(These problems have been recorded in the patients’ own words – we have not edited them)

The Ministry of Health

• Mobility – The list of handicaps for determining a person’s eligibility for the mobility pension – and its rate of payment – is a closed list; multiple sclerosis is not one of the impairments on the list. In many cases, an MS patient is rejected by a medical committee on grounds that his medical condition is not included in the list of impairments – there is no doubt that this is absurd; there is no doubt that MS patients are very limited in their mobility.
• Physiotherapy treatments – Patients should not be limited to 12 treatments, these should be an integral part of the “maintenance” of the patient. It is clear to everyone involved that such treatments improve and strengthen the patient so that there will no further degeneration and his or her condition will be contained.
• Permission to use medicinal cannabis – In the case of MS patients who experience recurrent attacks and where the status of the disease is variable and worsening, why does the Ministry of Health raise difficulties for those applying for permission to use medicinal cannabis and in setting its dosages?
  It is known that cannabis is approved only for someone who has tried all medication treatments and that this (the cannabis) is the only one proven to help.
  The inclusion of drugs in the health basket – Drugs such as Sativex, which is a replacement for marijuana (without the “trip” and without smoking), should be in the medical basket and this after more than four years in which the health basket committee has been rejecting its inclusion.
• Assistance devices – Approval of assistance devices that are tailored to the patient and not to the budget of the Ministry of Health, which is low and does not reflect realistic costs.
  – Motorized wheelchairs
  – Bath wheelchairs
  – A decrease in the level of participation even though there is deterioration in a patient’s condition.(Example: We were surprised by the decrease in the level of participation relative to the chair we bought previously. They explained to us that the reason for this was the deterioration in my wife’s condition.
  This, in my opinion, is reverse logic that needs to be corrected. The need for a chair has not changed, even if additional help is needed from our caregiver from the Philippines.
• Medical tests – To allow MS sufferers to undergo the required medical examinations and to receive the required treatment immediately upon arrival at the MS clinics and MRI institutes, without the need to go through the long and exhausting bureaucratic procedures of the health funds (HMOs), which are anyway not equal and not logical (a certain HMO gives approvals for all the treatments, whereas with another HMO the patient has to go through hell and even then may not receive approval).
• The Health Basket – Placing all the tests required by senior neurologists from MS clinics into the health basket so that patients who survive on low benefits will not be forced to pay the cost of tests out of their own pockets.
• The HMOs – Health funds make things difficult, give patients the runaround, and cause indescribable injustice; they refuse to provide treatments or drugs prescribed by a senior neurologist. They reject requests for cost commitment forms, and a long list of other complaints.HMOs try in every possible way to save and not give patients the range of treatments available for them in the basket.
• Work and earning – The ability to work and earn a decent living without reduction in the disability pension or, as occurs today, under the Laron Law, converting it into an incentive pension that reduces over time.IDF disabled veterans who work receive a higher disability pension than those who do not work – this is because the army came to realize that going out to work is beneficial to the person and they therefore encourage it, while National Insurance keeps the disability pension recipient at home.

National Insurance

• Mobility – The list of handicaps for determining a person’s eligibility for the mobility pension – and its rate – is a closed list; multiple sclerosis is not on the list. In many cases, an MS patient is rejected by a medical committee on grounds that his medical condition is not included in the list of handicaps – there is no doubt that this is absurd; there is no doubt that MS patients are very limited in their mobility.
• Special services – A few months ago, the regulations at the National Insurance Institute were updated, as were the tests for determining a person’s eligibility for special services. A test called IADL was added, which apparently assesses the degree to which a person needs the help of another to run the household: the test examines whether the person is capable of making a shopping list, able to operate electrical appliances, and manage his affairs with the authorities. As part of this reform, the method of scoring was changed for determining the rate of eligibility and the lone exception test was abolished.Under the new system, many MS sufferers are being hit and are not being awarded eligibility at a level of 105%, which in turn impacts on their eligibility for a mobility pension. This is due to the fact that when the pension for special services is set at a rate of only 50%, the patient has to choose between a special services pension and a mobility pension. When eligibility for a special services pension is set at 105%, there is no need to choose.In conclusion: the new scoring method and the elimination of “the lone exception” test does not represent the difficulties that MS patients suffer in an appropriate and fair way. (Even a person who drinks through a straw is considered capable of drinking independently…).
• Exemption from standing in a line – National Insurance has issued disability certificates containing an exemption from standing in queues; the most absurd thing of all is that MS patients, despite their difficulties in standing for an extended period of time, and in spite of their lack of stability and their tendency to fall, are not entitled to a disability certificate with a queuing exemption because MS is not included in the list of diseases.
• Multiple sclerosis is not a recognized disease – Only certain symptoms related to disability and mobility are, whereas other diseases have a section of their own.
• Disability Pension – The disability pension is set at a level of NIS 2,434 and the supplement for two children is 20%. If the family has three children or more, they do not receive any supplement to the pension.It’s important to emphasize that the patients add about NIS 450 for medications.Medicinal cannabis is NIS 350 per month.92% of the patients use diapers, which cost about NIS 500 per month.
• Special Services Pension – The maximum is NIS 4,735MS patients are considered the employer of the foreign worker.The foreign worker is subject to the same law as any other worker in the country and works six days per week.The salary is composed of 12 days of paid holiday + 9 festival days + recuperation pay + provision for a pension fund, totaling a monthly cost of a minimum of NIS 6,000.Additionally, an MS patient has to employ another worker on Sundays at extra cost.
• Mobility Pension – The mobility pension is divided into a pension for a disabled person who drives his own vehicle and a person who is incapable of driving and needs the assistance of, for example, a member of the family or a foreign worker to drive his vehicle.

o When the patient himself drives, he has a full exemption from taxes when replacing the vehicle.

o When the patient has a foreign worker or a family member who drives the vehicle, he must pay 25% of the taxes when replacing the vehicle.

o It is clear that this is an illogical law as a person that can’t drive is in a very serious condition and sometimes totally confined and unable to move his limbs. He or she must have the assistance of a driver otherwise they will be a prisoner in their home forever. The law punishes a person who is seriously disabled.

• Disability/Old Age Pension – When a person reaches pension age, his disability pension turns into an old age pension.

o Not only is his disability pension a meager one, he now receives the old age pension and his disability pension is denied him or vice versa.

o A disabled person who reaches retirement age becomes an old person and not a disabled one.

• Raising the minimum wage – As the minimum wage increased, so too the wages of the foreign workers have risen by around NIS 350 per month.

o National Insurance promised to transfer employers an amount of up to NIS 280 per month in accordance with their disability level.

o The increase has been reflected in wages as of May 2015 and until today National Insurance has not transferred the supplements.
Treatment of MS sufferers by the different entities at the National Insurance (NI)

o The patients are required to come to the NI offices again and again without consideration of their condition.

o Humiliation during committee assessments.

o In the committees, they treat the patients like phonies – after all there is no treatment for MS.

o Patients in wheelchairs are awarded temporary disability status – has the committee found a cure for a person confined to a wheelchair?

o Humiliating personal questions; a lack of respect. Questions such as: Can you turn on a tap? Can you drink with a straw? These questions and similar ones are used to determine whether a person is capable of taking care of himself and his percentage of disability may be reduced.

• Studies and work – Building a special program of studies and integration into the workforce or in studies appropriate to the patient’s level of education and condition.
• Employment and earning – The ability to work and earn a decent living without a reduction in the disability pension or, as occurs today, under the Laron Law, converting it into an incentive pension that reduces over time.IDF disabled veterans who work receive a higher disability pension than those who do not work – this is because the army came to realize that going out to work is beneficial to the person and they therefore encourage it, while the NI keeps the disability pension recipient at home.

Ministry of Social Services

• The Rehabilitation Division of the Ministry of Social Services must provide services to the entire target population under its remit, including multiple sclerosis patients. It is also tasked with developing new services for these populations. The Rehabilitation Division has received more than 50 letters during the past 12 years requesting cooperation with representatives of The Israel Multiple Sclerosis Society and with patients to find out which services it provides, and how MS patients can be assisted by the Division – to this day we have not succeeded in holding such a meeting in light of the fact that the Rehabilitation Division ignores MS patients.
• The Rehabilitation Division Fund for severely disabled people in the community
  This fund awards allowances in an amount of NIS 1,600, paid by statute to severely disabled people from the age of three to pension age, who are alone without family in the community.

o Most social workers are unaware of this fund because the Rehabilitation Division has not informed anyone of its existence.

o This allowance is stopped when a disabled person reaches pension age – he has stopped being alone and stopped being disabled.

Ministry of Housing

• Assistance in renting an apartment on the ground floor for disabled people who are reliant on the assistance of a walker or wheelchair.
• Assistance in adaptation of the apartment.
• There are large numbers of severely disabled people who do not receive priority treatment, despite the many difficulties with which they have to cope.

o People with special needs who live in buildings with stairs.

o The Ministry of Housing must increase the supply of ground floor apartments for handicapped people.

o It should not happen that people with high levels of disability resulting from diseases such as multiple sclerosis, where the expectation is that they will worsen, should have to deal with the question of accommodation over lengthy periods of many years and remain imprisoned in their homes during the waiting period.

o It is very important that the Ministry of Housing appoint a committee to legislate that diseases that have a tendency to exacerbate, should have mitigating conditions and receive adapted housing before deterioration in health.

• The interaction of MS patients with the Ministry of Housing.

o As of the beginning of the application and up to its approval two to five years can often go by.

o The Ministry of Housing sends a letter in which it gives the entitled person two options, almost all of which are unsuitable for the person concerned – 1st floor with stairs, an apartment that is too small to allow a foreign worker or a member of the family to live with the patient.

o The entitlement ends after a year and it does not matter that the offered apartments were unsuitable. The patient then has to again submit a new application and start the whole process all over again.

o After handling dozens of such cases, it is absolutely clear that the entitlement letters are being sent not out of a duty of care or a genuine desire to solve the problems and to provide suitable accommodation to those entitled to it, but simply to fulfill the mandatory ‘exit’ in a manner that is quite meaningless.