Dep’t head: Child dental care effort is lacking

Litzman's program "underused," faulted for lack of objective assessment; experts question planned expansion to age 18 in current form.

By
November 7, 2011 01:53
Jonathan Mann

Jonathan Mann_311. (photo credit: Courtesy)

Although Deputy Health Minister Ya’acov Litzman regularly boasts about the “success” of his NIS 235 million-a-year dental program for children, senior dental experts charge that only 15 percent to 20% have taken advantage of it and those in charge refuse to allow an independent, objective assessment of it.

Since the program – which offers free or subsidized basic dental care to children from birth through age 10 – began in the summer of 2010, 145,000 children have been examined or treated.

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Prof. Jonathan Mann, former dean of the Hebrew University- Hadassah School of Dental Medicine and currently head of its community dental medicine department, told The Jerusalem Post on Sunday that much is at stake, as Litzman aims at expanding the program to all youths up to the age of 18.

Mann also presented questions about the “dental reform program” at a conference organized last Thursday by PEF-Israel Endowment Funds, which funds seven dental clinics for poor children and elderly around the country, including three run by Jerusalem’s Casper-Plitnick Center.

Less than two years ago, Litzman induced the public committee for expanding the basket of medical technologies to hand over NIS 65m. to cover part of his child dental care program instead of for new lifesaving medications for the patients who need them. Since then, additional public funding has been allocated to cover the costs, but the expansion of the health basket in 2010 remains only NIS 300m.

The haredi press, representing Litzman’s constituency, frequently praises the deputy minister, a Gur hassid from United Torah Judaism, for “creating a new era of dental care” for children. As haredim have large families that often lack dental care, it has proven to be a popular program among them, and he himself mentions it often.

Mann said that while it was “good that kids get dental care,” 80% of eligible children have not been taken by their parents to the dental clinics that belong to for-profit subsidiaries of the four public health funds, or to for-profit clinics outsourced by them.

As only a tiny number of infants and toddlers from birth through age three are taken for their first examination under the program, those who have benefited from it are aged four to 10.

A first examination is free; to undergo basic treatment, parents pay NIS 20 per visit per child.

The ministry has only 4.5 manpower slots to monitor the program’s implementation around the country – and only 1.5 job slots are filled by pediatric dental specialists. When the School of Dental Medicine presented requests to the health funds to carry out transparent research on the program, they were turned down, Mann stated, because the health funds did not agree.

“Inspectors can examine medical equipment, check sterilization equipment and see whether the sinks in the clinics are clean, but it is impossible for such a small number of dental inspectors to look into the mouths and the files of children to see if they received the proper care,” Mann declared. “There is something wrong with this. I don’t like it,” he told the Post.

“The satisfaction of parents and the dentists also has to be investigated in an objective way before it is decided to expand the program,” stressed Mann. “Are the dental hygienists being used properly and adequately to teach prevention? “Did those parents who have not used the service decline because they don’t trust the health funds to supply a high level of service? Have too many children been given general anesthesia? As the program includes only the health funds, have private dental clinics been hurt?” Mann added that the health funds – Clalit, Maccabi, Meuhedet and Leumit – have been allocated NIS 166 per year for every child member from birth through 10 years even though the vast majority have not gone for examinations and treatments.

“There is a conflict of interest between the health funds, which naturally want to get the money and save, and the dentists in the field, who are paid per treatment and not per hour and want to earn a good income from treating the children,” the former head of one of the country’s two dental schools said. Only a minority of the health fundaffiliated dentists are pediatric specialists, he added.

The dental school in Jerusalem applied to the Israel National Center for Health Policy Research, which is funded by health taxes from the public, for grants so it could perform an objective, academic and transparent ven though the vast majority have not gone for examinations and treatments.

“There is a conflict of interest between the health funds, which naturally want to get the money and save, and the dentists in the field, who are paid per treatment and not per hour and want />
As prevention of dental disease from a very young age is better and more economical than treating it, said Mann, the program should have set up dental education programs for parents and small children.

But the ministry included prevention only from age five in mandatory kindergartens and in the lower grades of schools with no instruction of parents.

“It is nice that free and subsidized care is available to children, but before that, 80% of the population who paid their health fund for supplementary insurance enjoyed free dental care for children, some up to age 18,” Mann said.

“Now, the health funds get paid for treatment they had provided free to those holding the policies. One has to study which program is more effective,” he added. “The health funds benefited by offering benefits that induced families to join as members.”

The former dental school dean said he would be happy to join in the research as a volunteer, and that he has a dozen dentists – both senior and younger researchers – who are eager to investigate whether Litzman’s initiative is really successful or not.

“Forecasts predict that there will be a shortage of dentists in 2020, so whether there will be enough professional manpower to implement the program also has to be investigated.

From the outset, there should have been a supreme independent body in charge of the project to supervise and accept complaints, but the ministry rejected it,” Mann said at the conference in the capital’s Leonardo Plaza Hotel.

Asked to comment, Health Ministry chief of dental medicine Dr. Shlomo Zusman said that his office supervises the program and that “it is excellent and growing. I am not an expert in employment relations, so I can’t comment on payment per hour or per treatment.”

As for the health funds being paid for all relevant children even though 80% do not benefit, he said that “this is the same capitation system used to pay the health fund for regular medical services. All children are eligible.”

Zusman conceded, however, that dental education programs should be available from infancy and for parents to teach children proper oral health.

Moshe Kahan, director of the Casper-Plitnick charitable dental clinics for children for 27 years, said at the conference it was unfortunate that the ministry did not choose voluntary clinics around the country to provide pediatric dental care under the program.

“We are glad that some children are getting care, but we pay our dentists by the hour and not per treatment, which means they are not induced to overtreat. Those working for the health funds get a fixed percentage of money received by the insurer.

“We are experts in pediatric dentistry. We put an emphasis on inviting children to a friendly visit, not when a tooth hurts, so they are relaxed. Hygienists teach them how to care for their mouths, and kids get a ‘certificate of excellence’ and a photo of them holding it. This creates a positive experience.”

Rami Edut, chairman of the Association for Civil Rights’ coalition for dental care, worried that if only a minority of middle-class parents sent their children for care through the health funds, and most “have no stake in it, they eventually would oppose paying taxes to cover it for poor children. Quality is the biggest problem.”

The director of the PEF clinic in Bat Yam, Ettie Halevy, said dental hygienists must have more of a role in Litzman’s program.

“There are many large families that can’t afford NIS 20 per child per visit. Many have dropped out. And what happens when they become older than 10? Children need continuity of care; they get attached to the dentist who has treated them,” Halevy said.


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