Consumers are paying too much for dental services because competition is restricted and discouraged by an outdated system of regulation, according to a new report on the profession from the Competition Authority.
Major reforms are needed to ensure consumers have more choice in choosing dental services and to ensure there is an adequate supply of dentists and orthodontists, the report states.
Dentists are not allowed to advertise their prices, offer discounts or canvass for each other's business, it notes. Meanwhile, Irish consumers do not have the option, available in many other countries, of going directly to a dental hygienist or technician for dental hygiene services or dentures.
"Consumers are paying too much for dental services in Ireland. This is not surprising given the rules that are currently in place," commented Bill Prasifka, chairman of the Competition Authority.
"Consumers are in the dark when it comes to shopping around for a dentist. Why shouldn't dentists advertise and compete on the same terms as any other business?"
The Irish Dental Association gave the report a guarded welcome but cautioned against applying a purely economic approach to healthcare issues. "While we will endorse any responsible proposals to encourage competitiveness within the profession, we must ensure that any changes do not prioritise competitiveness over professionalism," said chief executive Ciara Murphy.
The association welcomed recommendations that more dentists and orthodontists be trained each year as well as proposals to broaden the practice of dental hygienists and technicians. "However, any changes [to the work of hygienists and technicians] should be matched with appropriate technical qualifications and training to ensure patient safety and standards are maintained," Ms Murphy said.
The Dental Council, which is composed entirely of dentists and their educators, said it would give the report due consideration but many of the proposals would need legislative change. The report shows the cost of going to the dentist has increased massively since 1990; up 171 per cent, compared with 69 per cent for general inflation and 147 per cent for health costs.
Although 80 per cent of the population is entitled to a free examination and clean yearly, only 44 per cent visit the dentist at least once a year. Yet the State still spent more than €105 million on dentists' services in 2005.
The report says the regulatory system for the profession needs to be reformed. The requirement for consumers to visit a dentist for all their dental services is outdated, while restrictions on advertising deny consumers access to basic information. Ironically, dentists in the Republic are at a competitive disadvantage vis-a-vis dentists in the North and elsewhere, who can advertise freely.
The Dental Council does not have strong powers to pursue those practising dentistry illegally in Ireland, and it must wait until damage is done to a patient before it can act, the report notes. There are no regular checks on the standard of dental services. The authority says there are insufficient dentists and orthodontists to meet demand.
The average income of dentists is €117,000 a year and of orthodontists, €280,000.
Dental work home and abroad: indicative prices
Crown
Dublin €600
Munich €550-590
Ceramic inlay
Dublin €650-750
Budapest €550
Munich €490-590
Implant and crown
Dublin €900-1,200
Munich €700-1,100
Three-point bridge
Dublin €2,100-2,500
Munich €1,500-2,000
Competition Authority report: main recommendations
• a new profession of advanced dental hygienist should be created, and allowed to operate independently of dentists
• the Department of Health should review the number of training places for dentists to see if it needs to be increased
• the ban on discounts by dentists should be ended
• the Dental Council should be reconstituted so that a majority of members come from outside the profession
• dentists should be allowed to advertise
