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== Please Note == <!--חשוב לדעת-->
 
== Please Note == <!--חשוב לדעת-->
*
+
*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 the 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.
גם אם עיקרון הרצף הטיפולי אינו שולל מהקופה , במקרה מסוים, את האפשרות להעביר את מבוטחיה למוסד רפואי אחר בשל שינוי שחל בהסדרי הבחירה, הרי שעליה להודיע
+
*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.
להם על כך זמן סביר מראש, באופן שיאפשר להם להתארגן כך שרציפות הטיפול הרפואי לא תפגע.  
+
*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. 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.
*במקרה שבו הקופה מסרבת להמשיך ולממן למבוטח שירות רפואי שספקה לו בעבר,  עומדת למבוטח האפשרות לטעון כי הוא זכאי להמשיך ולקבל את השירות הרפואי  מטעם הקופה מכוח עיקרון הרצף הטיפולי.
+
<!--== Legal Precedents ==--> <!--תקדימים משפטיים-->
* סטיה מעקרון הרצף הטיפולי בניגוד לעמדתו של המטופל יכולה להיעשות במקרים חריגים בלבד, ובתנאי שהדבר נעשה משיקולים של שיפור הטיפול בחולה או משיקולים של העדפת מדיניות טיפול שונה מזו שהעניקו לחולה עד כה. במקרים אלה על מנהל קופת החלים לשקול את ההחלטה ולנמק אותה בכתב. כמו כן עליו למסור את החלטתו המנומת לידי החולה.
 
 
 
== Legal Precedents == <!--תקדימים משפטיים-->
 
<!--
 
* רשימת תקדימים משפטיים המשפיעים על הזכות
 
-->
 
 
 
 
== Aid Organizations == <!--ארגוני סיוע-->
 
== Aid Organizations == <!--ארגוני סיוע-->
<!--
+
* For a comprehensive categorized listing of healthcare organizations offering assistance and support, [[Health and Illness/Aid Organizations | click here]].
* יש להכניס כאן רשימת ארגונים מסייעים
 
* בצורת רשימה, כהפניות לדפיהם במערכת כל-זכות
 
-->
 
  
 
== Government Agencies == <!--גורמי ממשל-->
 
== Government Agencies == <!--גורמי ממשל-->
<!--
+
* [[:he:משרד הבריאות|The Ministry of Health]]
* רשימת גורמי ממשל המסייעים במימוש הזכות
+
* [[:he:נציבות קבילות הציבור לחוק ביטוח בריאות ממלכתי|The National Health Insurance Law Ombudsman]]
-->
 
  
 
== Laws and Regulations == <!--חוקים ותקנות-->
 
== Laws and Regulations == <!--חוקים ותקנות-->
<!--
+
* [[:he:חוק ביטוח בריאות ממלכתי|The National Health Insurance Law]]
* רשימת חוקים ותקנות מכוחם מוקנית הזכות או משפיעים עליה
+
* [http://www.nevo.co.il/Law_word/law06/tak-6366.pdf National Health Insurance Regulations (Arrangements for Selection of Service Providers), 5765-2005]
-->
 
  
 
== Additional Publications == <!--הרחבות ופרסומים-->
 
== Additional Publications == <!--הרחבות ופרסומים-->
<!--
+
*[http://www.health.gov.il/hozer/sbn06_2011.pdf 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
* רשימת הרחבות בנושא, למי שמעוניין לקרוא מעבר
+
*[http://www.old.health.gov.il/download/forms/a3121_00005329.pdf Ministry of Health Director Circular 2/99 "Trapped Doctors - Preserving Trust in the Era of Conflicting Interests"]
-->
+
*The Knesset Research and Information Center - [http://www.knesset.gov.il/mmm/data/pdf/m02067.pdf "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"]
 +
* [http://www.patients-rights.org/uploadimages/Health_department_guidelines_on_Continuity_treatment.pdf Medical Administration Circular 13/2012 from 07.05.2012 "Continuity of Care for Health Plan Policyholders - Guidelines"]
 +
* [http://www.health.gov.il/hozer/mk21_2007.pdf Ministry of Health Director Circular from 22.11.2007 "Recognition of a Specialized Medical Services"]
  
 
== Sources == <!--מקורות-->
 
== Sources == <!--מקורות-->
<!--
+
* Original information provided by the [[:he:המרכז הקליני מזו"ר - המשפט למען זכויות החולה בישראל|Mazor Clinical Center - Providing Legal Advice Regarding Patients Rights in Israel]].
* בסעיף זה יש להכניס רשימת מקורות לטקסט לצורך סימוכין ומתן קרדיט
+
* Original translation by [[AACI - Association of Americans and Canadians in Israel|AACI]]'s [[The Shira Pransky Project|Shira Pransky Project]].
-->
 
  
 
<!--כותרת דמה עבור הטמעת כותרת. לא לגעת!
 
<!--כותרת דמה עבור הטמעת כותרת. לא לגעת!
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{{זכות/תחילת טור שמאלי}}
 
{{זכות/תחילת טור שמאלי}}
{{סטטוס | בעבודה}}
+
 
 
{{זכות/ראו גם  
 
{{זכות/ראו גם  
| החלף בפורטל האב של הזכות
+
| [[Health Plans - Community Medicine (Kupot Cholim)]]
| זכות/הליך הקשורים לזכות
+
| [[Hospitals - In-Patient and Out-Patient Clinics]]
| ערכים נוספים הקשורים לזכות, כל אחד בשורה נפרדת
+
| [[Health and Illness]]
 +
| [[:he:בחירת נותני שירותים רפואיים|Choosing medical service providers]]
 +
| [[Obtaining a Payment Voucher (Form 17) from the Health Plan]]
 +
 
 +
 
 
}}
 
}}
 
{{זכות/חדשות  
 
{{זכות/חדשות  
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{{זכות/סיום טור שמאלי}}
 
{{זכות/סיום טור שמאלי}}
 
  
 
<!-- יש לכתוב תגיות כאן בתחתית -->
 
<!-- יש לכתוב תגיות כאן בתחתית -->
 
[[קטגוריה:זכויות]]
 
[[קטגוריה:זכויות]]
 
[[Category:Rights]]
 
[[Category:Rights]]
 +
 +
[[he:שמירה על רציפות הטיפול (עקרון הרצף הטיפולי)]]

Revision as of 13:41, 6 November 2013

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According to the Principle of Treatment Continuity, no policyholder may be forced to switch treatment facilities while being treated for the same illness or condition
Health plans are required to maintain continuity of medical services (continuity of care) regardless of any changes with regard to service provider agreements that may impact their policyholders
The Principle of Treatment Continuity is also applicable with regard to medications
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, and with health plan administrative approval

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 the same illness or medical condition, regardless of any changes with regard to 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.

Example
A health plan policyholder with severe and prolonged chronic pain problems who was successfully treated for a year at a specific pain clinic after treatment at other medical facilities proved unsuccessful will not be moved to different pain clinic even if his health plan changes its arrangements with the aforementioned clinic.

The Principle of Treatment Continuity is also applicable with regard to medications. Accordingly, if a health plan stops providing a specific medication to its policyholders (i.e. if a brand-name drug is replaced with a generic drug or one generic drug is replaced with another), and a patient's doctor indicates that the patient's conditions requires provision of the medication s/he was already taking (i.e. if the medication a diabetes patient was taking was more successfully at stabilizing his/her condition), the health plan is obligated to continue providing the medication.

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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 required 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

  1. Kidney failure being treated by dialysis
  2. AIDS
  3. Gaucher's Disease
  4. Thalassemia
  5. Hemophilia

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 the Ministry of Health Director Circular 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.

Organ Transplants

  1. Heart
  2. Kidney
  3. Liver
  4. Pancreas
  5. Lung

Other Medical Conditions

  • Patients with any of the following conditions:
  1. Current or previous malignant disease requiring continual monitoring and follow-up
  2. Orphan diseases
  3. Patients who have undergone an operation and who require monitoring and follow-up due to chronic complications, the possibility of complications or follow-up surgical procedure (such as closing a stoma)
  4. Patients with a complex medical condition requiring monitoring in a hospital (including outpatient clinics and facilities)
  5. Repeat or additional hospitalization/surgery due to the same illness or medical condition
  6. Dialysis treatments including resumption of dialysis treatment after a discontinuation of less than a year, not including dialysis treatment performed during hospitalization
  7. Child development services
  8. Physical therapy
  9. First clinical visit after surgery in the hospital in which the surgery was performed
  10. Oncological treatments
  11. Monitoring and specialized treatments related to transplants

How to Claim It?

  • The issues related to application of the Principle of Treatment Continuity are complicated. Policyholders whose health plan has refused to continue providing a medical service they received previously (i.e. by refusing to issue a payment voucher (Form 17) or paying for a medication) is entitled to do the following:
Example
A case in which the National Health Insurance Law Ombudsman required a health plan to issue a payment voucher (Form 17) due to the Principle of Treatment Continuity, despite the fact that the health plan did not have any arrangements with the service provider: A 70 year old policyholder underwent a right hip implant in Ichilov Hospital before choice of service provider arrangements were publicized, and required on-going monitoring after recovering from the implant. She later required a left hip replacement, but was then told by her health plan that she may only have the procedure performed in Tel Hashomer Hospital due to the fact that the health plan did not have choice of service provider arrangements with Ichilov Hospital. Her son submitted a complaint that as a result of these circumstances, she would have to have the examination of her right hip performed at Ichilov Hospital, and the examination of her left hip performed at Tel Hashomer Hospital. After the health plan was contacted repeatedly by the ombudsman and the attending physician, the health plan provided the policyholder with a payment voucher (Form 17) for Ichilov Hospital. For more information, see The National Health Insurance Law Ombudsman Report for 1998-1999 - Section 4.

Please Note

  • 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 the 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. 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.

Aid Organizations

  • For a comprehensive categorized listing of healthcare organizations offering assistance and support, click here.

Government Agencies

Laws and Regulations

Additional Publications

Sources

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