Government drilling holes for country’s dentists

Why can’t private dentists participate in the government’s free dental care for children scheme?

By DAN CHEIFETZ
DEPUTY HEALTH Minister Ya’acov Litzman 311 (photo credit: (Ariel Jerozolimski))
DEPUTY HEALTH Minister Ya’acov Litzman 311
(photo credit: (Ariel Jerozolimski))
The government’s free dentistry plan for children has been an unmitigated disaster for dentists, and may not be so great for patients, either.
The 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.
Private 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?
Dentists 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 salary.
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 patient.
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 option.
Despite an IDA request to delay the start of the program until the new dentistry fund could be established, Litzman launched the program in August 2010.
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 option.
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 sector.
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 Modi’in Illit.