Health worker Q&A: Child dev. policy change

The Ministry of Health is committed to expanding child development services provided within the public healthcare system, with the aim of ensuring accessible, high-quality, and equitable care for the entire population and reducing the financial burden on parents. As part of implementing this policy, the budgets for the support program for expanding child development services provided through the health funds have been increased.

The program will be implemented gradually starting from February 1, 2026, until 2030.
As part of the reform, the reimbursement mechanism will be abolished, and treatments will be provided as part of the health basket. The provision of treatments will be accompanied by professional oversight and feedback questionnaires from patients.

This move comes after the completion of a consultation process and public engagement, and an in-depth discussion of all comments raised regarding the change in the reimbursement policy for child development, placing the well-being of children and families at its center, and aiming to create a more equitable, efficient, and accessible system that gives every child a fair opportunity for optimal development.

As part of the reform, will the staffing levels be increased and new positions added? Will appropriate treatment rooms be budgeted for?

The change in policy is intended to expand developmental care within the public system. To this end, a substantial increase in staffing levels within the health funds is required. All health funds have removed restrictions on recruiting therapists and have opened all positions. In addition, the need for infrastructure, such as treatment rooms, is recognized. To this end, the support program for health funds has been updated, and an additional NIS 50 million has been added to its previous budget.

Will the conditions for therapists change accordingly?

Therapists’ salaries are a central component of the process. The recently signed salary agreements for healthcare professions include a retention bonus and a position expansion bonus, which will improve salaries in healthcare professions for employees in health funds and government hospitals. It is important to emphasize that working in the public sector has many advantages beyond salary – such as training, professional development, and multidisciplinary teamwork – thanks to which the public service in Israel is among the world leaders in child development.
To date, health funds have expanded their workforce in the field by 7%–11%, and they continue recruitment processes and expanding agreements with suppliers.

How do the new salary agreements in healthcare professions – occupational therapy, speech therapy, physiotherapy, and nutrition – manifest in the change of reimbursement policy?

The salary agreements are intended to strengthen the response provided within the public system by offering incentives to professionals to increase their employment scope and maintain employment continuity within the public framework. The change in reimbursement policy is intended to bring child development services back to the public system, and the salary agreements are a complementary step supporting the policy change, so that there will be more therapists in the public system who can provide services.

How is the developing initiative expected to strengthen the public service?

The existing reimbursement policy strengthens the private market, thereby increasing the cost of child development treatments for families who need them. A gradual reduction of the reimbursement policy, combined with the new salary agreements and the increased budget for the support program for health funds, will allow health funds to recruit additional therapists, and will enable families to receive treatment within the public system. When more patients receive care in the public sector, alongside the improvement in employment conditions, more therapists will be interested in working in the public sector.

What is the difference, from the perspective of professionals, between the current initiative and the attempt to implement a similar initiative in 2020?

Unlike the initiative undertaken in 2020, which was carried out without adequate budgetary infrastructure and without accompanying salary increases for healthcare professions, this initiative involved extensive work by the Ministry of Health, including:

• A new salary agreement that allows for salary increases for healthcare professionals in the public system.
• Implementation of the Prime Minister’s report on healthcare professions, including increasing the number of academic places for undergraduate studies in healthcare professions, and increasing the training rate in clinical fields. 
• An additional budget of NIS 50 million for the support program for health funds.
• A Ministry of Health directive on minimum requirements, which mandates work within the public system to receive reimbursement for treatment.

Within the new framework, will individual treatments be provided to the public, and not just remote parent training or group therapies?

The Ministry of Health emphasizes that individual therapy, group therapy, remote therapy, and parent training are important tools in the professional’s therapeutic toolkit, and their use should be adapted to the child’s needs with professional discretion.

Parent training, remote therapy, or group therapy are excellent treatment methods when done according to professional judgment, and it is important to integrate them according to the needs of the child and their family. Alongside this, children will continue to receive individual therapy without change.

Will the accessibility and availability of treatment be ensured within the change, especially in light of the long waiting times currently existing in the public system and the importance of rapid response in early childhood?

The long waiting times in the public system are due, among other things, to the existence of many reimbursed treatments, as many therapists currently work in the private sector to increase their earning potential. Shifting treatments from the private sector to the public system, along with improving the salaries of professionals in the public system and establishing a new regulatory condition for working in this system before receiving reimbursement recognition, will increase the number of therapists in the public system and over time will reduce waiting times for treatment and increase access to care.
As a complementary step, an initiative to integrate digital technologies for appointment management and to reduce the phenomenon of “No-shows” (confirming an appointment and not attending it) in the public system is currently being promoted, which is also intended to increase service availability. 

We emphasize that health funds are compensated within the framework of the support program for increasing contacts for subsidized treatments. As a result, the funds are required to increase manpower and subsequently reduce waiting times. The Ministry of Health will conduct continuous and frequent monitoring of waiting times and will ensure that they do not lengthen compared to the corresponding period in the preceding year.

How does the change ensure that the quality of treatment will not be compromised and that its personal suitability for children’s needs will not be compromised?

Public treatment in the field of child development in Israel is based on research evidence and is personalized for each child according to their needs. The Ministry of Health has directives and procedures for healthcare professions in child development, which define for service providers the duration and treatment tools that allow for maximum professionalism in a child and family-centered approach. Unlike the private sector, which is not under supervision, services in the public sector are under constant supervision by both the responsible professional bodies in the health funds and the Child Development Department at the Ministry of Health, which conduct weekly inspections at child development institutes and units. The quality and duration of treatment will continue to be subject to professional judgment, and the Ministry of Health is responsible for its supervision.

The public healthcare system in Israel is not a private system and does not allow for the selection of a therapist. However, the child development system consists of approximately 160 institutes and units across the country, allowing parents to choose a treatment location recognized by their health fund that is accessible and suitable for the child’s needs. As we strengthen the public service, its reach will increase, and parents from all segments of the population will have a wider choice of high-quality and accessible treatment locations.
Regarding the necessary training and development of services for treating specific populations, health funds will be required to develop services for these populations so that care is provided within the public system, as the abolition of reimbursements will be carried out gradually, and health funds will have a preparatory period for this.

How will treatment continuity be maintained for patients already undergoing treatment with private therapists, during the transition to the new format?

In order to maintain treatment continuity, a child currently receiving reimbursed treatment will continue to be treated by the same private therapist. In the final stage of abolishing reimbursements in 2030, health funds will be required to provide subsidized treatment for all patients, including those already receiving reimbursed treatment, but health funds will have sufficient time to prepare for this, including planning for optimal “handover” from the reimbursed therapist to the subsidized therapist or the absorption of the reimbursed therapist into the health fund for the purpose of providing subsidized treatments.

It should be noted that following comments from professional associations, the Ministry of Health has clarified in the directive abolishing reimbursements the definition of a new patient, so that a new patient will be defined as a patient who has not received reimbursed treatments from healthcare professionals, social workers, and psychologists in the same field in the past year. In addition, it was clarified that approvals for reimbursed treatments granted to patients after the date of the directive’s publication will not be considered new patients if they are implemented by 01/01/2026.

Can you detail how the change will be implemented for unique populations – such as autistic children and children with somatic conditions, who require personalized interventions? 

In the first stage, these populations are not included and will continue to be treated with reimbursement.
Concurrently, health funds will develop dedicated services for this population by training therapists for children up to age 18, and will sign agreements with recognized suppliers who are skilled in providing these services. After the establishment of the appropriate infrastructure within the health funds, these populations will also receive services as required by the National Health Insurance Law by the health fund or a contracted provider on its behalf.
Attached is a summary table of the reform’s implementation stages:

What metrics will be used to evaluate the success of the reform, and how will its impact on treatment quality be assessed?

To evaluate the success of the reform and its impact on treatment quality, the following metrics, among others, will be examined:

• The scope of treatments provided within the public system compared to the average in previous years, including a distinction between treatments provided by the health fund and treatments provided by contracted suppliers.
• The number of treatments that continue to be provided through reimbursements.
• The number of professionals in the public system and their scope of employment.
• The distribution of services and professionals by region in Israel.
• Average waiting times from the opening of a file at the health fund until the first diagnosis, and until the first treatment for each profession a child requires.
• Waiting times by different professions and different regions in Israel.

Will an external supervision mechanism be implemented to monitor the implementation of the reform in the health funds?

The Ministry of Health conducts ongoing inspections of the activities of health funds, both proactively and through surprise inspections. As part of these inspections, data will be collected on professionals and their scope of employment, as well as on the number of subsidized and reimbursed treatments across the country.
In addition, the Ministry is working to establish a methodology for measuring waiting times, in cooperation with professional bodies. Waiting time measurements will be carried out according to the established methodology, and health funds will develop the necessary reporting mechanisms for this purpose. The Ministry will continue to closely monitor the progress of the phases, with health funds presenting data on the quantity of treatments and therapists in each district, by profession, and in comparison to the corresponding period in the previous year. 
In addition, a questionnaire will be published for patients to fill out, through which families can directly report to the Ministry on waiting times for diagnosis and treatment, and on responses they received during the waiting period, so that the Ministry will have an additional data source beyond that of the health funds.

Will the new salary agreements also apply to therapists employed by local authorities?

The new salary agreement, similar to other salary agreements, is made with health funds and government hospitals only. Bodies not supervised by the Salary Commissioner have full flexibility in determining therapists’ salary conditions and are entitled to adapt their conditions to the new salary agreement, but are not obligated to do so.

Will an exceptions mechanism be implemented to allow for adjustments in special cases?

Health funds will continue to exercise professional medical discretion in accordance with the Ministry of Health’s policy and the health basket’s regulations. Within this framework, funds will be able to provide solutions in exceptional cases, prioritize patients requiring urgent treatment, and provide tailored solutions for children with complex or unique medical needs. This policy is intended to ensure that every patient receives medical care tailored to their needs, with sensitivity to medical and personal complexities. 

Concurrently, a dedicated monitoring committee headed by the Director-General of the Ministry of Health, including representatives from health funds, hospital institutes and units, as well as representatives from organizations, associations, and parent organizations, is accompanying the implementation of the initiative.

How will the reform support municipal units in case therapists move to work in health funds due to the salary agreements, and will they receive appropriate budgetary support?

The support program for health funds encourages providing treatments within a single framework, as well as contracting with “registered suppliers,” which include municipal units. In addition, the Ministry of Health is working with the Ministry of Finance to ensure budgetary support for the activities of municipal units, as an integral part and a necessary condition for the success of the reform.

The Ministry is considering the possibility of making adjustments to the support program for 2026, so that it better addresses the needs of municipal units.

Is broad inter-ministerial thinking being conducted to prevent therapists from moving between different public services?

The Ministry of Health has begun joint work with the Ministry of Education and JDC Israel, in order to address cross-cutting issues concerning therapists moving between public services.

Therapists Ask – We Answer: The Reform in Child Development Services