Wednesday, July 21, 2010

International Healthcare

Why is it that I've worked in healthcare related fields for ten years now, and it still gives me more frustration than nearly anything else?  This month my major project has been figuring out how our healthcare here works.  I had a rather long draft of the steps I have been taking to learn the new process and succeed in getting some basic appointments, but I decided to scrap that in favor of a more summarized version, because I figured that it's been painful enough for me - why put all of you through it too?

The one thing I should mention is that you have to differentiate healthcare provision from healthcare insurance.  These are two entirely different things, as the doctor yesterday reminded us.  "First we talk about your health.  Then we talk about bureaucracy."

Healthcare in Israel (what I've learned so far)
- Citizens pay taxes (less than US insurance premiums) that guarantee them access to care
- They then have the right to pay a small additional fee for supplemental plans that give them access to additional services, and some of the private providers
- Appointments can be made with just a few days notice (I have been able to get same day appointments)
- They have better health outcomes than in the USA
        - Ave man lives to age 78, average woman to 82
        - Several of the practitioners I have met have practiced or trained in the US at some point, and all of them prefer the Israeli system
- They all still complain about the bureaucracy of the system here.

Healthcare in USA
- Quality of care is the same.  For me, it is easier to understand American practitioner's English (big surprise, right? But at least the Israeli practicitioners can speak it.  It's the office staff I struggle with).
- Choice of practitioner is much more restricted, unless you can afford to pay huge premiums (much higher prices than Israeli's despite the practitioners being just as qualified, and in some specialities moreso).
- Regular battles getting insurance to make payments for care.
- Access is linked to employment in the US.  In Israel, if you lose your job, your social benefits allow you to keep your healthcare, even if you can't pay your healthcare taxes, at least for a while (it's as if it is part of collecting unemployment benefits, which are also available here, although the unemployment rate is only 8%, so they have not extended benefits beyond the regular 6 or 9 months).

Healthcare Insurance
This is entirely different, as some of the bullets above outline.  I hope to learn more how it works for Israeli's, as we are waiting to hear from the tax specialists which status Dan should claim (Israeli returning citizen which gives him all the rights and responsibilities, or expat). 

Right now we have employer sponsored health insurance.  There was only one option given to us for going abroad - Cigna International.  Dan pays our portion of the premium through his paycheck, just like for US plans.  Then we have an annual deductible, and pay a % of all care after the deductible is met up to a maximum at which point they theoretically pay 100%.  They say there are no restrictions on which providers we can use (including private or public).  I haven't found a facility yet that will take the insurance directly, but past Ford employees say they never had a problem paying up front and getting reimbursed (I'll believe it when I see it).  They also offer a service called International SOS which is who Cigna connects me to whenever I request help finding a practitioner.  However, I have found them mostly useless so far.  They transfer me to Paris which is the office that supposedly "knows" Israel.  Well, they don't.  They have taken 10 days and still haven't found me a name and # for an accupuncturist (which is surprisingly a covered benefit at 90% for up to 15 visits per year, no particular diagnosis needed).  So I did a 5 minute google search, found a guy who runs a school as well as practices, and have already been in to see him.  He was excellent.  They also offer accupuncture at Ichilov/Tel Aviv Medical Center, which is about a 20 minute walk from our apartment.  I found their contact information myself while trying to get a nearby allergist to continue my shots that I brought from the US docs.  I've been transfered so many times via phone I can't recall anymore, usually because they want me to talk to the Medical Tourism office in each facility.  This is partly because of our insurance, and partly because speaking english with the receptionists is a nightmare.  Making appointments is so hard (due to language) that at least 50% of the time I've had to give up and have Dan call.  Then he gets me an appointment within a day or two. 

After the appointments,  I have to scan and submit a claim form, itemized receipts (which have to be translated), the doctor's explanation of why I was seen and what he did, as well as his suggested next steps (which also have to be translated) online, then wait 15 days for processing.  I am only a week into the waiting period on the first one, so I will update you regarding the reimbursement process when I have more to tell. 

With all the paperwork, confusion regarding benefits, and battles over reimbursement with US insurance providers, we wonder why US healthcare costs so much?  

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