In my previous posting, I gave a short synopsis of the situation of the dental profession in Israel,and how it developed historically. Today I will describe the working conditions in the public sector, at kupot cholim (health fund) clinics.

Last month, the employees of Maccabident, the chain of dental clinics operated by the Maccabi Health Fund, went on strike for three and a half weeks. Last year the employees organized under the auspices of the Israeli Labor Federation (histadrut). A few months ago they declared an official labor dispute and last month went on strike. The strike ended with the two sides agreeing to enter discussions or negotiations. None of the issues have been resolved.

Dental assistants and receptionists, including those with many years experience were being paid minimum wage, which was recently raised to 25 shekel an hour. (A little over $6.00). Dentists are paid per procedure. The compensation for a dental restoration (filling) performed on a child covered under the National Health Insurance Law was between 30 and 40 shekel, depending on the type of filling. ($7.50 -$10.00 a filling).

Compensation for treatment on older children and adults is dependent on the level of supplemental insurance the patient has. The kupot cholim are allowed by the health ministry to offer two supplementary insurance plans to their members. This creates 3 categories of patients. Non-insured, low tier insurance, and high tier insurance. The insurance offers different health benefits not covered under the National Health Insurance Law, including dental benefits.

At the different kupot cholim, the prices for dental treatment for those with no supplementary insurance are quite high. In fact, they are significantly higher than my prices in my private clinic, for most procedures. According to statistics from 2012, 73% of Israelis have purchased supplementary insurance. So in fact, very few patients who seek dental treatment at kupot cholim clinics pay the high fees.

Patients at Maccabident who have the higher tier insurance pay only 20 shekel for most operative dentistry procedures, including root canal treatments, which can cost up to 1500-2000 shekel in private clinics.

I do not have the figures for dentist compensation for all the different categories of treatment , according to insurance level, but needless to say, it is not fair or acceptable to the dentists.

Other issues for the dentists involved in the strike were that they were not paid for holidays or for patients that broke appointments. Also, they want the kupah to cover professional malpractice insurance costs, which currently is being paid by the dentists out of their own pocket. This comes to over 6,000 shekel per year.

I want to focus on the conditions for dentists that are providing the services under the National Health Insurance Law, treating the children. Dentists are being paid 30 -40 shekel per procedure, gross income. If a dentist works a 6 hour shift, performing one filling per appointment of a half hour, he/ she earns a gross total of between 360 and 480 shekel a day.($90-$120). For someone working 5 days a week, this comes to between 6400 and 9600 shekel a month. ($1800 -$2400) . And this is based on no lost time to broken appointments or holidays. It also does not include appointments used for examinations, where the dentist receives no payment, or as little as 10 shekel per exam.

(For readers outside of Israel, please note that Israel is an expensive country to live in. Housing costs are extremely high, at $250,000 – $500,000 for an apartment, with rentals running at $1000 to $1500 for 3-4 rooms. Gasoline currently goes for $1.50 a liter, and the price of a meal at McDonald’s is about $12.00. Taxes are also very high and can easily reach 50% for people earning relatively low salaries.)

Therefore, a dentist who works at a normal speed, cannot successfully earn a living working at a kupat cholim clinic. So, what are the consequences of this? Many dentists are working faster. They are doing multiple treatments per short appointment, to increase their income to minimally acceptable levels. This of course affects the quality of treatment and it also affects the relationship between the dentist and the patient. There is no time for explanations. Patients are treated like an assembly line. In and out, in and out. Also we must not forget, these are impressionable children, aged 4, 5, 6, -12, that are being treated this way. I am afraid we are creating a generation of individuals that will have severe dental phobias.

Because of the inadequate budget offered by the Ministry of Health, corners are being cut on equipment and dental materials available to the treating dentist at the kupot. The dentist must make do with what is available, and this also affects the quality of the treatment.

The blame for this abysmal situation can not be placed fully on the kupot cholim. They have been losing money on the socialized dentistry program. The blame must be placed on the Ministry of Health. They set up a program, in a convoluted way, with a totally inadequate budget. They ignore the financial problems of the dentists and do not comprehend the consequences of the low quality of treatment.

In future posts I will describe the interactions I have had with those in charge in various capacities within the Health Ministry, as well as the role the Israel Dental Association has played in this story.