Bankruptcy: monetary and moral
The newly imposed government dental program is having a tremendous effect on many private practices.
Child at the dentist Photo: Thinkstock
I am a self-employed dentist. After two years of being discriminated against by the Health Ministry, I am bankrupt. Since June 2010, I have been prevented from treating my youngest patients by the policy set up by the ministry whereby free dental treatment was provided to children only via the health funds.
In June 2010, the program covered children up to age eight. During July 2011 it was extended to age 10 and in July 2012 it was raised to age 12. Previously all dental treatment in the country was private. No government money paid for or subsidized any dental treatment, either by self-employed dentists or by health fund dental clinics. There was competition among the various health funds, and between the funds and private dentists.
Not that this competition was fair.
The funds were advertising their dental services for years before private dentists were allowed to advertise. Also, the funds have been subsidizing discounts from premiums collected for their complementary health insurance programs, giving them a market advantage over the self-employed dentists.
But there was competition.
That is, until the ministry set up the free dentistry for children program, thereby eliminating free competition between the funds and private dentists, at least with regard to those patients in the age group covered by the program.
This affected my practice, and as the coverage age was raised, it affected it more. Basically, the ministry took a percentage of my patients and redirected them to the health fund clinics.
Thus my economic situation.
At the beginning of this process, the ministry and the Israel Dental Association (IDA) announced that a Dental Health Fund would be set up that would compete with the existing health funds. All private dentists would be able to sign up it if they wished, and they could then provide treatment to children via the free dentistry for children program.
Prior to the implementation of the program in June 2010, the IDA requested that the program be delayed until the establishment of the DHF. Deputy Health Minister Rabbi Ya’acov Litzman refused, claiming that the children were too important, and that the private dentists would be able to participate soon enough. The private dentists were led to believe that the delay in the establishment of the DHF would be a matter of a few months.
As time passed, and my debts started to grow (due to a monthly earning deficit caused by the disappearance of my young patients), I started to inquire as to what was going on. I was in weekly contact with the IDA, and they kept changing the information they released. At times they said it was a matter of another month or two and at other times they said they had no information.
ABOUT A year ago I wrote a letter to Dr. Shlomo Zusman, the head of dentistry at the ministry. In my letter I complained that the ministry’s policy was unfair and that it was ruining me.
This letter was answered by a subordinate who stated that while she was sorry I felt the ministry was harming me, a private dental clinic is a business venture, and as in any business venture, success is not guaranteed. I always had the option of moving to another area or of closing my clinic and working for one of the health funds, she wrote.
I was upset by this answer, and after much haggling with secretaries managed to get Dr. Zusman on the phone.
Dr. Zusman claimed to be sympathetic to my situation, however he refused to take any responsibility for the situation and the only advice he had was to sign up with one of the health funds as an out-source clinic. When I argued that the funds were not interested in signing dentists in this way, he quoted statistics regarding other clinics that had done so. However, this claim of the Health Ministry is very misleading.
Here’s why: When the program was being implemented, three of the funds had a small problem and one, Leumit, had a very big problem. Leumit had never opened any dental clinics of its own, and the other three had their clinics in the larger cities and towns, but not in peripheral areas or in the Arab sector. Now they were being held responsible for providing dental treatment in those areas.
So, instead of opening clinics at great cost, they rushed to sign agreements with private dentists in the areas they needed coverage in. Most of these clinics are in the Arab sector, and in the case of Leumit, they are all over the country. Once they had their minimal coverage taken care of, all of the funds stopped signing private dentists, and none are signing up any more today.
A few months before my talk with Dr. Zusman I had applied to Leumit and they rejected my application, saying they did not want competition with their clinic in the area.
When I made this argument to Dr. Zusman, he claimed to have been unaware of this phenomenon and said that he would “look into it.”
I then wrote a letter to Rabbi Litzman in which I raised the same complaints, adding that I was now approaching bankruptcy because of his policies. In his reply, he wrote that there were two sides to every coin, and pointed to how much good the program was doing. In the future, private dentists would be able to participate with the establishment of the DHF, he wrote, and in the meantime I could work for one of the health funds.
As Rabbi Litzman had apparently completely ignored most of what I wrote in my letter, I wrote to him again. I also tried, many times, to speak to him on the phone. His office stonewalled, however, and when I asked for a response to my second letter, they said the response to the first was all I would get.
I then wrote a letter to the prime minister and to every MK, with a copy to The Jerusalem Post. Same basic content.
I was going to lose everything I have because of this situation. A few days later I received a phone call from the office of Health Ministry Director- General Ronni Gamzu. They invited me to a meeting with Professor Gamzu.
At this meeting, Gamzu basically told me there was nothing he could do. He said he had no information as to when the DHF would be set up. He said the law allowed for the establishment of the DHF, but did not require the Health Ministry to set it up. And as of that time, no organization had come forward meeting the requirements established by the ministry to do so. The organization put forward by the IDA was repeatedly rejected by the ministry for being underfunded.
THIS BRINGS us to the crux of the matter.
Health Ministry people wrote the amendment to the Health Law that allowed for the establishment of the DHF. The wording of the law did not obligate the ministry to set it up, but only allowed for “someone” to do so.
However, the ministry also decided to make major changes in the dental health market. These changes had consequences, and many dentists were severely hurt. The solution to this state of affairs was to have been the DHF, but the ministry refused to take responsibility for setting it up, and blocked the IDA-sponsored applicant.
In the meantime, over two years have passed, and many dentists, myself included, have been financially ruined.
The ministry created a problem, has refused to acknowledge it and has refused to take responsibility for fixing it. In addition, it has been actively blocking attempts to rectify the situation.
This is morally reprehensible.
Gamzu claimed he had invited me to the meeting because he cared. However, the only thing he could do for me was to personally call Leumit to request that they accept my clinic as an outsource clinic. (When I asked him about all of the other dentists in my position, he had no answer.) Leumit still refused, as they are not signing more dentists.
I am now financially bankrupt. But the Health Ministry, including Rabbi Ya’acov Litzman, Dr. Shlomo Zusman and Professor Ronni Gamzu, is morally bankrupt.
At the cabinet meeting held at the end of June, the decision was made to raise the coverage age to 12. Before the vote, Prime Minister Binyamin Netanyahu was informed by Limor Livnat that private dentists were still not allowed to participate. Netanyahu responded angrily, asking Litzman why had he not implemented a cabinet decision from two years before. He then handed responsibility to Harel Locker, director of the Prime Minister’s Office.
On August 27th the IDA sent out a letter to IDA members stating; "At a meeting that occured in Harel Locker's office with representation from the Health Ministry, the Finance Ministry, and the IDA, the representatives of the Health Ministry put stringent requirements to establish the corporation [DHF], with the purpose of preventing the establishment of the corporation." The IDA has now appealed directly to Prime Minister Netanyahu to intervene.
In the meantime, I am going bankrupt.
The writer is an American-trained dentist with a private practice (for now) in Modi’in and Modi’in Illit.