Chok Hatzinun: What We Know, What We Don’t, & Why to Worry

By: Ayala Laub Waltuch, Director of Programming & Organizational Development, Yad L'Olim

Some of you may have heard of a new law in Israel, being referred to as “Chok Hatzinun”. Others may not have heard of a specific law, but have noticed some changes in the Kupot Cholim’s policies, and how they relate to private institutions. What is clear to us is that much of what surrounds these changes in unclear to the majority of the public. After months of research, phone calls, and meetings on the subject, I’d like to relay to you some of our observations, insights (as well as lack of insights), and concerns that we’ve found with this newly expanded rule.

Background: What is Chok Hatzinun?

Chok Hatzinun is a newly expanded law implemented by Misrad Habriut (The Ministry of Health). The law states that anyone who has seen a physician through their Kupah (i.e. public sector), will not be allowed to see the physician privately for 6 months. The rule, which original applied to surgeons only, was recently expanded to include any consultation with any doctor or specialist. In addition, the list of private surgeons and specialist that would normally be partially covered by your Kupah’s Supplemental Insurance (SHABAN), has been limited.

Misrad HaBriut has claimed their goal is to stop doctors from encouraging their clients to see them in the often costly private sector. They also allege that this new law will encourage more doctors to work more hours in the public sector, thereby shortening the long wait time that sometimes causes patients to seek out private options.

What We Know:

• Under no circumstance may one see a physician in the kupah, followed by privately within 6 months, even for continuity of care, or for a subsequent private surgery.
• You can see a doctor privately, and then continue seeing him through the kupah, but can not go back to him privately for 6 months after your last kupah visit.
• It is the doctor’s responsibility to enforce this rule, not the patient (i.e. the doctor will be fined).
• If you choose to have surgery with a surgeon who is not on the kupah’s approved reimbursement list, the kupah will no longer cover your hospital stay. This means, in addition to paying fully out of pocket for the private surgeon, you also need to pay for the anesthesiologist, and the daily costs of hospitalization.

What We Don’t Know:

• Is any and all interaction with your physician through the kupah considered a consult, barring you from seeing him/her privately for months? For example, if you have a regular prescription that you request from you doctor online, is that considered seeing him/her through the kupah?
• If one is already admitted to the hospital (for emergencies, or with the correct payment vouchers from the kupah), and then wants a private surgeon, do they retroactively need to pay for the entire hospital stay?
• Where does SHARAP fit in? SHARAP has recently put up signs in their offices informing people of the new law, but it seems some doctors can still be seen at the discounted rate with SHABAN, regardless of association with a specific kupah.

Why We’re Worried:

• Lack of knowledge: The majority of people we have spoken to had little to no understanding of this law, let alone that it existed. Even employees of Misrad Habriut, and the Kupot Cholim were unaware of how far the law extended, what exactly it included, and in some cases, did not know the rule applied at all.
• Lack of continuity of care: For patients that need regular appointments with specialists, and can not wait 4 months+ for an appointment, making use of their SHABAN benefit of seeing their doctor privately in between for partial reimbursement was often a good solution. This is no longer the case, meaning a patient that needs to be seen more regularly may not be able to consistently see his/her regular physician.
• A divide between the public and private sector: We believe this is the beginning of an attempt by Misrad Habriut to further separate the previously well connected public, and private sector, and to limit the benefits of supplemental insurance as a whole. This has been seen in other areas, such as the new limitation on the SHABAN pregnancy package. While Misrad Habriut claims this will eventually save the patient money, and expand public programming, we are concerned that this is unlikely to be the case. Instead, those who can still afford to go to private consultations, and have private surgeries without partial reimbursement will continue to do so, and the private sector will continue to thrive. Those who can’t afford these luxuries, will be forced into the already bottlenecked public sector, which will ultimately lead to even longer wait times, and lower quality patient care.

If anyone has any information or insight on this subject, please feel free to reach out to us at healthcare@yadlolim.org

We also encourage you to call your Kupot Cholim to ask for information and voice your concerns.