After 7 years, will discrimination against private dentists in Israel end? New law proposed

Two weeks ago a small article was published in the Yisrael Hayom daily newspaper. The article stated that Knesset Member Oded Forer of the Yisrael Beitenu party has proposed a private members law in the Knesset which will allow self- employed dentists to treat children covered under the basket of health services. The article claims that the proposal has the support of 40 Knesset members. The Israel Dental Association (IDA) notified its members about the article in its email newsletter. The IDA followed up a week later with a short explanation.

In 2010, the Knesset passed an amendment to the National Health Insurance Law, providing free dental treatment for children until the age of 8. Over the past 6.5 years the age of coverage has been incrementally raised to age 15. While the majority of the Israeli populace, including many politicians and social groups, have praised this law, which has provided financial relief for parents of children who could not afford the costs of dental treatment, there have been many negative aspects to this dental reform program.

First and foremost, the free dentistry for children program has discriminated against self-employed dentists. Dentists whose private practices included the treatment of children were being prevented from treating their former patients. This was because the free treatment was provided only at health fund (kupot cholim) dental clinics. In the 2010 amendment, a provision was included to allow the establishment of a “Dentistry Only Health Fund” which would serve as a mechanism to allow private dentists to treat the children, under the same financial conditions as the kupot cholim. However, over the past 6.5 years, the Health Ministry has prevented every attempt to establish a dental health fund. In addition to the discrimination against private dentists, with its negative economic consequences to those dentists, this has also impacted negatively on the human rights of the population, by preventing them (us) from being able to choose who will treat our children.

Another major fault in the free dentistry program is that it is severely underbudgeted. This has had major ramifications on many aspects of the program. Before the amendment to the law was passed, Health Minister Rabbi Yaacov Litzman was told , during deliberations, that the country could not afford this law. Litzman replied, “With the prices I will pay, we can afford it”. Over that past 7 years, the Ministry of Health has budgeted between 120 -150 NIS ($30-$40) per year per child to fund the program. This is an absurdly low amount that affects many aspects of the program. The pay per treatment dentists receive from the kupot cholim are absurdly low, as low as 30 NIS ($8.00) per filling. The kupot cholim ration treatment, by not providing enough appointments to meet the demand, resulting in children waiting up to 6 months to get appointments. There are not enough treatment facilities to cover demand, and no effort is being made to increase them. The treating dentists, perform multiple treatments in short appointments in order to earn a semi decent salary. Remember, they are paid per treatment. This of course leads to substandard treatment and even negligent treatment.

In June 2014, there was a meeting of the Health committee of the Knesset which discussed the program. The person representing the Health Ministry, Revital Topper, chief economist responsible for the kupot cholim, was asked about the budget by MK Gila Gamliel. Ms. Gamliel asserted that if only 28% of the children were utilizing the free dental services, and the kupot were working at a deficit, ie losing money, then the problem is in the budgeting procedure. Ms Topper explained that in the budgeting, it is taken into account that not every child will come for treatment every year and that it is not necessary for all children to come for treatment every year. She said that the dental professionals in the Health Ministry, including Dr. Lana Natapov, Head of Dental Services in the Health Ministry, had taken the opinion that many children do not need dental treatment every year .

MK Apu Agbaria, a physician by training, then asked “What about yearly examinations?” Ms Topper then explained that some children need exams every year, some every six months and some once every two years is enough. She continued that when parents were asked why they did not bring their child in for an exam , 62% answered that their children did not need treatment.

So we see that the Health Ministry was not concerned about proper preventive dentistry. The obvious way to prevent serious dental disease is to diagnose the problems and treat them on time. The large number of children in this country that need to undergo pediatric root canal treatments, stainless steel crowns, extractions and space maintainers is because they are not being diagnosed and treated on time. The fact that this type of negligence was built into the system is scandalous in itself.

Earlier I mentioned that there are not enough kupot cholim facilities and dentists to provide for demand. There are more than adequate facilities and dentists available on the private side, but they are currently prevented from offering their services under the basket of health services.

After I read the article in Yisrael Hayom, I tried to locate the proposed law via the internet. I was not successful. I then sent MK Forer an email, asking about the proposed law. He responded the next day, asking me to call his Knesset office. He said his parliamentary aid would answer all of my questions. The proposal is currently undergoing text revision in the Knesset’s Legal Bureau and has not yet been formally presented in the Knesset, thus it is not yet available online.

The proposal states that the kupot cholim will be obligated to enter contracts with all licensed dentists or dental clinics, so that the patient can choose freely between all dental clinics, private, commercial or health fund clinics.

To prevent the Health Funds (kupot Cholim) from creating difficulties for the contracting dentists/ clinics , or implementing unfair or irrelevant requirements, it is proposed that the Health Minister be authorized to issue the terms. It is also proposed to authorize the Health Minister to determine the terms regarding the payment to the service providers, in order to prevent the kupot cholim from circumventing the implementation of the law by establishing unrealistic (low) monetary compensation.

My take on this proposal is this. If this law is passed in good faith and is upheld and implemented by the Health Ministry, it could correct a 7 year period of discrimination and could improve work environments for dentists which in turn could lead to significant improvements in conditions and levels of treatments for Israel’s children.

However, I have many doubts. Is this law being supported by the Ministry of Health, and its Minister, Yaacov Litzman? If Litzman decides to fund the treatments according to the guidelines currently in place, this law will not succeed. Most self-employed dentists will not agree to work for the low pay now provided. The pay is not realistic. While Kupot Cholim can afford to lose large amounts of money, because the Health Ministry eventually bails them out, privately owned clinics cannot afford to lose money. A dental practice is a business, and it has to be run according to sound business principles.

In order for the law to work, to solve all of the problems listed above, the budget for the free dentistry for children program must be expanded significantly. It must be large enough to cover proper payments to the treating dentist and it must be enough to cover the costs of much larger numbers of children being treated.

Putting the decision of what the compensation for treatment will be, in the hands of Litzman, who said 7 years ago “With the prices I will pay, we can afford it”, seems to me to be failure in the making. Has he shown any concern for the dentist’s welfare in the last 7 years? I am not aware of it. If Litzman ,and his Health Ministry, and the finance ministry as well, are not supportive of the law and its financial necessities it entails, then even if it passes into law, it will not succeed. The Dental Health Fund clause in the 2010 amendment to the current Health law is testimony to this truth. 7 years later, still no Dental Health Fund.

About the Author
Dr. Dan Cheifetz is a graduate of Georgetown University Dental School. He has been practicing dentistry in Israel for 31 years. He served in the IDF as a dentist from 1989-1991.