The doctors stopped receiving payment directly from the patients - and the cost of surgery fell

Initial data collected by the Health Ministry from the HMOs prove that the "reimbursement arrangement" has succeeded in dramatically reducing the price paid by private surgery patients

Data collected by the Ministry of Health indicate that, in the first months of its existence, the "restitution" reform succeeded significantly in changing the private-sector surgery market in Israel: the prices of private surgeries and self-participation of policyholders declined significantly, The most expensive ones apparently dropped significantly.

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Since July of last year, the supplementary insurance policyholders can no longer choose a surgeon, pay him and the hospital, and receive a refund from the supplementary insurance. Instead, they can choose a surgeon from a closed list of surgeons offered by the HMO, and pay only a pre-determined deductible for the surgery.

so what happened? First, the surgeons began to join en masse to the closed lists of the health funds: As of April 2017, the number of surgeons who have agreements with the health funds is 4,304, compared with 2,762 only two years earlier. The lists of surgeons are open and of course visible on the HMO sites, and it can be seen that the closed lists also include senior surgeons who in the past did not join the HMO's arrangement lists. In terms of policyholders, this is in itself a big line: the repayment track, where they would go to a private surgeon, pay him the amount he demanded and receive a refund from the insurance was more expensive than the arrangement track in which they paid only a deductible. Following the reform, they now have much higher financial access to senior surgeons.

The most significant change occurred in Maccabi

The move affected the various health funds differently, because of the unique characteristics of each fund. Clalit Health Services did not change Clalit Health Services' supplementary insurance coverage to surgery. The reason is that Clalit worked before the reform of the return arrangement to a large extent, using a method of arrangement and closed lists, and the repayment method was relatively rare. However, from the point of view of general policyholders there was a 24% decrease in expenditure on private surgery - both due to the entry of some of the senior surgeons into the arrangement list and due to the fact that the accessories, which in the past were the insured's expense,

Maccabi's health fund recorded the most significant change compared with other funds: the fund's expenditure on private surgery fell by 28% in the first six months of the reform, compared to the same period a year earlier, and the expenditure of insureds dropped by 50%. The reason Maccabi is the most affected by the change is that its insurance plan was based on the change in the reimbursement method to a large extent, and a large part of the analyzes of Maccabi's supplementary insurance members were performed in this manner. The transition to a closed list system (arrangement) enabled the fund to pay lower prices to physicians, and significantly cut the deductible amount of insureds in the fund.

In Meuhedet, expenditures on surgeries actually increased

The change in the third largest fund, Meuhedet, is also interesting: Meuhedet is the only fund whose operating expenses actually rose following the reform (by 4 percent in the first half of 2016). The reason, explain the Health Ministry, is that the HMO added to its lists senior and expensive surgeons - who before the reform worked on the repayment track, so that most of their pre-reform expenditure fell on policyholders rather than on the fund. This is especially true in the Jerusalem area - Hadassah and Shaare Zedek. However, uninsured beneficiaries earned from the reform: their total expenditure decreased by 12%.

The smallest fund, Leumit Health Services, reduced its expenses by about 15%, and its policyholders spent 1% less following the reform.

The Ministry of Health presented several examples of dramatic reductions in the self-participation of insureds in various private surgeries following the reform. For example, in a partial breastctomy before the reform began, the insured paid NIS 20,000 to the surgeon and the hospital, and received NIS 1,947 from the supplementary insurance, so her total expenditure was NIS 18,000. After the reform, it is required to pay a deductible of NIS 1,164 only. The total cost of the surgery also dropped from NIS 20,000 on the payback route to NIS 8,700 in the settlement track.

In the operation of acromioplasty (orthopedic surgery on the shoulder), the cost of the surgery was reduced from NIS 40,000 to NIS 30,386 in the settlement method. The cost to the insured for the surgery dropped from NIS 35,500 to NIS 8,250. The data are of course based on averages, since various surgeons reach different agreements with the HMOs and have previously charged different rates for surgery.

The surgeons moved to closed lists-and the self-participation in surgery fell

The purpose of the move was twofold: first, reducing the public's expenditure on surgery by reducing the amount