National Health Insurance Law Research Articles

"When everyone is responsible, no one takes responsibility": exploring pediatric physiotherapy services in Israel.

According to Israel's National Health Insurance Law (1994), the Ministry of Health is responsible for the provision of health services in the country including physiotherapy services; moreover, the Special Education Law (1988), stipulates that physiotherapy services for children with motor disabilities, as well as other allied health services, are provided by the Ministry of Education in educational settings. Thus, children with motor disabilities are entitled PT services under two different laws by two different ministries. To describe the physiotherapy services for children with motor disabilities and examine how policymakers view these services, we conducted a qualitative study including in-depth semi-structured interviews with 10 policymakers from the Ministry of Health and the Ministry of Education, and the national directors of physiotherapy services from three of the four health maintenance organizations in Israel. Study results indicate that there is an array of physiotherapy services and providers. Despite the regulation of these services for children with motor disabilities, uncertainty and lack of knowledge were found about various issues. Therefore, the thematic analysis was structured around four descriptive questions: Where do the children receive physiotherapy? Who is eligible for physiotherapy treatment and who receives treatment? What interventions do children with motor disabilities receive? Who provides therapy for children with motor disabilities? Policymakers are dubious regarding the provision of these services, questioning whether children with motor disabilities receive physiotherapy services according to their needs. In addition, the abundance of suppliers does not necessarily improve the quality of services provided to children with motor disabilities, which may ultimately harm their developmental potential.

Healthcare utilization is increased in children living in urban areas, with ethnicity-related disparities: A big data analysis study.

This study aimed to investigate differences in pediatric healthcare utilization in Israel over 10 years by examining differences across populations defined by living environment and ethnicity. Data was obtained from the Clalit Health Care data warehouse, covering over 250,000 children residing in Haifa and Western Galilee districts. The population groups were categorized based on ethnicity (Jewish vs Arab) and residential settings (urban vs rural). Healthcare utilization was consistently higher among Jewish than Arab children, irrespective of the specific dimension analyzed. Additionally, urban-dwelling children exhibited higher usage rates than those residing in rural areas in all investigated dimensions. However, Jewish children showed significantly about 18% lower hospitalization rates than Arab children across all years (P < 0.001). No significant differences in hospitalizations were observed between urban and rural children (RR 0.999, CI (0.987-1.011)). Notably, the study revealed reduced antibiotic consumption and hospitalizations over the years for all populations. Additionally, we found that Arab children and those living in rural areas had reduced access to healthcare, as evidenced by 10-40% fewer physician visits, laboratory tests, and imaging (P < 0.001). Conclusion:This study highlights the substantial population-based disparities in healthcare utilization among children in Israel despite the equalizing effect of the national health insurance law. Rural and low socioeconomic populations seem to have reduced healthcare access, showing decreased healthcare utilization. Consequently, it is imperative to address these disparities and implement targeted interventions to enhance healthcare access for Arab children and rural communities. The decline in antibiotic usage and hospitalizations suggests positive trends in pediatric health care, necessitating ongoing efforts to ensure equitable access and quality of care for all populations. What is Known: • Healthcare systems worldwide vary in coverage and accessibility, including Israel, which stands out for its diverse population. • Existing research primarily focuses on healthcare utilization among adults, leaving a need for comprehensive data on children's healthcare patterns globally. What is New: • Investigating over 250,000 children, this study reveals higher healthcare utilization among Jewish and urban children across all dimensions. • Despite Israel's national health insurance law, the study underscores the significant population-based disparities in healthcare utilization.

Construction of BPJS National Health Insurance Membership Regulations in Indonesia

The issuance of the BPJS National Health Insurance Law was a government effort to enhance the welfare of citizens by making it mandatory for them to become BPJS health insurance participants, with a deadline set for January 2019. However, as of May 2022, around 13.79% (according to Worldometer) or 12.26% (according to the Home Ministry) of citizens have not yet joined, due to various factors, including issues related to the BPJS health insurance membership regulations. This paper aims to provide clarity on the construction of health insurance membership regulations as outlined in Law Number 24 of 2011 concerning the Social Security Agency connected to the National Social Security System. The research utilized a descriptive analysis with a statutory approach, along with secondary data obtained through a library study to collect data, and systematic and teleological analysis to analyze the data. The results of the study indicate that the construction of BPJS health insurance membership regulations follows the Stufen theory, which is in accordance with the hierarchy of occupying concrete norms (Hans Kelsen) or formalgezets (Hans Nawiasky).&#x0D; Keywords: construction, national health insurance, national social security system regulation

Factors affecting the use of dental services among Arab children in Israel: a qualitative study

BackgroundIn 2010, Israel reformed its hitherto dominantly privately financed dental services and included preventative and restorative dental care for children in the publicly-funded basket of healthcare services. A survey conducted by Brookdale Institute, found that only 67% of low-income Israeli-Arab children were using the new service (compared to 85% of Jewish children) while the majority of others continue using privately funded services. The aim of this study is to explore and explain Israeli-Arab children’s low utilization of publicly-funded preventive and restorative dental care.MethodsA qualitative study designed to describe and understand the parents’ motivations and choices. As a preliminary stage, eight semi-structured interviews were conducted with directors of HMO dental departments and Israeli-Arab dentists. In the second stage, ten one-on-one interviews with parents, and five focus group discussions with 55 parents held on February–March 2017. All discussions in the focus groups were conducted in Arabic and each group was moderated by one of the research team accompanied by another person who documented and recorded the discussion. All interviews and discussions were recorded, transcribed in full and translated into Hebrew.ResultsThe prevalent attitude is that one goes to the dentist only when there is a serious problem. The importance of preventive care is not appreciated. A childhood fear of the drill is very remembered and passed onto the children. Social and cultural factors such as kinship with service providers (GPs and dentists) influence the choice and utilization of health services. Economic barriers are still existing since even the small co-payment is daunting to low-income parents of large families. Provision of the public service is inadequate in some Arab villages.ConclusionsThe extension of Israel's National Health Insurance Law’s basket of services to include dental care for children, while important, is not sufficiently embraced by Israeli Arab children. The remaining barriers include poor living conditions, low educational level that requires very clear sharing of information about the new service, and the resistance of cultural and social traditions. Public dental services providers should focus on conveying relevant oral health messages to the parents too, either through their children or directly.

Association of Nationwide Water Fluoridation, changes in dental care legislation, and caries-related treatment needs: A 9-year record-based cross-sectional study

ObjectivesThe implementation of Nationwide Water Fluoridation in Israel in 2002 led to a significant reduction in caries among children. However, this practice was discontinued in 2014 due to a change in legislation. In 2010, as part of the Israeli National Health Insurance Law, free dental care for children under 10 years of age was legislated. This policy was gradually extended to include adolescents under 18 years of age in 2018. We examined the association between these efforts and changes in the caries-related treatment needs of young adults over the course of two decades. MethodsThis cross-sectional study analyzed data on the need for dental restorations, root canal therapy, and extractions that were retrieved from dental records of 34,450 soldiers recruited into military service between 2012 and 2021. These data were cross-matched with the subjects' year of birth to determine whether the implementation of water fluoridation, dental care legislation, or both were associated with changes in the need for and provision of dental care. Sociodemographic data, including sex, age, socioeconomic cluster (SEC), intellectual capability score (ICS), body mass index, and place of birth, were also extracted. ResultsA multivariate generalized linear model (GLM) revealed that male sex, older age, low ICS, and low SEC were significant predictors for greater caries-related treatment needs (P < 0.001). Our findings indicated that subjects exposed to fluoridated water during their childhood had significantly lower rates of caries-related treatment, regardless of access to free dental care. ConclusionMandatory water fluoridation was associated with significantly lower caries-related treatment needs while national dental health legislation providing free dental care to children and adolescents was not. Therefore, we suggest that water fluoridation should be continued to maintain the observed reduction in treatment needs. Clinical significanceOur findings provide support for the effectiveness of water fluoridation in preventing caries, whereas the impact of free dental care programs focused on clinical intervention remains to be determined.

Israeli Arab Independent Health Clinics: Personal Incentive Systems and Motivational Rewards

The Israeli healthcare system is a universal system, based on the National Health Insurance Law 1995 (NHIL), which mandates all residents in the country to join one of four official health insurance organizations, known as ‘Kupat Holim’ (HMOs). This resulted in an increase in the accessibility of health services and their distribution throughout the country. Lack of physicians, especially in the peripheries, and the competition to recruit clients forced HMOs to change and expand the concept of operating medical services. One way was to establish independent health clinics (IHCs). The current study focuses on a social and cultural phenomenon that was changed and expanded following the NHIL. The research literature lacks studies addressing IHCs in the context of the impact of the NHIL on Arab society. The research design is mixed methods with a qualitative stage followed by a quantitative stage. Specifically compiled research interviews and questionnaires were built to collect information. The main findings of the studies indicated that most physicians and managers recognized the NHIL and its contribution to the population. Addressing social and environmental rewards and deciding on moral rewards at an early stage anchored in the contract from the beginning was significant and strengthened the future of contracts between HMOs and self-employed physicians. Findings and conclusions of the study indicated a need to continue operating IHCs on condition they kept initial promises and provided feedback to physicians from time to time while improving terms of engagement, visits, and problem solving when needed in a timely manner.

A retrospective cohort study of pediatric hospitalization due to dentoalveolar infection before and after a change in national health insurance

This retrospective cohort study aimed to examine trends in pediatric (0–18 years old) hospitalizations due to dentoalveolar infection, before and after the inclusion of pediatric dental care in Israel’s National Health Insurance Law. Data were collected from the medical records of one oral and maxillofacial surgery department. Data were compared between patients hospitalized during 2002–2010 (group A, n = 531) and 2011–2019 (group B, n = 381). The mean age of the cohort was 8 years. A dentoalveolar abscess was the main cause of hospitalizations in both groups. Group B exhibited a higher rate of previous dental treatment in general (p = 0.001), and of previous dental treatment for the tooth responsible for the infection (p = 0.03). The prevalent treatment during hospitalization combined intravenous antibiotics and extraction, with or without drainage (58.1%) for group A; and intravenous antibiotics and drainage (49.4%) for group B (p < 0.01). Dental care provided by the Israel’s National Health Insurance should focus not only on operative treatment but also on oral health promotion and caries prevention, to reduce hospitalizations due to dentoalveolar infections.

Dental Services Utilization by over 65 Years Old in Israel in 2020

To understand dental service utilization in the over-65 age group and to identify the main patterns and barriers to uptake of dental care after the 2019 expansion under the National Health Insurance Law to include dental benefits&lt;span dir="RTL"&gt; for the over-75 age group. Phone interviews with a random sample of 512 people over the age of 65 were conducted between February and April 2020. About half had visited a dentist during the previous year (an average of 2.9 visits) while 17% reported they had never visited one. Dental service utilization was lower among those living in the periphery, non-Jews and those who had difficulties covering their monthly expenses. Treatment cost was the main barrier to dental treatment, especially for those with difficulties in covering their monthly expenses. Despite the inclusion of dental treatment for people over the age of 75 in February 2019, the majority of respondents were unaware of this reform, thus the potential of the over-75 age group in lowering the cost barrier has not fully materialized.

Public legitimacy of healthcare resource allocation committees: lessons learned from assessing an Israeli case study

BackgroundThe National Health Insurance Law enacted in 1995 stipulates a list of health services to which all Israeli residents are entitled. For the past 20 years, the list has been updated annually, as a function of a predetermined budget, according to recommendations from the Public National Advisory Committee (PNAC), which evaluates and prioritizes candidate technologies. We assessed the legitimacy of this resource-allocation process as reflected in Israeli public discourse and its congruence with the accountability for reasonableness (A4R) framework.MethodsA qualitative analysis of public discourse documents (articles in the print media, court rulings and parliamentary debates (N = 119) was conducted to assess the perceived legitimacy by the Israeli public of the PNAC. Further content analysis of these documents and semi-structured interviews with stakeholders (N = 70) revealed the mainstays and threats to its legitimacy. Based on these data sources, on governmental documents specifying PNAC's procedures, and on data from participant observations, we assessed its congruence with A4R’s four conditions: publicity, relevance, revision and appeals, regulation.ResultsThe PNAC enjoys ongoing support for its legitimacy in Israeli public discourse, which stem from its perceived professional focus and transparency. These strengths are consistent with the A4R’s emphasis on the publicity and the relevance conditions. The three major threats to PNAC's legitimacy pertain to: (1) the composition of the committee; (2) its operating procedures; (3) its guiding principles. These perceived shortcomings are also consistent with incongruencies between PNAC's work model and A4R. These findings thus further support the empirical validity of the A4R.ConclusionThe analysis of the fit between the PNAC and A4R points to refinements in all four conditions that could make the A4R a more precise evaluative framework. Concurrently, it highlights areas that the PNAC should improve to increase its legitimacy, such as incorporating cost-effectiveness analyses and including patient representatives in the decision-making process.Hebrew and Arabic abstracts for this article are available as an additional file.

PRIVATIZATION OF THE HEALTH SYSTEM

Foreword In this chapter we will discuss the privatization of the health system in Israel since the enactment of the National Health Insurance Law (hereinafter: Law) in 1995. As explained below, this law constitutes a nationalization of important parts of the health system. Therefore, when we consider the extent to which the health system is undergoing a process of privatization, it is important to distinguish between two questions: Have fields that were private before 1995 remained so? Has there been a setback in the scope of nationalization within the law and a greater role has been placed on the private sector?

Mechanisms for racial separation and inequitable maternal care in hospital maternity wards

Few studies have examined mechanisms of racial maternal separation (RMS) of birthing mothers in hospital maternity wards (MWs), and how separation might reinforce institutional healthcare racism and discrimination, leading to inequitable maternal care (MC). In Israel, while birth mothers report mostly pleasant experiences, RMS has become a matter of public debate. Although the Ministry of Health (MoH) condemns the practice, birthing Palestinian-Arab women have sued hospitals for discrimination after being assigned to separate MW rooms from other women. We drew on critical race theory (CRT) and intersectionality to uncover mechanisms for RMS and inequitable MC in hospital MWs at three levels—policy, practice, and women's experiences. In 2019–2020 we conducted 10 in-depth interviews with hospital directors (HDs) and 8 focus groups (FGs) with 40 midwives and nurses; then, in 2020–2021, we held 26 in-depth Zoom interviews with birthing women. Our findings reveal intersecting mechanisms for RMS through which structural racism and institutional discrimination outside hospitals in the form of ethno-racial residential segregation penetrate hospitals via women's requests to maintain separation in MWs. While all HDs opposed RMS and prized quality care, they instituted insufficient mechanisms to prohibit racial separation, which helped to institutionalize the practice. Commodification of Healthcare services (HCS) accelerates RMS as hospitals compete for funds derived from birthing mothers' care. Under the guise of cultural sensitivity and indirect pressure of hospital management, nursing staff comply with requests for RMS. Nurses assigned rooms based on stereotypical categorizations of women's group membership (ethno-national, religiosity level, class). RMS targeted mostly visibly religious Muslim Palestinian-Arab women. These mothers felt MC discrimination; others normalized RMS as preference. While the MoH cannot eliminate outside-hospital structural discrimination, more efforts should be made to eradicate inside-hospital RMS, as the practice violates the principle of universality enshrined in the National Health Insurance Law.

Oral health of the 65+ age group in Israel-2020

BackgroundIn 2019, a reform of dental services for older adults was implemented in Israel to improve access and reduce barriers that stood in their way. The reform stipulated that preventive and restorative dentistry would be included in the basket of services of the National Health Insurance Law. The current study was conducted by the Myers-JDC-Brookdale Institute (MJB) and the Division of Dental Health of Israel’s Ministry of Health to examine the dental status and patterns of utilizations of dental services among the 65+ age group. This paper reports on the dental status of the 65+ age group in comparison with the same population two decades earlier.GoalsTo describe the dental status of Israel’s 65+ age group, and to identify the population at risk of dental morbidity.MethodologyTelephone interviews were conducted with a representative sample of 512 older adults aged 65+, from February to April 2020.Main findingsSome two-thirds of the 65+ age group assessed their oral health as good or very good. Twenty-four percent did not have natural teeth, while the rest had 19 teeth on average. Ten percent had not lost any teeth. In the 65–74 age group, 19% had no natural teeth and the rest had 20 teeth on average. In contrast, in the 85+ age group, 38% were edentulous and the rest had 13 teeth on average. Of the older adults who found it difficult to cover their monthly expenses, 39% were edentulous—twice the percentage of those who did manage to cover their monthly expenses (19%). Of the 65+ age group 44% had dentures—37% in the 65–74 age group, and 66% in the 85+ age group. Approximately 40% of the 65+ age group saw a dentist for preventive check-ups. The rest did not, mainly due to lack of awareness of the importance of doing so.Conclusions and recommendationsThe perceived status of oral health among the 65+ age group is currently better than it was 22 years ago. However, despite the improvement in oral health and health behavior, there are still barriers to the utilization of dental services. The main barriers are a lack of awareness of the importance of proper health behavior, and the cost of care for people with financial difficulty. This study provides decision-makers with data on the status of oral health, the utilization of dental services and the geographical disparities. The findings will help policy makers evaluate the effectiveness of the reform and fine tuning it in the future. Policies should be instated to increase awareness of constituencies and their access to the services, in addition to the entitlements the reform granted.

Changes in the activity levels and financing sources of Israel\u2019s private for-profit hospitals in the wake of reforms to the public-private divide

BackgroundThe Israeli National Health Insurance Law provides permanent residents with a basket of healthcare services through non-profit public health insurance plans, independently of the individual’s ability to pay. Since 2015, several reforms and programs have been initiated that were aimed at reinforcing public healthcare and redressing negative aspects of the health system, and specifically the constant rise in private health expenditure. These include the “From Reimbursement-to-Networks Arrangement”, the “Cooling-off Period” program and the program to shorten waiting times. The objectives of this study were to identify, describe, and analyze changes in private hospitals in 1) the volume of publicly and privately funded elective surgical procedures; and 2) private health expenditure on surgical procedures.MethodsData on the volume and funding of surgical procedures during 2013–2018 were obtained from Assuta Medical Center, Hertzelia Medical Center, the Israeli Ministry of Health and the Central Bureau of Statistics. The changes in the volume and financing sources of surgical activities in private hospitals, in the wake of the reforms were analyzed using aggregate descriptive statistics.ResultsBetween 2013 and 2018 the volume of surgical activities in private for-profit hospitals increased by 7%. Between 2013 and 2017, the distribution of financing sources of surgical procedures in private hospitals remained stable, with most surgical procedures (75–77%) financed by the voluntary health insurance programs of the health plans (HP-VHI). In 2018, following the regulatory reforms, a significant change in the distribution of financing sources was observed: there was a sharp decline in the volume of HP-VHI-funded surgical procedures to 26%.Concurrently, the share of publicly-funded surgical procedures performed in private hospitals increased to 56% in 2018.,. During the study period, private spending on elective surgical procedures in private hospitals declined by 53% while public funding for them increased by 51%.Conclusions and policy implicationsIn the wake of the reforms, there was a substantial shift from private to public financing of elective surgical activity in private hospitals.Private for-profit hospitals have become important providers of publicly-funded procedures. It is likely that the reforms affected the public-private mix in the financing of elective surgical procedures in those hospitals, but due to the absence of a control group, causality cannot be proven. It is also unclear whether waiting times were shortened. Health reforms must be accompanied by a clear and comprehensive set of indicators for measuring their success.

The National Immunization Technical Advisory Group in Israel

National Immunization Technical Advisory Groups (NITAGs) are defined by the World Health Organization as multidisciplinary groups of health experts who are involved in the development of a national immunization policy. The NITAG has the responsibility to provide independent, evidence-informed advice to the policy makers and national programme managers, on policy issues and questions related to immunization and vaccines.This paper aims to describe the NITAG in Israel. The Israeli NITAG was established by the Ministry of Health in1974. The NITAG’s full formal name is “the Advisory Committee on Infectious Diseases and Immunizations in Israel”. The NITAG is charged with prioritizing choices while granting maximal significance to the national public health considerations. Since 2007, the full minutes of the NITAG’s meetings have been publicly available on the committee’s website (at the Ministry of Health website, in Hebrew).According to the National Health Insurance Law, all residents of Israel are entitled to receive universal health coverage. The health services basket includes routine childhood immunizations, as well as several adult and post - exposure vaccinations. The main challenge currently facing the NITAG is establishing a process for introducing new vaccines and updating the vaccination schedule through the annual update of the national health basket. In the context of the annual update, vaccines have to “compete” with multiple medications and technologies which are presented to the basket committee for inclusion in the national health basket. Over the years, the Israeli NITAG’s recommendations have proved essential for vaccine introduction and scheduling and for communicable diseases control on a national level. The NITAG has established structured and transparent working processes and a decision framework according to WHO standards, which is evidence-based and country-specific to Israel.The recent global COVID-19 pandemic is a major concern for all countries as well as a challenge for NITAGs. Currently, the NITAGs have a key role in advising both on sustainment of the routine immunization programs and on planning of the COVID-19 vaccination campaigns, with ongoing updates and collaboration with the Ministry of Health and health organizations.

OP230 How Legitimate Is The Process Of Updating the Benefits Package In Israel? A 20 Year Overview

IntroductionThe National Health Insurance Law enacted in 1995 stipulates a minimum list of health services (benefits package) that the four health plans in Israel have to provide to their members. The recommendations on which new technologies or new indications for existing ones should be added every year to the benefits package, subject to a predetermined budget, are made by a public committee that evaluates and prioritizes candidate technologies according to their clinical merit, economic (mainly budget impact), social, ethical and other aspects. We assessed the legitimacy of this coverage decision process over the past 20 years.MethodsThe legitimacy of the process was assessed by adherence to the conditions outlined in the accountability for reasonableness (A4R) framework. A4R defines four conditions for legitimate and fair healthcare coverage decision processes: relevance, publicity, appeals/reversibility, and enforcement. We reviewed the changes made in the coverage decision process over the past 20 years and examined whether these changes have changed its legitimacy.ResultsOur analysis suggests that despite several changes made over the years in the process for updating the benefits package, for example, increase in transparency, introducing a structured appeal process, it only partially fulfills the four A4R conditions. In order to accomplish these goals more fully, several widely used considerations such as cost-effectiveness analysis and incorporating views from patients should be included. Additionally, this decision-making process should become even more transparent than it currently is.ConclusionsThe annual process of updating the benefits package in Israel where hundreds of technologies are “competing” with each other for coverage under a pre-defined budget is unique and not without merit. This process has been operating in the same pattern with only minor changes made since 1999. The main barriers for fulfilling all A4R conditions may relate in part to the large number of technologies assessed each year within a short time frame. Several changes in the process including the assessment of societal values, involvement of diverse stakeholders including patient advocate groups should be made to improve its legitimacy.

Current Status of Cardiovascular Medicine in Israel.

Current Status of Cardiovascular Medicine in Israel.

AB038. Rare diseases are not orphans in Israel

: The big change in Israel accrued in 1995 with the ‘National health insurance law’. Since then every citizen is initialed to be insured in one of the 4 health insurance company. The law defines our basket that includes over 3,000 therapeutics. The cost is about 11 billion Euros. We update our Basket every year and everybody can apply. We add new orphan drugs to our basket almost every year. For example was approved in 2007 the drug Meyozyme for 21 patients with Pompe. The cost was almost 150 thousand Euros for each of them. We don’t have a price limit for a drug per person, as our law demand ‘mutual assistance’. In 2014 I had the honor to lead a committee set by our minister, for rare diseases in Israel. We discussed many aspects of the subject, including definition and wither we need a special law for rare diseases. We agreed about the need of a register and the minister of health office support and pay for it. We found that there is a big problem with genetics examinations; also it is in our basket since1995. We found that because of the high price of the new exams the health insurance companies are not very happy to provide them. We can’t pay the insurance companies for what we already paid and included in our Basket. As we understand that diagnosis is the basic for everything, the government decided to give an extra 9.5 million Euros a year for this purpose and we pay directly to the laboratories. We have some specialized medical services especially for rare and unique diseases. We found that, much less patients then expected come to these clinics. The peripheral areas where we know we have more patients is missing. We decided to finance 3 new clinics for rare diseases: 2 in the peripheral areas of the country and one in the center. Those clinics are not for one disease but for all the patients. They are multidisciplinary clinics with Drs. Nurses, therapeutic teams, social workers and genetic consultants. The health insurance companies must pay and send there every patient that known to have or has a question on having a rare disease, and wants to be diagnosed or treated there. I want to end with an example from our clinic in the north. The frequency of rare diseases in Israel is slightly higher than the frequency in Western countries because of the high incidence here of marriages between cousins in some of the populations. We have more than 1 million Muslim leaving at the north of the country. Many of them are marry in the family. A new recessive mutation will lead to many affected individuals families and even villages. We send our teams to the villages and they talk to the people. If they agree and want to be valuated we get an informed concern from them, they get the genetics consultation and tests with no charge and the government pays for it all.

Two-year supervised tooth brushing program evaluation in preschools in Southern Israel

Abstract Background Dental care for children was included into National Health Insurance Law in 2010 and eligibility age went up gradually to 18 in 2019, providing universal dental care. As a part of dental care reform, community based preventive School Dental Services were extended to preschool children. School dental service (SDS), funded entirely by the State, was extended to younger ages providing supervised tooth brushing module. The national supervised teeth brushing program (STBP) was first implemented in 2015-2016 amongst 3-4 year old children attending 600 nurseries in Israel. Due to the program’s success, it was gradually extended to more nurseries in low socio economic regions across the country, reaching 2200 settings in 2019. The objective of this study was to assess dental health among preschool children participating in the program during the last two years, comparing to those who did not. Methods Participant and non-participant kindergartens were randomly selected in Jewish and Bedouin Arab towns in the Southern district matched according to SES level. DMFT index measuring mean number of decayed, missing and filled teeth was recorded among preschool 5 years-old children. Results 283 children were examined, 157of them Jewish (86 participants in STBP, 71 non-participants) and 126 Bedouins (59 vs 67 respectively). Mean untreated carious teeth (d) was 1.15 vs 1.8 for Jews and 3.22 vs 3.9 for Bedouins. Percent of treated teeth within total caries experience index (f/dmf) was higher in tooth brushing group: 37% vs. 29% for Jews and 23% vs. 8% for Bedouins. Key messages Supervised tooth brushing shows favorable effect. Less carious teeth and more treated caries were recorded in STBP group.

Is the oral health reform in Israel optimally distributed? - A commentary

A traditional and ethical principle recognizes a country’s primary general welfare responsibility to the young and the old. However, the middle, adult, age group cannot and should not be disregarded. The current dental component of the National Health Insurance Law (NHIL), in Israel, only includes children and the elderly. The present commentary focuses on the large group of adults, age 19–74, which are currently excluded.The cumulative incidence of disease increases over the lifetime of a person. We believe that a NHIL commitment with a major age gap in coverage is unacceptable. The recent manuscript, published by Natapov et al., in this journal, has documented the overall dental health of the older Israeli population, with emphasis on nutritional aspects. This contribution to the literature is commendable. However, we aim to follow in the steps of the Alma Ata Declaration and Ottawa Charter of the World Health Organization (WHO) and to clarify that the government’s responsibility should cover all residents regardless of their age. In addition, a dental health epidemiological data base, currently nonexistent for adults, is called for.

The Politics of State Welfare Expansion in Africa: Emergence of National Health Insurance in Ghana, 1993-2004

After years of military rule, Ghana returned to democratic governance in January 1993. Since then, it has consolidated its democracy, evidenced by seven successive general elections, three alternations of power, and institutional actors using the rules of the game to pressure elected officials to influence policy development and implementation. This article examines the passage of massive state expansion of welfare legislation in 2003, the National Health Insurance Law (Act 650). I argue that not only was healthcare reform a salient issue in the 2000 general elections, the new law was the result of civil society and citizen pressure on the governing New Patriotic Party to fulfill its campaign promise to overhaul the country's healthcare system. This article contributes to the literature on the welfare state from the developing world, which mostly focuses on Latin America and Asia.