The Principle of Treatment Continuity requires the health plans to allow their policyholders to continue receiving treatment for a given illness or medical condition at the same facility or service provider, regardless of any changes with regard to agreements or arrangements.
- The Principle of Treatment Continuity requires the health plans to maintain continuity of medical services (continuity of care) provided to a policyholder being treated for a given illness or medical condition regardless of any changes with regard to agreements or Health Plan Choice of Service Provider Arrangements.
- This principle is based on the notion that, in some cases, quality of care and provision of medical care at a reasonable level require maintaining continuity of a patient's medical care.
- The Principle of Treatment Continuity is also applicable with regard to medications. If a health plan stops providing a specific medication to its policyholders and a patient's doctor claims that the patient's condition requires provision of the medication s/he was already taking, the health plan is obligated to continue providing the medication to that policyholder.
Who is Eligible?
- From time to time, the Ministry of Health publishes a list of medical conditions that require continuity of care to be maintained.
- Nonetheless, this is not a closed list, meaning that there can be situations and conditions that require continuity of care to be maintained that are not included in the listing.
Conditions Defined as "Serious Illnesses" According to the National Health Insurance Law
Treatment in a Specialized Medical Service Center
- A Specialized Medical Service center is a medical facility that offers a special level of medical knowledge and professional experience, usually for special and rare diseases the treatment of which requires unique skills and training on the part of the medical staff. For more information, see Ministry of Health Director Circular 22/07 from 22.11.2007.
- Someone being treated at a specialized medical service center is entitled to continue receiving treatment there regardless of his/her health plan's arrangements or agreements with the facility.
Other Medical Conditions
- Current or previous malignant disease requiring continual monitoring and follow-up
- Orphan diseases (such as Pompe disease, Fabry disease and Hunter syndrome
- Patients who have undergone an operation and who require monitoring and follow-up due to chronic complications, the possibility of complications or a follow-up surgical procedure (such as closing a stoma)
- Patients with a complex medical condition requiring monitoring in a hospital (including outpatient clinics and facilities)
- Repeat or additional hospitalization/surgery due to the same illness or medical condition
- Dialysis treatments including resumption of dialysis treatment after a discontinuation of less than a year, not including dialysis treatment performed during hospitalization
- Child development services
- Physical therapy
- First clinical visit after surgery in the hospital in which the surgery was performed
- Oncological treatments
- Monitoring and specialized treatments related to transplants
How to Claim It?
- Continued provision of a medical treatment/service or medication due to the Principle of Treatment Continuity should occur automatically.
Appealing a Health Plan Decision Not to Continue Provision of a Medical Treatment/Service or Medication
- The issues related to application of the Principle of Treatment Continuity are complicated, and there are cases where the health plan will refuse to continue funding a a medical treatment/service or medication.
- In cases where the health plan refuses to continue funding a medical treatment/service or medication that was previously provided (i.e. by refusing to issue a payment voucher (Form 17) or paying for a medication), the policyholder may do the following:
- Submit a complaint to the health fund
- Submit a complaint to the National Health Insurance Law Commissioner
- Submit a claim in a court of law
- Even if the Principle of Treatment Continuity does not keep the health plan from transferring policyholders' care from one facility to another due to a change in service provider arrangements, the health plan must still inform policyholders of any such changes enough time in advance so that they are able to ensure that their continuity of care is not negatively impacted.
- Policyholders whose health plan has refused to continue providing a medical service they received previously may claim that they are entitled to continue receiving such services from the health plan due to the Principle of Treatment Continuity.
- In rare cases, a decision may be made to deviate from the Principle of Treatment Continuity due to professional considerations given to the improvement of treatment or preference given to one treatment policy over that which had been provided previously. In such cases, a health plan administrator/manager must consider the decision and defend it in writing. Moreover, the administrator/manager must provide this decision to the patient.
- For a comprehensive categorized listing of healthcare organizations offering assistance and support, click here.
Laws and Regulations
- The National Health Insurance Law
- National Health Insurance Regulations (Arrangements for Selection of Service Providers), 5765-2005
- Medical Administration Circular 13/2012 from 07.05.2012 - "Continuity of Care for Health Plan Policyholders - Guidelines"
- Assistant Director of Health Plan and Additional Healthcare Services Supervision Circular 06/2011 from 09.06.2011 - Implementation of National Health Insurance Regulations (Arrangements for Selection of Service Providers), 5765-2005
- Ministry of Health Director Circular 21/07 from 22.11.2007 - Recognition of Specialized Medical Services
- Ministry of Health Director Circular 2/99 from 12.01.1999 - "Trapped Doctors - Preserving Trust in the Era of Conflicting Interests"
- "The Impact of Payment Arrangements between the Health Plans and the Public Hospitals on the Options for Service Providers Offered by the Health Plans to their Members" -The Knesset Research and Information Center
- Original information provided by the Mazor Clinical Center - Providing Legal Advice Regarding Patients Rights in Israel.
- English translation and maintenance by The Shira Pransky Project.