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{{דגשים  
 
{{דגשים  
 
| מידע = 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
 
| מידע = 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
| חשוב = 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
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| מידע2 = 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
 
| איסור = <!-- דוגמה: אסור לעשות -->
 
| איסור = <!-- דוגמה: אסור לעשות -->
| חשוב2 = The Principle of Treatment Continuity is also applicable with regard to medications
+
| מידע3 = The Principle of Treatment Continuity is also applicable with regard to medications
| חשוב3 = 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
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| חשוב = 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
 
| פיצוי = <!-- דוגמה: מגיעים לכם X שקלים -->
 
| פיצוי = <!-- דוגמה: מגיעים לכם X שקלים -->
 
| שאלה  = <!-- דוגמה: שאלה -->
 
| שאלה  = <!-- דוגמה: שאלה -->
 
| ממשל  = <!-- קישור לגורם ממשל אחראי -->
 
| ממשל  = <!-- קישור לגורם ממשל אחראי -->
 
}}<!-- פרמטרים סטנדרטיים: מידע/איסור/חשוב/פיצוי/שאלה/ממשל. ראו [[תבנית:דגשים]] למידע על אפשרויות הפרמטרים בתבנית -->
 
}}<!-- פרמטרים סטנדרטיים: מידע/איסור/חשוב/פיצוי/שאלה/ממשל. ראו [[תבנית:דגשים]] למידע על אפשרויות הפרמטרים בתבנית -->
 +
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.
 +
{{זכות/סיום הקדמה}} <!-- תבנית זו דואגת לכך שהכותרת הבאה בתור תתחיל רק מתחת לתוכן העניינים -->
  
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 [[:he:בחירת נותני שירותים רפואיים|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 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 [[:he:בחירת נותני שירותים רפואיים|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.
 
{{ דוגמה | 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.}}
 
{{ דוגמה | 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. 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.
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.
+
{{דוגמה|A patient suffers from a chronic illness and was treated with a specific brand-name drug. His health plan stopped providing that drug and began providing a generic alternative. The patient's attending physician claims that his condition requires that he continue taking the brand-name drug. Due to the Principle of Treatment Continuity, the health plan must continue providing the patient with the original brand-name drug.}}
 
 
{{זכות/סיום הקדמה}} <!-- תבנית זו דואגת לכך שהכותרת הבאה בתור תתחיל רק מתחת לתוכן העניינים -->
 
  
 
== Who is Eligible? == <!--מי זכאי-->
 
== Who is Eligible? == <!--מי זכאי-->
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== How to Claim It? == <!--תהליך מימוש הזכות-->
 
== How to Claim It? == <!--תהליך מימוש הזכות-->
*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:
+
* 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 a medical treatment/service or medication that was previously provided (i.e. by refusing to issue a [[Obtaining a Payment Voucher (Form 17) from the Health Plan|payment voucher (Form 17)]] or paying for a medication), the policyholder may do the following:
 
:* [[Submitting a Complaint to the Health Plan|Submit a complaint to the health plan]]
 
:* [[Submitting a Complaint to the Health Plan|Submit a complaint to the health plan]]
 
:* [[Submitting a Complaint to the National Health Insurance Law Ombudsman|Submit a complaint to the National Health Insurance Law Ombudsman]]
 
:* [[Submitting a Complaint to the National Health Insurance Law Ombudsman|Submit a complaint to the National Health Insurance Law Ombudsman]]
:* Submit a claim in a court of law
+
:* Submit a claim in a court of law
 
 
 
{{דוגמה | 1= 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:
 
{{דוגמה | 1= 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 [http://www.old.health.gov.il/pages/default.asp?maincat=21&catid=60&pageid=318#4 The National Health Insurance Law Ombudsman Report for 1998-1999 - Section 4].}}
 
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 [http://www.old.health.gov.il/pages/default.asp?maincat=21&catid=60&pageid=318#4 The National Health Insurance Law Ombudsman Report for 1998-1999 - Section 4].}}
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== 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
+
* [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.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"]
+
*[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
 +
* [http://www.health.gov.il/hozer/mk21_2007.pdf Ministry of Health Director Circular 21/07 from 22.11.2007] - Recognition of Specialized Medical Services]
 +
* [http://www.health.gov.il/hozer/mk02_1999.pdf Ministry of Health Director Circular 2/99 from 12.01.1999] - "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"]
 
*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-->

Revision as of 10:55, 10 November 2013

Template:זכות/תחילת טור ימני

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 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. Template:זכות/סיום הקדמה

  • 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 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. 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.
Example
A patient suffers from a chronic illness and was treated with a specific brand-name drug. His health plan stopped providing that drug and began providing a generic alternative. The patient's attending physician claims that his condition requires that he continue taking the brand-name drug. Due to the Principle of Treatment Continuity, the health plan must continue providing the patient with the original brand-name drug.

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?

  • 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 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:
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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