The double disadvantage in early childhood public health
When the Ministry of Health announced changes to its child development reform, following an outcry from parents of children with disabilities, it seemed like responsive policymaking. Evidence suggests we are missing the bigger picture: the children who need help the most may end up further behind.
The reform moves developmental therapies (speech therapy, occupational therapy, physiotherapy) into the public system, gradually eliminating the current reimbursement model by 2030. Instead of families paying 2,000 NIS (some $620) monthly out-of-pocket for partial reimbursement, everyone would access treatment for 35 NIS ($10-11) per session.
The proposal sounds good on paper, but in reality, the public system is already overwhelmed, with months-long waits. The reform adds more children while removing the safety valve for families who currently pay privately and seek reimbursement.
The ministry’s stated goal is to reduce inequality. But wealthy families will simply continue paying privately — now without reimbursement — while middle- and lower-income families join increasingly long public queues. The reform eliminates the middle ground where families could stretch budgets for partial reimbursement, creating an even more stratified two-tier system with longer waits for everyone who can’t afford full private care.
Research published by KI and the Taub Center reveals just how urgent this is. Analyzing data from over 1.2 million children who visited Tipat Halav clinics between 2016 and 2022, the research found alarming trends in language milestone attainment.
The rate of delayed language milestone attainment increased from 3.9 percent in 2016 to 5.3% in 2022. That’s not just better detection: it’s real. These assessments are not diagnostic tools, they examine whether infants and toddlers can perform basic developmental skills, making the climbing numbers all the more troubling. Even more concerning, these delays follow a steep socioeconomic gradient. Among 2-3-year-olds, children whose mothers completed high school showed delayed language development at a rate of approximately 7% in 2022, compared to just 3.3% for children of mothers with academic degrees. These findings highlight that children from lower-SES families already start behind. Now they’ll face longer waiting times for services that could help them catch up.
This bottleneck in accessing developmental therapies has consequences beyond the health system. Another Taub study found that delayed language has become the dominant driver of special education preschool enrollment, suggesting families may be turning to educational services as a substitute when health system access is blocked. The reform risks accelerating this workaround, with significant fiscal implications: special education services cost substantially more per student than general education, and special education funding has already grown much faster than the overall education budget. If families are seeking educational solutions for healthcare problems, as the parallel trends suggest, this may inadvertently drive up costs in both systems.
The reform attempts to reduce inequality while it may actually widen access gaps and increase costs across multiple social systems. Two policy options could improve access for all children, both leveraging Tipat Halav’s existing infrastructure. First, strengthen coordination between health, education, and welfare ministries and with municipalities, using Tipat Halav’s developmental surveillance data (which is already being collected) to project future service needs and enable proactive resource allocation. Second, integrate therapeutic services directly into Tipat Halav clinics, eliminating bureaucratic barriers by providing monitoring and treatment under one roof. These approaches are efficient: they build on current systems and data collection rather than creating new systems, reduce red tape for families navigating multiple agencies, and use a familiar setting that families already trust and visit regularly.
The Ministry deserves credit for listening to parents and adjusting its timeline. But the direction matters more than the pace. A more effective approach would expand capacity first and leverage our universal health infrastructure to narrow the gaps facing our most vulnerable children.
