The cabinet unanimously approved on Sunday the expansion of basic free and
subsidized dental care for children up to the age of 10, a year after it
authorized the initial program – initiated by Deputy Health Minister Ya’acov
Litzman – for children up to the age of eight.
Initially, Litzman took
NIS 65 million from the 2010 addition to the basket of medical technologies to
cover part of the costs, finding another NIS 85m. to produce a NIS 150m.
program. In the future, he said, the money will not come from the health basket
but from the Treasury and the Health Ministry.
Litzman said that with the
expansion, 300,000 more children, aged eight to 10, will benefit, and that in
two years, the program will include all until the age of 12 – with intentions to
expand it to everyone under 18.
According to data he presented at the
cabinet meeting, health fund dentists (only, and not private dentists) provided
1.2 million dental treatments to some 200,000 children up to the age of eight in
2010; they constituted 30 percent of the age group.
Binyamin Netanyahu, who is formally health minister, added: “There has been a
great response to the free care that was previously available up to age eight.
The people understand that there has been a very welcome change
This is a very important breakthrough.”
But while critics of
the program are not organized, numerous complaints have been voiced regarding
the lack of an objective body of professional pediatric dentists who could
assess the clinical dental health of children before the program began and after
a year. They have argued that the health funds’ 500 dental clinics that treat
children have too little supervision; that some dentists overtreated children so
they could charge for dental care not included in the basket; that the health
funds previously gave free dental treatment to children as part of their
supplementary health insurance plans; and that much more effort and funding
should have been devoted to educating parents and preventing dental disease than
has been accorded under the Litzman plan.
Critics have also claimed that
Litzman, a Gur hassid from Agudat Yisrael, which along with Degel Hatorah forms
United Torah Judaism, is especially interested in child dental care because of
the large number of children, lower incomes and relatively poor dental health
among his constituents.
Dr. Eli Mass, a veteran pediatric dentist who
previously taught dental students at Tel Aviv University and now teaches the
specialty at Barzilai Medical Center in Ashkelon, wrote an article for
publication on Monday in the GC-Israel dentistry magazine that looked at the
Health Ministry’s children’s dental care reform. Mass wrote that most of the
treatments have been given by young dental school graduates who lack experience
in dental treatment of children.
“Because of the lack of experience,
[health fund dentists] give unnecessary treatments, and younger children up to
the age of three or four are referred [to the hospitals] for treatment under
general anesthesia,” he wrote.
There are just 105 pediatric dentistry
specialists in the country, and only a handful work for the four health funds,
Mass told The Jerusalem Post.
He added that specialists in this field
feel they were “deprived, affronted and had missed” the opportunity to treat the
children; no private specialists were included in treatment or supervision of
the health fund clinics’ work, said Mass. He added that if the government wants
dental care for children to be fully part of the health basket, dental clinics
could be opened as part of pediatric medical facilities around the country –
including in the periphery that has very few pediatric dentistry specialists who
would give the most professional level of care. But that, he wrote, would
require much more funding to be introduced into the system.
suggested that the ministry’s program should be assessed objectively by
pediatric dental specialists who would compare dental health in the children
before the program began and after a few years of functioning to see if it
indeed had helped.
Dr. Shlomo Zusman, the ministry’s head of dental
medicine, told the Post that access to dental care for children has
significantly improved. “I’m very happy with the program, which is revolutionary
and changed dental habits. I have not heard many complaints. It has been
relatively good for a beginning and very encouraging.
We hope the project
Zusman said Mass did “not have all the facts” when he
wrote his article.
Nir Kaidar, a health economist (not a dentist) in the
office of the ministry’s deputy director for economic policy, Dr. Tuvia Horev (a
dentist by training), told the Post that although the health funds offered free
dental care as part of their supplementary insurance plans, only 75% of families
have such extra coverage and only those who bought the most expensive got the
Asked how many ministry dentists supervise the plan in the
over 500 health fund clinics, Kaidar said there were 17, and 75% of the clinics
were “visited at least once in the past year. This year they will visit the rest
As for the argument that children need pediatric specialists
and not general dentists, Kaidar said that dentists who have experience but are
not recognized as specialists can treat them as well. Dental hygienists have
given parents and children lessons before and during treatment on how to protect
their mouths from disease, the economist said.
Kaidar could not say how
much an average dentist received for examining and treating each child, but said
that each health fund received funding according to the number of children of
the age group they had as members. A team from the National Institute for Public
Health Research is to study the program, examining the mouths of schoolchildren
to see if there has been a change in average dental health, he said.