In February 2017, a new law was proposed as a private members bill in the Knesset. The purpose of the proposed law is to correct an injustice that has being going on since 2010. In 2010 the Ministry of Health instituted a free dentistry for children program, which prevented private dentists from treating children under the basket of health services in their clinics. The treatment was restricted to Health Fund (kupot cholim) dental clinics only. The mechanism for allowing private dentists to participate, a Special Dental Health Fund, as described in the 2010 amendment to the National Health Insurance Law, was never established. The Israel Dental Association (IDA) tried a number of times to establish such a fund, but the Health Ministry blocked those attempts.
The February law proposal is supposed to force the 4 kupot cholim to sign contracts with all interested qualified dentists to provide dental health treatment in their private clinics. To avoid a situation where the kupot circumnavigate the law by creating terrible work conditions to dissuade private dentists from joining, the law proposes giving the Health Minister the authority to determine the work terms. The Israel Dental Association would advise the minister and it would be ratified by the Knesset’s health committee.
30 Knesset Members from across the political spectrum have signed on as proposers of this bill. Since February the bill has not moved. The next stage is a deliberation by the Ministerial Committee for legislation, to determine what the governments stance on the bill is.
In May I spoke to a parliamentary aid of Knesset member Oded Forer, who is the main proposer of the bill. The aid told me that the bill was being held up by Health Minister Yaacov Litzman, who is still discussing the issue with the Israel Dental Association.
In July, the IDA reported in its newsletter to its members that Minister Litzman has accepted the proposed law, but needs to know how many dentists are interested. If there were not enough interested dentists, he would not implement it. The IDA requested all interested dentists to submit a non binding form indicating their interest within 2 weeks, as they claimed time was of the essence.
A week after the deadline the IDA gave, I had a meeting with Dr. Yitzhak Chen, long time chairman of the IDA and some other officials, to talk about the proposed law and the IDA’s intentions.
This is what I learned. Over 800 dentists had submitted the form. (There are between 7000-9000 dentists in Israel, with slightly over 4000 members in the IDA). Dr. Chen claimed this number was sufficient for the Health Ministry to proceed with implementation of the proposed law. To my astonishment the IDA has no requests as to the terms or conditions of employment. Dr. Chen claimed that the IDA can not represent public health dentists as it is an organization of self employed members. This is absurd. The IDA is a professional organization that includes both self employed and public health dentists. The proposed law would convert all participating private dentists to public health dentists. The IDA, in my opinion , is being negligent in its purpose, if it has adopted this opinion.
Since July, nothing has progressed. Both the IDA and the parliamentary aid have said the Minister Litzman is blocking all progress.
I will finish this blog session with a discussion of economics.
The Ministry of Health publishes a pricelist of all medical treatments that are performed in the Public Health sector in Israel,both in hospitals and out patient clinics. They claim that this price list is used for accounting purposes in the Israeli health system. This price list includes all dental treatments performed in Israeli hospitals and hospital outpatient clinics. The prices listed are what the Health Ministry has determined to be realistic prices for those dental procedures. A few quick examples, a simple one surface amalgam filling- 274 NIS = $78. A 2 surface amalgam filling 345 NIS = $98. White composite filling posterior tooth 465 NIS = $132. A white composite filling anterior teeth 501 NIS = $142.
For exactly the same treatment, a participating dentist with kupat cholim Leumit who treats the patient in his private clinic, receives:
one or more surface amalgam filling 103 NIS = $29.
White composite filling, posterior or anterior 110 NIS =$31.
Kupat Cholim meuchedet pays even less.
Amalgam fillings 87.60 NIS = $25
Composite fillings 102.90 NIS = $29
Why should a private dentist working in the public health sector, working for a kupat cholim treating children under the National Health Insurance Law, receive less than a clinic associated with a government hospital? Participating dentists are being paid 20-30% of what the Ministry of Health has determined to be the proper price for the same treatment done in government hospitals. Are not the costs of running a private clinic similar to those of running the hospital clinic?
The truth is that the health ministry is taking advantage of the dental work force in a brutal and malicious way. Litzman wanted to provide free treatment for children, primarily Ultra Orthodox children. He did not have the budget for doing this in a fair and proper way. So he implemented his program on the limited budget that he had, by screwing over the dentists. The government in 2010, and every subsequent government has gone along with it.
I can attest to the fact that it is impossible to make a living as a dentist based on the prices that the Kupot Cholim currently pay. Obviously if the kupah receives a total of 170 NIS per child per year, they can not afford to pay proper compensation to the treating dentist. The dentist working in this system, if he/she wants to survive financially, must do multiple treatments in short appointments. Remember, dentists are paid per treatment. Obviously this is not in the interests of the patient.
Israel today has a free dental system for children that provides for very fast shoddy treatment with little regard for the patient experience.
I think the Israeli public deserves better. The Israeli dentist certainly deserves better.