Navigating the Israeli Health Care System

I’m pretty familiar with the US health care system. When I worked in Congress, I oversaw the Federal Employees Health Benefit System. I also worked some on the Medicare program. Until recently, however, I rarely used the system in the US or Israel because I was rarely sick. That changed two years ago when I was diagnosed with ulcerative colitis.

After the diagnosis, things have been manageable until about a month ago when I experienced a serious flare-up. Until then I was assisted by our family physician on the kibbutz, and a gastroenterologist at a hospital about forty minutes away. In the meantime I had been communicating with my cousin at the University of Chicago who is an expert in colitis and related diseases. He referred me to a doctor in Haifa. That’s where the saga began.

Israel has national health insurance. It’s administered through several private insurance companies, which, like the US, have specific relationships with certain hospitals and doctors. We originally chose a particular company because the health clinic on the kibbutz, as well as the nearby hospital, is connected to it.

The problem with my cousin’s referral is that neither he nor the hospital he’s connected to is part of our health insurance network. He agreed to see me privately for a $250 consultation fee (ouch). He was great and extremely thorough – he knows my cousin well. He ordered a number of tests, including a sigmoidoscopy (a type of colonoscopy). I took his orders to our family doctor who got visibly upset. Normally, she’s a very nice person. She asked why I went to him since he’s not part of our insurance network. I explained that my cousin, who is world renowned in this field, recommended him. She didn’t seem impressed. She said our insurance company has many good gastroenterologists. I said I’m sure that’s the case, but I like this doctor and want to continue with him. She then mumbled to herself about all the tests he ordered. She said our insurance company likely will not approve going to him (as if he has the plague). My new gastroenterologist arranged for the colonoscopy at his hospital, but the insurance company rejected the location for the procedure. He then called my family doctor, who, according to her, screamed at her for an hour (normal Israeli behavior), but she wouldn’t concede. Apparently, she’s a heavy weight with our insurance company. My gastro doc pointedly said she wears two hats. She said she’d order a colonoscopy at one of their hospitals quickly.

This past Saturday (yes, Shabbat) Stacy and I traveled to the Italian hospital in Nazareth for the sigmoidoscopy. This exemplifies how the Israeli and US systems differ. In Richmond, Virginia, a metro area of approximately one million people, there are over 10 hospitals, associated with two or three networks. Consequently, for almost all medical procedures, one goes to one local hospital. In Israel, it’s different, especially if you don’t live in a big city. Here, you’re directed to multiple hospitals in completely different cities for different procedures, some of which are very routine. By the time I’m finished with this process, I’ll have gone to at least five hospitals/clinics, located in different parts of the country.

Anyway, the sigmoidoscopy went fine, and I received the report right away – severe ulcerative colitis – I knew that much – but it had spread farther up my colon. I scanned the report, sent it to my gastro doc, who responded right away and said we need to meet immediately. But again we had the insurance issues. He told me that for these consultations, paying privately only costs around $25. I have no idea how that works. I went to the hospital in Haifa, where his offices are, found the gastro department and was told I needed to wait an hour to see the doc. Not thrilled, but what can you do. I had multiple legal appointments later in the day at my office, an hour and a half away. I sat around, twiddling my thumbs, and after an hour asked the clerk about the appointment. She then said, go down the hall and wait outside his office. When I got there, someone was already seeing him, and others were waiting to see him. I was confused as to why I was told to wait in the first place. I explained, in my rudimentary Hebrew, to the others sitting there, that my appointment was scheduled an hour earlier. After waiting another 20 minutes, I went in to see my doc. He asked where was my registration slip (at least he speaks in English). I said the clerk didn’t give me one. He said he couldn’t do anything without it, so I needed to go back and register. Why this didn’t happen in the beginning (as no one told me it was necessary) is part of the phenomenon of Israeli service or lack thereof.

I returned to the clerk and asked for the registration. She spoke no English and didn’t seem happy with my Hebrew. Who knows, maybe I accidentally said she was ugly. Anyway, she handed me the registration and said I must pay the $25. No problem, but when I handed her the money, she said no; rather, I must go somewhere else in the massive hospital and pay it. Whatever. I went back to the doctor and now waited another half hour because he had grabbed the next guy in the interim. When I finally saw him he basically said my previous treatments were not working, and he wanted to start me on immuno-suppressant therapy. Since colitis is an auto-immune disease, it means my immune system is attacking my colon for no reason. (Sounds like colitis originated in Iran). So, I get to start these immune-suppressant treatments this week, meaning that now I will be more susceptible to infections because my immune system will be compromised. To top it off, I have the privilege of taking these meds for the rest of my life.

He ordered another barrage of tests, of course, to be administered in various hospitals around the country, including one on Mars. Also, I had to bring in poop samples (it keeps getting better and better), and who knows where they go – maybe Iran. He also requested I see him in another month, meaning I had to visit again with Nurse Ratchet to get an appointment. When I got to her station, her window was closed, but she was sitting next to another “friendly” woman, who refused to help me, and indicated Nurse Ratchet had to give me the appointment. Of course, this is all in Hebrew, which makes me worried, because I don’t want to accidentally schedule a kidney transplant.  Nurse Ratchet apparently overheard the conversation, and suddenly handed over a new order – presumably the next appointment and not the kidney transplant. I again asked about where to make the payment. She blurted out the answer in some foreign language, which I figured meant down one floor. I went down one floor, which was the lobby, and left. Never did find the place to pay. I’m not sure what will happen when I return next month, but if the guards at the entrance look Iranian, I’m outta there.