The government’s free dentistry plan for children has been an unmitigated
disaster for dentists, and may not be so great for patients, either.
plan was launched in August 2010, with free basic dental care for children up to
the age of eight. Last June, the service was expanded to include children up to
the age of 10, and is expected to include all citizens under the age of 18
within two or three years.
The program has a budget of NIS 156 per child
per annum. Service is provided by the four national health plans (kupot holim),
which employ approximately 15 percent of the country’s dentists. The other 85%
are self-employed, with their own private clinics, but this majority is currently
excluded from the program.
This arrangement put a strain on the health
funds, which cannot adequately cover the demand for services, in terms of both
manpower and facilities. It has also left private dentists in an extremely
precarious position, and it does not serve the needs of patients.
dentists cannot compete with free dental care, so many dentists – myself
included – have lost nearly all their under-10 patients. In my case, I may be
forced to close my practice in Modi’in Illit because it no longer makes
financial sense to keep it open.
Most importantly, young people suffer
because the current arrangement does not allow for quality dental care. NIS 156
a year per child might cover the kid’s first check-up and teeth cleaning, but
that’s about it. What happens if the child needs a couple of fillings?
who do participate in the program are not salaried employees. They are
contracted workers who get paid per procedure done, meaning they have to ramp up
the number of procedures done in a shift in order to earn a decent
That means the dentist has to work fast. This is achieved
by not waiting for anesthesia to take effect properly, starting treatments
whether or not the tooth is numb and by cramming as many treatments as possible
into a half-hour appointment. Obviously, the faster a dentist works, the quality
of the work goes down. Fast dentistry is definitely not in the interest of the
PRIOR TO the implementation of the program in 2010, the Israel
Dental Association (IDA) appealed to Deputy Health Minister Ya’acov Litzman to
include self-employed dentists in the program. Litzman refused, wanting to
implement the program as quickly as possible. The IDA bypassed Litzman and
appealed to Prime Minister Binyamin Netanyahu, also the Health Minister, who
ordered Litzman to comply.
To include private dentists in the scheme, the
Ministry proposed creating a special health fund for dentistry. Parents would
register their children, either with one of the health funds or with the special
dentistry fund, and the child would receive treatment only via that
Despite an IDA request to delay the start of the program until
the new dentistry fund could be established, Litzman launched the program in
A year and a half later, the health fund for dentistry still
does not exist. The Ministry established such stringent conditions for this fund
that no medical non-profit organization would provide funding. The IDA was
willing to create the fund, but they were not allowed to, as it is considered a
conflict of interest. IDA sources say every time progress was made, the
Ministry added new stumbling blocks. As a result, there is no solution to this
problem on the horizon.
The Health Ministry has many
responsibilities. In addition to the obvious responsibility of
supervising the services provided to the public, it must also be concerned with
the welfare of medical service provider. This includes the 85% of the country’s
dentists who do not work for the national health funds.
In this regard,
the ministry has failed miserably. The free dental program has brought
many dentists to the brink of economic ruin.
The plan to provide free
dentistry for young Israelis is certainly well-intended, but the government must
take responsibility for all aspects of the endeavor. It must budget enough
funds, not a measly NIS 156 per child, to do it properly, and it must establish
a the dental health fund that would allow private dentists to provide treatment
under the program.
Another option would be to establish a National Dental
Insurance Office that would pay dentists directly per procedure, just as the
dental insurance companies do. This option would allow the public full freedom
to visit the dentist of their choosing, instead of being limited to one
The Health Ministry, under the leadership of Ya’acov Litzman, has
established a system that discriminates against the private dentist and ensures
shoddy dental care for many children. He has pushed this program because the
main beneficiaries of free dental treatment are haredi (ultra-Orthodox)
children, who constitute both a majority of children in this country and the
most impoverished sector of Israeli society, along with the Arab
Netanyahu and Litzman must take responsibility for the current
situation, rectify the mess they have created and allow a dental health fund to
be established immediately.
If they fail to do so, dentists and children
will continue to pay a dear price, indeed.The writer is a graduate of
Georgetown University Dental School in Washington, DC. He has been practicing
dentistry in Israel for the past 27 years, currently with clinics in Modi’in and