背景:2010年《国家健康保险法》儿童牙科保健改革通过建立儿童牙科保健的全民健康覆盖,标志着以色列口腔保健系统的转折点。最初,这项改革包括8岁以下的儿童,并在2019年逐步扩大到18岁。服务篮子包括四个健康维护组织(HMO)提供的预防性和恢复性治疗。这项研究的目的是检查在改革的第一个十年中对儿童牙科服务的吸收。
方法:进行回顾性分析,以确定治疗摄取,根据HMO在2011-2022年向卫生部提交的年度服务利用报告,提供的服务类型和数量。
结果:参保儿童人数从2011年的1,546,857人增加到2022年的3,178,238人。在研究期间,牙科服务的摄入量逐渐增加,2020年略有下降。使用服务的儿童比例从8%逐渐增加到33%,逐步纳入额外的年龄组。从2012年起,最常见的治疗方法是预防性的,然而,最常见的治疗是牙科修复。2022年,以色列35%的人口年龄在18岁以下。在这些中,大约三分之一的人通过HMO接受了牙科治疗。这是一项重大成就,在改革之前,所有的治疗都是自付的。在短时间内增加摄取后,一个稳定的服务利用模式很明显,可以表明更好的公众意识和服务接受度。
结论:虽然这是一个合理的吸收,需要作出更多努力,以增加在公共保险范围内接受牙科护理的儿童人数。这种努力可以是多学科方法的一部分,儿科医生和公共卫生护士可以在预防龋齿方面发挥重要作用,增强意识和服务利用率。
BACKGROUND: The 2010 Child Dental Care
Reform of the National Health Insurance Law marked a turning point in the Israeli oral healthcare system by establishing Universal Health Coverage of dental care for children. Initially, the
reform included children up to age 8 and gradually expanded to age 18 in 2019. The basket of services includes preventive and restorative treatments provided by the four Health Maintenance Organizations (HMO). The aim of this study was to examine the uptake of child dental services during the first decade of the
reform.
METHODS: A retrospective analysis was conducted to determine the treatment uptake, type and amount of the services delivered based on annual service utilization reports submitted by the HMOs to the Ministry of Health in the years 2011-2022.
RESULTS: The number of insured children increased from 1,546,857 in 2011 to 3,178,238 in 2022. The uptake of dental services gradually increased during the study period with a slight decrease in 2020. The percentage of children who used the services gradually increased from 8 to 33%, with the incremental inclusion of additional age groups. From 2012 onwards the most common treatments provided were preventive, however the single most common treatment was dental restoration. In 2022 35% of the population of Israel was under the age of 18. Out of these, about a third received dental treatment via the HMOs. This is a significant achievement, since before the
reform all treatments were paid out-of-pocket. After a short period of increasing uptake, a stable service utilization pattern was evident that can indicate better public awareness and service acceptance.
CONCLUSIONS: Although this is a reasonable uptake, additional efforts are required to increase the number of children receiving dental care within the public insurance. Such an effort can be part of a multi-disciplinary approach, in which pediatricians and public health nurses can play a vital role in dental caries prevention, enhancement of awareness and service utilization.