The gap between Israel’s well-off and weaker sectors in dental care accessibility is growing, due to a lack of affordable public insurance packages and the proliferation of costly plans available privately or through the workplace, and top-tier supplementary packages from public health funds, according to health economist Prof. Dov Chernichovsky.
Chernichovsky, of Ben-Gurion University of the Negev in Beersheba and Jerusalem’s Taub Center for Social Policy Studies, has produced a Taub Center report with the Bank of Israel’s Dr. Guy Navon on the financial burdens of dental care on households.
Speaking to The Jerusalem Post
on Tuesday, Chernichovsky said he personally did not object to taking some money from the budget to expand the basket of medical technologies and using it to improve dental health.
“It would not be a disaster if the NIS 65 million were deducted from the basket expansion. The amount of benefit from NIS 65m. that the Israel Medical Association wants restored to the basket would not have a significant impact on the patients, as benefits from a few added drugs – some of which would replace previous drugs or whose effects would not be clear – would not be so significant,” he maintained.
The National Health Insurance Law of 1994, he said, originally required the government to cover the costs of dental care for schoolchildren, but it was never implemented. He recalled that when he was a child, a dentist had come to his school, examined teeth for cavities and other problems, and referred those who lacked a clean bill of dental health to a public clinic. But as only some municipalities – usually the wealthier ones – offer dental care to schoolchildren, the social gaps are widening, said Chernichovsky.
“Subsidized dental care is needed,” the health economist asserted. “We have to start somewhere.”
He added that the NIS 65m. would be well spent if dedicated to measures that would prevent caries in children, no less than if allocated – as Litzman had planned – for certain kinds of free or subsidized dental treatment only for children up to age eight.
“Litzman’s program in general is in a positive direction, but will not be enough. If it were serious and included enough money, it would of course increase accessibility of the weaker sectors to dental care,” he said.
Asked about dental care for the elderly, many of whom have diseased, painful or missing teeth, Chernichovsky said that “this is another tragedy. Subsidies are needed, but there should be a means tests to see who can’t afford to pay on his own, as dental care for this group is very expensive.”
His and Navon’s new report states that the average family expenditure for dental health is about NIS 175 per month, which is 1.5 percent of the overall family expenditure on consumer goods. But when those surveyed were asked to estimate how much money they had spent on dental care in the previous year, only one-quarter of households reported that they actually had. Thus the real average expenditure of households is some NIS 540, or 6.4% of their overall expenditure, the report said.
This does not mean that three-quarters of the population go totally without dental care, as even poor families are likely to spend money on orthodontic or emergency treatment for their children while forgoing necessities, and some poor people qualify for free or low-cost dental care from voluntary organizations, Chernichovsky noted.
The figures on expenditures were provided by a Central Bureau of Statistics survey. Total annual expenditure on private dental care is about NIS 4.5 billion.
The Taub Center study, “The Burden on Households and Implications for National Health Insurance,” found that the expenditure on routine dental care (fillings, extractions and so on) is most common among families with children and young adults who for the most part do not have supplementary health insurance that includes dental care. This expense – for those who reported it – reaches NIS 530 on average per month, which is about 6% of the total household expenditure. The study shows that when a family has to finance such routine treatments, the amounts are similar for all income quintiles, or fifths of the population surveyed. But people in the lower-income quintiles who cannot afford such expenses are often forced to forgo treatment.
The study also found that the expense for dental and jaw surgeries involving reconstruction was most common in families with adults over 45, who tend to have supplementary insurance that includes private dental insurance. The expenditure in this case is much higher and can reach an average of NIS 2,000 monthly, which is 18% of total reported household monthly expenditure.
This expense is considered “catastrophic” and often involves giving up spending on some other significant need. As a result, reporting of this type of expense is particularly low in the lower two income quintiles.
Only about 6.7% of Israeli households said they had dental health
insurance, which is not included in the basket of health services. This
is a relatively low rate by international Western standards, the report
The study further showed that dental health care expenditure was
clearly regressive; the rate of expenditure relative to income declined
with increased income. In addition, dental care insurance contributes
to a rise in inequality or disparities, since those with relatively
higher salaries are also those who hold dental insurance. As a result,
accessibility to services is higher for those with higher incomes.
The authors said that if no Israeli paid for dental care, as is the
case in some Scandinavian and other countries, it would cost NIS 3.3
billion annually – 5% of the national expenditure on medical services.
They also recommended that the recent government decision to offer some
dental care in the basket should be implemented.