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Tuesday, October 6, 2015

How to choose a health care provider (kupat cholim) in Israel

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Let's assume you'll never get sick in Israel, shall we?

My teacher in ulpan had a cute habit.  When we were learning about ailments, she refused to use the first or second person - "you're sick; I'm sick."  She would only let us talk about ailments in the third person:  "he's sick; she's sick; they're sick."

So in honour of Morah Sarah, let's do that here, too.  Let’s assume you’re going to pick a kupat cholim (health care provider) and never need to use it.

Because, I'll admit, I've been holding back. 

In all these years of blogging, I haven't really said anything about how to choose a kupat cholim, one of the four healthcare provider networks that exist in Israel.  I feel like I don’t know enough, but the truth is, I’ve been navigating this system long enough to know a thing or two.  So I’ll try to help you straighten things out as far as healthcare is concerned.  If you have questions, ask below and I’ll try to answer.  I’ll also give a list of links for good information at the bottom of this post.

What are those words again?  Practice saying them; you’ll be using them a lot here (but hopefully never in the first person):

  • קֻפַּת חוֹלִים / kupat choleem = sick fund, usually translated into English as “HMO” for people from the U.S. who don’t understand any other approach to healthcare
  • Note, the above is the vowelled spelling.  Without vowels, it’s usually spelled “קופת חולים” for clarity.  Pronunciation is the same:  kupat cholim.
  • It’s sometimes abbreviated as קופ"ח / koopach
  • קֻפָּה / koopah = “fund,” like a supply of money, but sometimes people use this as shorthand to refer to your particular health plan
  • The plural is  קופות חולים/ koopot choleem = sick funds.

How do I choose???

Here are the 4 choices (4 kupot cholim), in English alphabetical order:

  • כללית / Clalit
  • לאומית / Leumit (not to be confused with BANK Leumi!)
  • מכבי / Maccabi (pronounced ma-KAAAAA-bee, not the way English speakers say it in the Chanukah story)
  • מאוחדת / Meuhedet (the "h" is actually a "ch" but this is how they spell it)

All of these 4 have offices all over the country, though one may be more prevalent in a given area, which will probably factor into your decision-making.

These days, most new olim are asked to choose their kupat cholim at the airport when they arrive.  If you don't know your choice, however, you can still do it at the post office like in the old days.  There may be other ways to do it as well. 

Don’t let anybody force you to pick at the airport if you aren’t sure yet!

But the question everyone asks is:  how do I choose???

(Assuming, of course, that you and your family will never get sick!)

I’m sure you already know that Israel has a system of socialized medicine that ensures that every citizen has basic health insurance.  Olim are covered from the minute of arrival, though I'm not sure how that works if you haven't actually been and registered with your kupah yet.

Health care basics

Before we talk about how to pick one, I want to back up a second and cover a couple of basics.

This socialized medicine system is funded through the Ministry of Health (misrad habriyut) and Bituach Leumi (national insurance).  All the kupot ultimately answer to the Ministry of Health and are obligated to provide comparable services.

If you’re employed, your employer deducts part of your pay and it goes towards health insurance.  If you’re not employed, I believe Bituach Leumi (national insurance) charges you directly unless you’re collecting unemployment or disability or serving in the army.  However, all olim are entitled to one year free if they’re not working. 

The basic plan covers a basic “basket” of services, defined by law, which is generally enough to keep you and your family well, unless you have specific needs. 

But if you go with the “basic” plan, you’ll get lower-tier care in some cases.  For us, this has meant flu shots instead of a nasal spray, or an older, off-brand medicine instead of the latest & greatest.  Every kupah offers higher-end services for a monthly fee that varies based on age (higher as you get older).

The basic medical plan covers doctor visits, diagnostic tests and laboratory services, as mandated by law.  Specialist doctors and tests may require a small additional copay of anywhere from 20-40 shekels.  Much prescription medication is subsidized as well, even with the basic “basket” medical plan, but there are limits to this as set by the Ministry of Health.

How to choose a kupah

So which one should you pick???  That depends on your family situation.  Here’s the best advice I can come up with for you.

If you / your family have…

A) No existing health problems.

Find out what’s closest in the area where you’re planning to live.  If there are several clinics, find out which is biggest, best, fastest, whatever your criteria are.  Or just pick one; if you’re not happy, you can always switch, though there is a waiting period – transfers are allowed on 6 dates per year.  (If you really regret your choice, you may be able to transfer early if you’re a brand-new oleh.)

B) Specific existing health problems.

If you have known health problems, your best bet is seeking out people with very similar issues and finding out where the best care is.  You may also ultimately have to go to a doctor outside of your health plan and pay privately, but many great doctors do work for the kupot cholim (at least part time) and will be available to you if you choose the one they’re affiliated with.

For instance, if you have a child with developmental delays, talk to other parents and find out which kupah offers a great basket of services in order to really follow your child and make sure he/she doesn’t slip through the cracks.

I wish I could offer more advice than that, but really, it mostly comes down to common sense.  And if you choose wrong, you CAN switch, though it’s not always easy or immediate.

Our choice: Clalit

So which one did we pick??  I was originally going to go with Meuhedet, based on the sophisticated fact that they gave me a cool flashing keychain.  But when I told a rep at an Aliyah Fair in Toronto that we were moving to Karmiel, she said we should go with Clalit only.  She was right; Meuhedet is almost non-existent in our area. 

I haven’t regretted picking Clalit.  They definitely have the biggest presence in northern Israel.  Their clinics are in great locations and they have an urgent-care centre with many specialist services at the mall nearby (including things like X-rays, CT scans, etc., so you almost never have to go to the hospital).

But we have friends who also live in this area who have other kupot cholim.  Some moved from other areas in Israel and just stuck with their existing network.  Most folks nonetheless seem very happy. 

So I’m not advocating for Clalit specifically, but I have had good experiences with their call centre, doctors, pharmacies, and urgent care centre.  Baruch Hashem, we haven’t had to experience a hospital visit yet, so I can’t give you any insight into that.

Once you’ve chosen a kupat cholim, you’ll receive a paper indicating your entitlement as a new oleh.  Take that to your local clinic of the chosen kupah and they’ll register you in their system and probably assign you to a family doctor (General Practitioner).  You may want to make an appointment to meet your assigned family doctor just for a check-up at some point when you’re not particularly busy and want a low-stress intro to the healthcare system.

One perk of living in a religious neighbourhood: our local Clalit clinic is open on Shabbat and chaggim, with non-Jewish doctors filling in for 4 hours in the middle of the day.  You don’t need to sign anything, though it helps to have your magnetic card with you.  I happened to visit ours for the first time on Rosh Hashanah and it was a very nice Arab doctor, all by himself in the nurse’s room.  He didn’t have a lot of medication in stock, and the pharmacy was closed, but he was very nice anyway.  It was weird watching him use the computer and phone, but of course, completely permissible.  He made some helpful suggestions and gave us a prescription that we took & filled right after sunset.

Whether or not they’re open on Shabbat, when you check in with your local clinic for the first time, be sure to get a list of their hours, since many clinics shut down completely for a couple of hours in the middle of the day or at other odd times!!!

One more tip:  get your flu shot (it’s free!) before it starts to rain.  Once the rain begins, Israelis panic and think it’s winter, and they’ll all rush into their local clinic for a shot.  You don’t need a doctor for this – most clinics have nurses doing it at specific hours, with or without an appointment.

Points to know

A few quick points you should know, in no particular order:

  • Hospitals are generally funded directly from the Ministry of Health and will accept all kupot cholim; nevertheless, your kupah may have a special deal with a specific hospital and encourage you to go there. 
  • UNLESS it is a dire, life-or-death emergency (and please, don’t hesitate; I’m not a doctor, lawyer or anything of the kind and don’t want you endangering yourself on my advice!), you may be charged for an ER visit without the right referral / paperwork.  Ambulances, as well, are not included (I believe; please correct me if I’m wrong).  Most kupot have an “urgent” number to call to check if you should go to the hospital or a clinic.
  • Terem, a network of urgent-care clinics throughout the country, accepts all kupot cholim, and is a great alternative to emergency departments.  (There is no Terem near us… boo!)
  • Though there are private pharmacies (mainly the ubiquitous SuperPharm), you may save money if you go to one that is affiliated with your kupah.  In our area (I don’t know if this is countrywide), all Clalit clinics have at least a small pharmacy on-site.  This is incredibly convenient because it means that after you see the doctor, you don’t have to shlep to the pharmacy.
  • Dental care is not included in any of the basic plans, but dental care is free nationwide for kids under 12 (kids 12 and under???).  Inquire through your kupat cholim for details.
  • Basic plans never cover glasses, but some do offer this in their extended plans – which could make good financial sense for families with lots of glasses-wearers.
  • All of the kupot cholim have a special hotline number; you can usually get an English-speaking operator there.  I believe they all also have online services where you can make appointments and check test results.  I have found this incredibly convenient, because it’s visual (you click on a calendar), so not as language-dependent.
  • Even within the kupat cholim and clinic you are associated with, you are entitled to your choice of doctors.  If you get stuck with a family doctor or specialist you don’t “click” with, you can ask for another one next time.  In my case, when I make an appointment online, I can see the doctor’s name, so you can also pick male or female doctors if you’re more comfortable with one or the other.
  • You have the right to a second opinion about your (or a family member’s) care!  If you have only the basic plan, you may have to pay out of pocket.  However, the first physician and/or care centre can’t withhold your records, and must assist you if they can in finding someone with whom to consult.

One more note:  all kupot cholim now offer both long-term care insurance and travel insurance.  These are NOT part of the basic services provided by the kupah, and are less strictly controlled by law since they compete in a very busy marketplace.   Basically, that means there’s no reason to prefer one of these plans from your own kupat cholim.  Go with the one that offers the best deal instead.

Some great links – a partial list:

I’d love to hear your questions about healthcare here… and if I’ve gotten anything wrong, PLEASE let me know so I can fix this page!  Feel free to share your experiences of signing up, switching, or anything to do with health care.

On a personal note – yes,  I haven’t blogged since the summer.  Partly due to chagim, partly due to, well, navigating some medical challenges.  Baruch Hashem, I’m on the mend, and the chagim are over, and I hope to be back here as regularly as before!  You can always reach me at Tzivia@aliyahland.com just to say hi or to ask questions.

Let’s chat soon,

Tzivia / צִיבְיָה


4 comments:

  1. Excellent post. There are private opticians that give discounts for some kupot cholim. And emergency room cost less if you have a dr or terem referral.

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    1. Good tip. And yes, emergency room costs are complicated, and people should definitely find out their rights (and obligations) before they need to know! (I wish we had Terem here, but we don't.)

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    2. Not so easy when an emergency happens. You don't usually have time to say wait I have rights before being taken to emergency room.

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    3. True. But at least a typical emergency isn't likely to bankrupt a family, even if you do have top pay out of pocket. Which, if it's a true emergency, you probably won't. It's not a perfect system, but for most Israelis, most of the time, I get the impression that it works...

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