'Litzman’s 'fifth fund' reform plan ‘unrealistic’'

Expert says Deputy Health Minister’s plan would add fifth health fund consisting solely of private dentists.

By JUDY SIEGEL-ITZKOVICH
Yaacov Litzman 260 (photo credit: Ariel Jerozolimski)
Yaacov Litzman 260
(photo credit: Ariel Jerozolimski)
Deputy Health Minister Ya’acov Litzman said he had reached an agreement “in principle” that a fifth health fund – solely for dental care and involving only private dentists – would be established to provide subsidized dental care to children and eventually to the elderly. But Prof. Jonathan Mann, head of community dentistry at the Hebrew University- Hadassah School of Dental Medicine, dismissed this as unlikely, and criticized the “lack of planning, supervision and objective assessment” of Litzman’s program up to now.
Both were speaking at an all-day conference titled “Cooperation and Models in Dentistry’s Service to the Public,” attended by some 350 clinical and academic dentists and dental hygienists from around the country. But while Mann was present throughout – including at Litzman’s opening greeting at the Hadassah University Medical Center on Jerusalem’s Mount Scopus – Litzman did not stay for any of the professional discussions, even though he regards his dental program as one of the “crowns” of his three years at the helm of the ministry.
“When I launched it, I was told I had no chance. But now NIS 80 million more is allocated every year,” the United Torah Judaism MK said. “Children up to 12-years-old are now treated, and we will go to 18. And we will also provide basic dental care for the elderly from age 75, and every year we will lower the minimum age by a year.”
But Mann, a former dean of the dental school, said the establishment of a fifth health fund for dental care only made up of private dentists alone was “very unlikely.”
“Will a private dentist get higher payments?” he said. “Of course not; for them, it will be a waste of time, and I doubt the Treasury would allow a fifth fund to be established.”
As for subsidized dental care for the elderly: “We don’t have enough information about whether Litzman’s dental program for children has been successful,” said Mann, who received strong audience applause.
Mann reiterated criticism of two factors – no independent academic institution has been permitted by the ministry to assess the program, and it is supervised only by the health funds and a very small number of ministry staffers. “We don’t have any epidemiological information. It’s terrible,” he said.
The professor said that there are over 400 dental clinics owned by health fund subsidiaries or contracted by them, but “private clinics still provide about 70 percent of dental care in Israel. As for a fifth fund, I think we missed the train.”
Mann noted that at the last conference he helped organize on the subject, the ministry conceded that only 25% of eligible children were part of its program. That figure has since been raised by only a quarter – far from the majority of all eligible children that was publicized.
“What are the real costs of the reform? There is a real conflict, as the dentists want to do more fillings to earn more, as they get fee-for- service, but the health funds get paid per capita and want to make money,” Mann said. It was also not clear how much over-treatment is carried out by dentists for higher earnings.

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“If there is a deficit, where does the extra money come from to cover it?” he asked. “Are there more general anesthesis used now than before? Why isn’t there any thought to primary prevention?”
Mann continued: “We asked to conduct research on the program, but the ministry refused. There must be a study to find out why many parents do not bring in their children for treatment. Are the private pediatric dental clinics emptying out? Will there be enough dentists and other manpower in 2019 to provide service, or will whole system collapse?” Litzman, however, was not present to hear or respond to Mann’s arguments, and none of the aides who accompanied him remained for the conference.
A feature on the dental conference will appear soon on the Sunday Health Page.