Waking Up!

I just got back from an amazing/inspiring/motivating yom iyun, focusing on the accessibility of patient rights. There were presentations from doctors, professors, administrators, social workers and government officials, all surrounding this urgent objective. 

A few important points:

Everybody knows the challenge

Only within the past few years the concept of bridging the awareness gap between patients and the help and support that they are entitled to has gained a life of its own. There are now several organizations dedicated to finding and implementing solutions, and many more institutions collaborating on these initiatives.

Personally, I’m amazed at how an idea can suddenly be “in the air”, with so many people recognizing it on their own and tackling it from different directions. At the same time that I was first formulating my concept and approach to English accessibility, the Hadassah social work department was just launching their Kivunim  information center, Amitai Korn was conceiving Kol Zchut, Bituach Leumi was revamping their website, and many more institutions were waking up!

English is a slice of the (humble) pie

Israel has much to be proud of in its institutions of public support and protection. Universal healthcare, the social safety net, and the protection of patient rights are all enshrined in law and continually maintained and improved upon. But (!), Israelis of all stripes are missing out on some or all of these entitlements. The statistics on uptake of the support programs that are in place (from Bituach Leumi and elsewhere) for all of the relevant populations are dismal.

Still, certain populations are particularly weak, foremost- immigrants. Yes, English speakers in Israel are immigrants, sharing all the challenges of integration encountered by the Russians, French, Ethiopians, etc. with a few unique hurdles of our own. Something must be done to bolster the awareness and acquisition of entitlements among immigrant communities and every participant in today’s yom iyun agrees. The Shira Pransky Project is making sure that the English speaking community specifically is recognized and addressed.

So what is being done right now?

The general director of the Misrad Habriut issued a directive to all medical service institutions in February 2011 that they must reach a certain standard of “cultural competence”. The gist- all information and services must be accessible in Hebrew, Russian, Arabic and… English! Many people and organizations, including The Shira Pransky Project, are working hard to push this objective and assist institutions scrambling to fulfill it (more about that in a moment).

Government institutions are upgrading and updating their websites, opening information centers, and even co-opting social media to inform the public, respond to inquiries and give directions. (We have direct assurance from Gov.il that they respond to English questions on facebook and twitter.)

Kol Zchut, Kivunim and other organizations, are all constantly promoting information and awareness via their programs. The Shira Pransky Project is working directly with these organizations and others to assist them in English accessibility with translations, recruiting bi-lingual volunteers, and more.

The Shira Pransky Project is also constantly engaging more organizations to advocate for the assistance non-profits to adopt, and maybe even lead the way, in meeting the Health Ministry’s standards for cultural competence, and  our website is in a constant state of evolution to better simplify and present useful information

So what can you do right now?

  1. Get Familiar

    Get to know your rights, entitlements, and avenues for information and support. You can start with our website, but also visit your Kupat Cholim’s English site, and the various English Government sites. Read your Kupat Cholim’s English brochure(s). Read the other English publications out there. Save yourself the pain and frustration of navigating the system, or worse- missed opportunity, by understanding the system you belong to right now.
  2. Speak Up!

    Your Kupat Cholim has an ombudsman’s office, and the Health ministry has an ombudsman’s office, dedicated to receiving complaints and protecting your rights. These professionals need to hear your issues about compromised service in English (or any other issues) in order to address them, and to emphasize the importance of English accessibility in their institutions. The public ombudsman from the Health Ministry spoke today specifically about how even a single complaint about an issue can help them raise flags and result in huge reforms! 

    Also, the public advocacy organization Emun Hatzibur has specifically called for complaints relating to language barriers in health service institutions. They will fight for you to address any imminent situation, and they will use your issue to bolster the Health Ministry’s directive on cultural competence. They can be contacted directly, or you can email these specific complaints to The Shira Pransky Project to be passed on to them.

  3. Unite!

    I’ve held back considerably from launching into a diatribe on the need for English speakers in Israel to come together as a community, especially over important issues. We want institutions to recognize and address the specific needs of our community, but we must also recognize ourselves as such. Whether you have been here for years or weeks you are walking in the shoes of all those ancestors that passed through Ellis Island, and all those other ports around the world, for generations. Yes, this time at least we are immigrants to our own homeland (ironically enough), but here once again, we need the support of our fellows in order to integrate and make it in our (please God) final destination.
  4. Get Involved!

    The Shira Pransky Project recruits bi-lingual volunteers to directly assist health and support organizations in English accessibility and for specific projects. We could also use some help ourselves. Of course, our efforts require financial support, so please donate to support English accessibility. And spread the word.


You read the whole thing! I guess you agree that this is important stuff, so please share it with others, and leave a comment!


Where to Turn: Social Workers


When you are struggling to navigate the system, just remember that Israel’s medical social workers serve the number one guidance function in the healthcare system here.


Have you ever had a sit-down meeting with your Kupat Cholim social worker? Hospital social worker? Medical social workers are trained assistance professionals there to offer guidance when you need it. What kind of guidance?

  • Information about rights and services that relate specifically to a person’s circumstances, and practical guidance on acquiring them.
  • Practical insight, and some hand holding, on navigating the medical system, whether it be within the Kupat Cholim network,  in the hospital, or where the two overlap.
  • More practical insight and assistance with other bureaucratic institutions, like Bituach Leumi.
  • Help finding and connecting with organizations dedicated to particular conditions, where there may be even more resources of specific interest to you.
  • Help with emotional coping in difficult situations.


When to see a social worker

Make an appointment when you …

Feel like you’ve hit a brick wall. You’re trying to get a particular service from the Kupah and it’s not working out well. A decision was made and you need help appealing it.

Have an ongoing medical issue. There may be medical or social services you are unaware of, or specific organizations or government programs specifically dedicated to your circumstances.


Make sure the interaction is productive

A Few Tips:

  • Schedule a sit-down meeting and make sure there is enough time blocked out to discuss what you need.
  • Delegate tasks to accomplish your goals. Note the things you need to do (e.g. call this office, obtain these documents, etc.) and the things the social worker is committing to doing (e.g. calling that office, finding out about that service, getting ahold of those forms, etc.).
  • Schedule the next contact. e.g. The social worker will call you in two days with some more information on something, or you will meet again in a week to fill out forms together, etc.
  • Show your appreciation. Everyone in the healthcare sector chose to go into a profession dedicated to helping others. The social workers especially, did not do it for the glamour.


Okay, it’s not always peachy

Plenty of people have met with a social worker without productive results, or perhaps even had an unpleasant experience (I’m treading lightly here), but the thing is, guidance is a necessity in many circumstances. It shouldn’t be an option to resign oneself to fumbling around in the dark because the first match was a little soggy. Just like finding the right doctor, you can’t give up until you’ve found the social worker that you can communicate with and find the guidance you need. So just look for…


More Options

The first interaction with the kupah or hospital social worker may not have satisfied,  so try:

  • Another kupah or hospital social worker. Speak to a branch or department secretary and ask how you can arrange a meeting with another social worker, perhaps with better English…
  • Hadassah Kivunim. This is an admirable initiative in Hadassah Hospital, Ein Karem, where anyone, not just Hadassah patients, can access trained personnel for assessment of needs, assistance filling out forms and advice regarding benefits and services. Visit their offices, call 02-6777011 or email kivunim@hadassah.org.il.
  • The Shira Pransky Project has absolutely no pretensions of actually performing the functions of medical social workers, but we will try to help you find one if you’re having some trouble. Send us an email.


And remember

There are times when guidance in healthcare is absolutely necessary, and the medical social workers of Israel are at your service.


5 Things To Know About Your Kupat Cholim


Leumit Logo


1. Your Branch Secretary is the Center of the Universe

If you need anything the Kupat Cholim offers and you want to know how to get it, ask the branch secretary. In practically every publication from the Kupah you are told to contact your local branch for clarifications about rights, permissions, required documents, payment authorizations, etc.
There are surrogates, of course. While away from home you can call the closest branch, and you can always call the Kupah’s 24 hour number. You can even directly access most of the information you need straight from the Directory of Services (Madrich Sherutim) or online. But really, learning the local secretary’s name and establishing some sort of rapport might be the most valuable investment in your wellbeing that you could make.
Also, remember you can just call to ask questions, or fax to transfer documents. You may get a small charge if the Kupah has to fax some document to or for you, but the hours saved in making the trip are probably worth it.

Finally, it’s usually not worth it to ‘sort of get’ crucial information, so if you need to, speak English. Most professionals know it, or can pass you on to someone who does. Besides, you’re about to learn the most essential vocabulary-

2. Two Words: Hafnaya and Hitchayvut


Always ask if you need either or both of these to get the service you need.

A Hafnaya (הפנייה) is a referral to a specialist or other medical  services, sometimes necessary for internal Kupah services, and very often necessary for services from other institutions.

A Hitchayvut (התחייבות) is a payment voucher from the Kupah, usually necessary for services, including tests and hospitalization, from other institutions. This payment voucher is also referred to as Form 17 (“Tofes Shva Esrei”), or a letter of financial obligation (“Tofes Hitchayvut”).  Click here to learn more about this important concept from a page we translated as part of our collaboration with Kol-Zchut.

3. Your Primary Doctor is the Center of your Galaxy


Your primary doctor is the Kupah’s point man for your physical wellbeing. He/she should be the fount from which flows all (or most) referrals, prescriptions, and communiqués.

Got a prescription from a private specialist? Ask your doctor to reissue it as a Kupah prescription. Looking for lab results from blood work? They get sent to your doctor. Need to see a physical therapist? Ask for a referral from your doctor,  etc.

It’s true that you can find your own specialists and services in the Directory of Services, and many will not require a referral. Perhaps you don’t need to check with your primary care physician every time you want to see a dermatologist, but it’s important to keep in mind the Kupah’s point-man perspective when deciding a course of action.

You might even want to consider adopting the philosophy yourself. In many health related situations it’s important to have a professional to rely on with an eye on the big picture.

Not sure if the doctor you’ve got actually fits the bill for your ideal point-man? The Kupah won’t fuss if you change doctors after one calendar quarter. If you need a more immediate change, consult the branch secretary for advice.

Finally, keep in mind that if your doctor is not available, or you just want to see someone else for some reason, there are other options-

4. Round the Clock Service

Any time you’re in need when the Kupah is closed, or the timing is simply inconvenient, call the Kupah’s 24 hour number to check if the service can be sent to your door, or  where the closest emergency medical center is that you can walk into any time.

Despite the operating hours of local branches, the Kupot have admirably committed themselves to round the clock basic medical services like diagnosis and prescriptions, and sometimes even lab tests and imaging.
The Kupah has arrangements with emergency medical centers, like Terem, as well as house-call services, though the services offered by these institutions will vary, as well as the expected co-payment.

It’s worthwhile to know the capabilities of the closest emergency medical center for times when your need is not just a matter of convenience. In certain urgent situations you should go straight to the hospital or call an ambulance. Click here for information about coverage of ambulance costs from a page we translated as part of our collaboration with Kol-Zchut.

5. Knowing Your Insurance Plan is Totally Worth it

In the USA  “good health insurance” is so elusive (read: expensive) and coveted it’s almost mythical. Here it’s really quite cheap.

By law, the Kupot cover doctor visits, diagnostic and laboratory services, some paramedical services, medical equipment, rehabilitation, hospitalizations and many prescription medications. Still, what’s left out, and how these services are provided can sometimes feel restrictive.

Supplementary Insurance (Bituach Mashlim) plans cost an extra monthly membership fee but offer a much wider selection of medications, more opportunity for using private doctors and specialists, and more options and benefits in general. If you already have it, review your additional benefits, and remember to check with the Kupah before paying for any medical service out of pocket.

If you don’t already have a supplementary insurance plan but want to join, do it immediately. There may be a waiting period before all the extra benefits kick in, though the Kupah must accept you to their supplementary health insurance plans regardless of age or medical history. Different benefits also may have different waiting (qualification) periods. Click here for more information about supplementary health insurance on a page we translated as part of our collaboration with Kol-Zchut.

Bonus: Long term care insurance may also be worth it, though it’s a different beast all together. Worthy of a separate post found here.


Tackling the Bureaucracy, Part 1: The Power Hour

Here are some tips on facing those times when you have questions to answer, people to reach, appointments to make, etc. and tackling the bureaucracy out there will take a special brand of cold determination. This game plan is geared towards situations when phone calls need to be made, but you can modify the principles to your situation.

The Power Hour

Dedicate a focused session to accomplishing your goal where your state of mind is: I am not going to be distracted until I get ‘er done! It doesn’t really have to be an hour, but it’s a different concept from setting aside a productivity day, or just saying, “I work on it a little every day”.



A power hour deserves its own list of steps to accomplish your goal. Actually, each power hour often deserves three lists, or a list with three columns:

  • Actions (e.g. numbers to call)
  • Results (e.g. answers to questions)
  • Follow-up tasks (e.g. fax documents)

Make sure you have a pen so you can check things off along the way, make notes, and adjust the list. You may call one phone number just to be given three more to call. You’ve dedicated the time, so just go through the steps methodically. Then again, don’t be afraid to…


Start Over


If you are making your way through your list and you start to get the impression that you’ve made a wrong turn, or you didn’t really understand what you were supposed to do from the beginning, or something you found out along the way modified your goal slightly, go back a few steps, or even to the beginning. Even if you call the same number you called twenty minutes ago and ask the same questions, you are now better equipped to ask more and/or understand the answers better.


Keep your Eye on the Prize


Ok, the frustration is already starting to creep in. You’ve gone down too many blind alleys and hit too many brick walls, and maybe somebody was even really rude. Keep your game face on. The Power Hour is only for focused determination and nothing else is going to slow you down. Save the frustration for another time. (See Bonus below)


Don’t Assume Anything


Nothing beats the frustration of, “I was never told…” So head ‘em off at the pass and ask as many questions as possible about your situation.


Try to Walk Away with Something Tangible


If you made the appointment, great! Got a question answered, awesome! You have a full follow up task list? Do whatever can be done right away (like send off that fax) and then give yourself a treat.


Congratulations! You made it through the Power Hour.


Bonus: 2 Tips for Sanity!



Dedicate Frustration Space


It’s not going to help you in the midst of a productive session, but you can’t just bottle it up either- that’s not healthy. You can save the groan/yell/diatribe/whatever, for later as long as you know where your outlet is, be it a (willing) friend/spouse/relative’s ear, a journal, a blog or anything else. (Just make sure you’re getting the frustration out so you can move on, and not amplifying it until you won’t be able to face it again.)


Have a Spotter

It may not always be possible, but sometimes just sitting next to someone who’s there to give you support in achieving your goal can give you the strength to make it through. Give them a job, like crossing items off the list or writing down numbers.


Stay tuned for Part 2: Attitude


And don’t forget to leave your own constructive tips on facing bureaucracy and getting things done in the comments!