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HMO Selection Criteria - Suggestions for Improvement



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Section 23 of the National Israeli Health Insurance Law permits Health Maintenance Organizations (HMOs) to reduce policyholders’ freedom of choice regarding certain service providers, per the HMOs’ choice. Although HMOs are alle

gedly obliged to offer selection criteria to ensure quality health services within a reasonable span of time and distance, in reality these vague parameters are undefined via case or common law, and are thus nearly unenforceable.

This situation may be gravely misleading, whether in referring policyholders to services that are quite remote from their places of residence, or in generating unbearably long wait times. The primary victims are residents of peripheral areas, who are often required to wait for extended periods of time, or to travel long distances to receive medical services that are primarily provided in the center of the country. The result is that the existing arrangement effectively generates discrimination between residents of central and peripheral areas.

Recently, The Ministry of Health established a committee to examine reform of HMOs’ selection criteria. ACRI, Physicians for Human Rights – Israel, the Coalition of Health Organizations in the Negev, and the Citizens' Forum for the Promotion of Health in the Galilee, submitted a petition to the committee, and were invited to join the appeal. In the petition, ACRI Attorney Debbie Gild-Hayo, and Nili Aleksandrowicz of Physicians for Human Rights – Israel, proposed changes to the arrangement, which aim to create a different point of balance between HMOs’ interests and policyholders’ rights. This does not concern granting the policyholder unlimited freedom of choice, or disregarding the importance of HMOs’ financial considerations, but rather entails prioritizing policyholders’ rights in offering accessible, high-quality health services that are geographically close to their homes, while preventing discrimination of residents of peripheral areas, and increasing oversight of HMOs. The changes are based on a bill submitted by MK Haim Oron and others in 2010, which was prepared by ACRI, the Society for Patients Rights in Israel, and the College of Management Academic Studies.

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