Program proceeds with criticism from private dentists, pediatric specialists.
By JUDY SIEGEL ITZKOVICH
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.Prime Minister 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 here.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.AdvertisementCritics 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.Mass 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 will improve.”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 best care.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 of them.”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.
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