Data published on Monday, 24 Cheshvan, reveals that Clalit HMO customarily fines clinics whose doctors provided patients, at their professional discretion, with a prescription for an expensive drug, Kikar Shabbos News reports.
According to the exposure of ‘Yisrael Hayom, at the same time the fund is ‘invigorating’ clinics where doctors have registered a cheap drug for sick insureds, by accepting a cash prize.
This is an unprecedented directive of the Clalit HMO, which is applied to diabetics, with the aim of providing clinics in the various districts with Bio Similar medicines, which are ten times cheaper than the relatively expensive source.
Last month, Dr. Nikki Lieberman, head of the community medicine department, announced that the districts in the fund providing the cheap drug will receive a financial incentive of up to NIS 5,000 for each new diabetic patient who will receive treatment with a biochemical drug (BASAGLAR) instead of insulin therapy called LANTUS.
In the official circular, Clalit is trying to calm the doctors and clinic managers, noting: “The incentive model is an additional one, when the prize is expected to exceed the fines.” According to them, the source of the money derives from the internal efficiency budget, as well as the savings provided by Siegler compared to the Lantos drug.
They also emphasize that there is no direct contact between the physician and the money, which is transferred to the district administration and is intended to serve the needs of all patients, especially that the drug recommended by them “is a qualitative alternative at a significantly lower price.”
Health organizations appealed to Health Minister of Health Yaakov Litzman, following this new directive that infuriated them. According to the Association for the Rights of the Patient, “Neeman – for stroke victims”, the Association of Psoriasis, the “Lenshom NGO” and the “Young Arthritis” Association, “activating monetary incentives may harm the doctor’s discretion when making medical decisions. In the autonomy of the physician in making a medical decision to choose the right treatment for the patient, while applying economic and non-medical incentives, which may cause injury to patients.”
Professor Itamar Raz, chairman of the National Diabetes Council, also said: “I am not at peace with this move. In my opinion, the aspect that says that if you start with a certain medication will be rewarded, and if the prize continues to increase, if you stop giving the medicine, you will receive a fine. I turned to Dr. Nikki Lieberman and asked him to reconsider some of the things because it seemed too extreme.”
According to him, “After three months of treatment, if the patient is unbalanced and the need to move to higher insulin is likely to be a situation where a doctor will not transfer the patient to another treatment, the doctor will be afraid of a fine or fear that he will not receive a reward and this may affect his therapeutic consideration. That the patient will receive the treatment he needs and if the doctor feels that the treatment does not help and that there is a need to replace the treatment of fines and prizes should not be involved.”
The Health Ministry said in response to the report released by Ran Resnick: “The issue is under examination by the ministry, and the point of departure is that when registering a medication for the insured, there is no room for a physician to act according to monetary fines / prize incentives that can distort the judgment regarding what is best for the patient”.
Clalit Health Services’ response to the announcement: “The drug was approved and registered by the Ministry of Health after its quality and effectiveness were examined and we are following the instructions of the Ministry of Health in order to provide optimal treatment for patients with new drugs available in the market.
“This is an internal budgeting system that is transferred to the district administration in order to improve service to patients, and does not concern doctors.”