Mother in Israel — Do you have the basic mandatory coverage or do you pay for an upgrade to one of the premium plans? As far as I know the basic coverage does not cover 70% of the fee to a private doctor, although many of the upgrades do.
As someone who just transitioned to the Israeli system from the U.S. one, I am not so happy with the system here. B”H I did not have any serious medical issues since I came, but a lot of the routine stuff is unbelievably complicated.
For example my son was having certain eye issue and I was told that the wait period for an appointment with a pediatric ophthalmology was over 3 months! This was not to see the “top” doctor — this was to get ANY appointment.
Similarly my baby hurt his foot and we were concerned about a broken toe. My pediatrician gave me a referral to Terem and an orthopedist. I called the Kuppah for an appointment with a pediatric orthopedist and was told that the pediatric orthopedist works for the Kuppah only one day a week, which happened to be that day. They would squeeze me in if I could get the x-ray and be an the office within the next 2 hours. After zooming to Terem and B”H not waiting too long, I rushed back with my x-rays (the Terem technician will only take the x-ray, not read it), and made it to the Kuppah. I got into the doctor who told me that since I was squeezed in he is only going to look at the results, but if my son needs treatment I would have to go to the hospital ER, as he will not treat him. (BTW, here in Beit Shemesh there is no hospital, so it would mean traveling to either Yerushalayim or Tel Aviv!!) B”H my son did not need any treatment, but I never had experiences like these in the U.S.!
Additionally, my husband and son both take maintenance medications for two completely different conditions, and both of their medications were covered in the U.S. with just a nominal co-pay. Neither of their medications are available here in Israel. B”H my husband was able to switch to a medication available here that seems to be working for him, but the medication my son had to switch too is causing him many more significant side effects then the one he used to take.
And that is not even discussing the whole immunization issue, where you have to deal with a whole separate bureaucracy (the Tippat Chalav by us doesn’t even answer their phone — you have to go in person just to get an appointment!). And once the kids outgrow Tippat Chalav, well-care transitions to school nurses who service entire regions of schools. I don’t want to talk about the nightmare I am in the middle of right now with regard to my 2nd grader’s booster shots, but suffice it to say that as we have a simcha coming up in the U.S. I think I’m just going to go to my old pediatrician and pay him out of pocket to give my son his shots, as I don’t have the koach to start fighting the bureaucracy here. (He didn’t get his shots in school because they lost the records that I sent in THREE times, and found it after they were packing up the immunizations, so they decided not to bother unpacking it. . )
And don’t get me started on “histapchut layaled” and developmental delays, where the evaluation process alone can take 6 months, followed by an 8 month waiting period to begin therapy. . .
I was lucky in the U.S., as I had excellent insurance provided by my employer (I was a unionized employee working for the government 🙂 — NYC), so I am not intending to minimize the difficulties for people who don’t have coverage, etc. But good coverage in the U.S. definitely comes with significantly smoother medical care, less bureaucratic hurdles, easier access to doctors, and quicker treatment then the Kuppat Cholim system. (And I do pay to upgrade my coverage to the highest level provided by the Kuppah.)