carrier’s authorization and carried it with me to my appointment; just as "CYA" since the vendor should have received the authorization from the insurer.
There I had a printer. Here I have a SMS-capable mobile phone.
SMS is efficient and as long as vendors accept SMS messages, a printer is not necessary.
But having the patient chase after a code from the insurance carrier — when the physician has a contract with the insurer and usually someone who daily deals with the insurer to get insurer approval for a process, the patient should be free of this task.
It’s an old truism: It’s not WHAT you know but WHO you know, and having an on-going relationship with an insurer and service provider expedites things and reduces errors.
- If the patient has special requirements, e.g., a walker taller than the usual height, then the patient and the office person who deals with the insurer need to work together.
Paperless office?
Not in my lifetime.
SMS does eliminate some paperwork.
But having just signed a dozen times during one pre-operation session at a government hospital, the future of a paperless office is still in the distant future. (Banks are a little better, but a real estate transaction in Israel can cause writer’s cramp. Five pages in the U.S. to sell a house vs. more than 20 pages in Israel to buy an apartment.)
Granted, this scrivener is a curmudgeon and I prefer paper. It doesn’t (usually) get DELeted by accident as an SMS message or email might. It is (for me) easier to read.
But why should a patient have to deal with a form that requires a code from the doctor’s office.
Even if the form is sent to the patient as an email or SMS, it should not be the patient’s job or responsibility to chase down a code for a form used between the doctor’s employer (the kupah) and the service provider.
Israel is a nation of clerks. Let the kupot (health insurers) add one more clerk to handle doctor-to-provider documentation and left the patient try to get well.
Will it change?
In a word: No.
There is an organization that claims to help new comers navigate the system.
When it was suggested that one thing the organization might consider as a project — especially since the organization’s founder is a former member of Knesset — the reply was “It’s always been that way.”
Inertia.
After thought I know it will sound like “sour grapes,” but I had far less trips for tests when I had open abdominal aortic aneurysm (AAA) repair and even less for hernia surgery.
To be fair, the hospital (Hollywood Memorial a/k/a Regional) had my medical records and the records followed me from doctor to doctor.
My surgeons' referral persons handled everything with the insurer at the time. All I had to do was show up for the Grand Opening.
THAT IS HOW IT IS SUPPOSED TO WORK.
Will progress ever come to Israel?
Will we ever have world peace?
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