Prior to 2010, all dentistry in Israel was private. Three of the health funds (kupot cholim) were operating for profit dental clinics. These clinics did not receive any public funding and competed with the private clinics on a relatively equal footing. I use the term relative for a reason. The kupat cholim clinics actually had an advantage over private clinics in two ways. Because of the size of the chains involved, these clinics were given significant discounts on the prices of dental materials by the large importers. Also during the period when advertising by dentists was forbidden, the kupot cholim were allowed by the Health Ministry to advertise their services in their in house publications as well as in the print media. Private dentists were not allowed to advertise at all.

Still,the competition was relatively fair, with over 85% of dentists working privately.

In 2010, Deputy Health Minister,(acting Health Minister) Yaacov Litzman pushed legislation through the Knesset to start a socialized program for children, up to age 8 at the time.All operative dentistry was to be provided to children for free, except for a nominal co-payment of 20 shekel per treatment. Over the years the age of coverage was raised gradually and on Jan. 1,2016 it will stand at age 14. The co-payment now stands at 23 shekel per treatment.

Most countries that have free programs established an office to deal with the supervision and running of the program. Participating dentists sign contracts with the office. Their participation is advertised by the program, and they treat their patients in their private clinics. The dentist is paid by the program per treatment performed. The dentists have a choice to participate or not, based on their own financial considerations. The patients have the right to choose the dentist of their choice.

Not so in Israel. For the past 5 and a half years, only kupot cholim clinics have been allowed to participate. Almost all of the private dentists have been locked out of the program, to their financial detriment. The largest kupot, Clalit, Maccabi and Meuchedet already had dental clinics in the larger cities. Where they did not have clinics, especially in the Arab sector and in development towns, they proceeded to sign deals with a few private clinics to give them minimal coverage in these areas. Kupat cholim Leumit, which never had any dental clinics, signed similar deals with private clinics nationwide, also achieving minimal coverage. Many dentists who tried to sign deals with the kupot were refused, as the kupot were not interested in expanding their coverage.

There is a simple reason for this. The government pays for the program via capitation. This means that the kupot are paid a sum per child registered, once a year. The amount paid per child has been between 120 and 156 shekel per year.With this amount, the kupah was given the responsibility of providing all the dental care each child needs. The kupah is not paid for the amount of treatment it provides. Therefore it is in the interest of the kupah to limit the amount of treatment as much as possible.Therefore, they limit their coverage in each geographical area.This leads to long waiting periods for appointments, and a very limited choice of dentists for the patients.

When the legislation, amendment number 50 to the National Health Insurance Law, was being discussed, the Israel Dental Association, (IDA, which represents slightly more than 50% of Israel’s dentists) got involved in the process. They requested a mechanism that would allow any private dentist who wanted to, to participate in the program. They came up with the idea to establish a dental corporation that would sign up the private dentists. The population would have the right, once a year, to register their children, either with this corporation or with any of the kupot, for the purpose of dental treatment. The conditions of the corporation were to be identical to those of the kupot. The corporation would receive similar capitation payments, the amount dependent on the number of children registered. This idea, was written into the legislation. It still exists in the law today. However, the Ministry of Health has refused to set up the corporation. They have rejected all attempts by the IDA and other interested groups to set up the corporation.

In June- July, 2014, meetings were held between the IDA and Health Minister at the time Yael German to discuss possible solutions to the problem. German basically rejected the idea of the corporation (even though it is the law) and decided the answer is for the private dentists to sign agreements with the different kupot on mass. However the kupot refused and the government decided they can not force them legally.

So, for the past five and a half years, private dentists have been denied the right to treat children under the National Health Insurance Law. Basically patients were transferred from their previous dentists to kupot cholim clinics, without having any choices. This had lead to financial distress for many dentists, as well as a serious degradation in the quality of treatment the children are receiving.

I will expound on these issues in future posts.