Introduction to the Israeli Healthcare System

So, this is a bit delayed since I have been busy at the Technion. The first tiyul we took in Israel was right before our second Shabbat.  We went to the Kineret, and it included seeing Rambam’s grave, ice cream on the side of the Kineret, and some unmentionable hygiene practices.  But on our second tiyul, at the beginning of January, we went to Jerusalem for Shabbat.  In Jerusalem, we stayed with old family friends of Abby, had dinner with them, and were planned to go to services followed by lunch at Adam and Allison’s place (http://agamzon.wordpress.com/).  Instead, while getting dressed in the morning, Rafi had a little accident.

I want to start by saying he is fine!

So Rafi, while getting dressed, was not paying attention, slipped, and fell backwards.  His head hit either a hard plastic piece or the marble floor.  All I can say, is blood was everywhere.  Abby, who was comforting his cries got it all over her shirt.  Myself, I freaked out and tried to figure out how to take him to the doctor/ER to get looked at.  I remembered, in the info packet I received from my insurance company, there was a number to call to get the doctor to visit you at home. Since we are on some sort of Israeli HMO, a doctor phone call or visit is required for all ER visits except for 7 exceptions:

1. An injury that requires stitches or other means of fusion

2. Aspiration of a foreign body into the windpipe

3. Any new fracture

4. Serious dislocation of the shoulder or a joint.

5. Penetration of a foreign body into the eye

6. A snake bite

7. Hospitalization of over 24 hours

Since we didn’t remember these exceptions (Rafi wouldn’t have qualified anyways), we called the doctor.  20 min later, we had a happy Rafi and a call from the doctor.  The doctor, who spoke no English, tried to talk medical terms to Abby. I have to say, Abby did great translating and staying calm. From what we could understand, we should take Rafi to an ER, and they would send papers over stating that we received a referral. We get a name for an ER but no directions or address.

Ok, so I installed this awesome program on my phone just the day before called Waze.  I start Waze, type in the name, and boom, we have an address (although wrong) and off we go.  (FYI: google maps is horrible in Israel). Rafi is a trooper, he was happy the whole time.

So we get to the hospital and need to find the pediatric ER.  It is on the sixth floor, and we wait on the Shabbat Elevator (the only one that works) stop at every floor on the way up.

When we get there, of course, they do not have our papers. They have no clue what to do with us. They don’t see a real emergency; therefore they do not have to treat us. And since Clalit never sent out papers, the ER is ready to turn us away.  (In Israel, you need papers for everything, including see a doctor).  Part of the problem is we do not have our insurance cards yet, since we just signed up two weeks prior. So I frantically call Clalit, because I do not want to be stuck with the bill, and, I think my son should be seen. They say they will fax the papers over, ask to speak with the receptionist, and the receptionist finally puts us on the list.

Everything else is typical of an American system.  You first go through triage. Except here, the triage nurse actually tells you how serious it is (which she said it was not). Then you wait in a room for the doctor.  The doctor, only one on staff for Shabbat, was swamped. So we waited about two hours for her to tell us it was nothing, but she will have the surgeon look at it to see if it needs one stitch or glue. The surgeon, 5 min later, said it was nothing, and put a little bit of glue on Rafi’s head.

Afterwards, time to check papers, our fax still did not arrive. They proceed to want to charge my credit card. I argued quite a bit, and the receptionist conceded to bill us later if the insurance does not come through. I call the insurance company, and they state to call back after Shabbat.

At this time, I want to say, my insurance agent is amazing!!  I called Einat’s cell, and she said she will take care of everything.  One fax later and a visit to the Clalit center, and it was all paid for and covered.  She said, although I did everything right, next time I should just call a slightly different number to talk to the doctor.  I will get better service that way.

So we tried to enjoy the rest of our Shabbat, but we were wet, cold, stressed from sitting in the ER for hours, and annoyed that our papers never came through.  But the process of seeing a doctor in Israel is different than what I am used to.  And the idea that you need papers even to visit an ER, is different.  It is not common to pay out of pocket for anything here, and definitely takes arguing to even see a doctor without the correct paperwork.  I guess that is where the “private” hospitals in Israel make their money.

-Jeff

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3 thoughts on “Introduction to the Israeli Healthcare System

  1. Thank God Rafi is fine but he must have been very frightened with the fall. I would not worry that much about money Jeff.The important thing is Rafi being ok

  2. Oy, what a way to experience the Israeli medical system! On Shabbos no less, no one is available. We, Pam, Amy and I all have been following your blog and discuss it in our morning meetings. Still miss you. Btw, it will be snowy and cold on Tu B’Shevat in Cleveland so no planting almond trees for us. You guys should enjoy it.

  3. The bureaucracy fairy went into overdrive. This would make me want to bubble wrap a child. Glad he is okay. Private hospitals are the way to go in Brasil too.

    For my hip surgery I went to a hospital that only recently went to a “nonprofit” status. I tell ya, it was great to have a room to myself, and everyone was incredibly on their game in terms of the nursing staff. The prior “for profit” system was readily apparent at the front door when they wanted to charge me my deductible ($2k) that I had already met for the year. I gave them a little since I knew I would I have an inpatient copay and told them to bill me the rest. I still expect to be near $0.00 when all is said and done.

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