Dentists say their service is under-funded and poorer people and children are suffering from new cutbacks, writes RONAN MCGREEVY.
OF ALL THE sectors affected by cutbacks in health, few have received as little attention as the dental service. Though dental treatment can be acute for a patient with a bad toothache, the service is not regarded as being frontline and rarely becomes a political issue except in the case of specialist orthodontic treatment for children.
A submission by the Irish Dental Association (IDA) on how to fund dental services in the future says the service has been underfunded historically and is even more so now given the new financial realities.
The submission has been made to the expert group on resource allocation and financing in the health sector which was set up earlier this year by Minister for Health and Children Mary Harney to assess value-for-money in the health service. It is also looking at how best to finance the health service.
The group, to be chaired by ESRI director Prof Frances Ruane, has been asked to report to the Government by April next year.
The IDA points out that as far back as 1979, the Joint Work Party on Dental Services identified inadequate provision for dental care. It has long contended that the money paid by the Government for treating patients with medical cards, about 30 per cent of the population, is inadequate and getting worse.
It says oral hygiene problems primarily affect under-privileged groups. As a consequence of a lack of investment in prevention, resources instead have to be primarily allocated to emergency oral care and pain relief.
Because prevention ultimately costs less than the cure, the IDA has called for the public dental services to be exempted from the HSE moratorium on recruitment.
The IDA describes funding through the Dental Treatment Benefit Schemes (DTBS) as working well and being administered efficiently. This is the one available to workers who pay PRSI and their spouses and is claimed by 45 per cent of adults.
The Dental Treatment Services Scheme (DTSS), which is provided by the HSE and offers dental care to adult medical-cardholders, covers about 30 per cent of adults.
For a long time it has been a source of conflict between dentists and the Government. Dentists have claimed it costs them to treat patients. The IDA report pulls no punches describing the scheme as seriously under-funded and on the verge of collapse in many areas. A third of all GP dentists are not participating in it.
The current situation has resulted in huge disruption for patients, dissatisfaction among dentists and intolerable pressure on public dental services, it says.
At the moment dentists have to contend with a double-whammy. The Government has cut the fee it pays dentists for treating medical card patients by 8 per cent, as it has done for many professions providing services to the state.
Private patients are postponing expensive elective treatments such as crowns and bridges because of the costs involved.
The IDA estimates that for the first two months of 2009 alone, dentists’ incomes were down by 11 per cent on average, though many in the profession say it is closer to 20 per cent.
Dentists may not be regarded by the public as one of the professions particularly hard done by in the recession, but IDA chief executive Fintan Hourihan said dentists are suffering from falling revenues while their cost base remains the same.
“Dentists would be generally regarded as having a good income; they would be seeing a rapid deterioration in it in very recent times,” he said.
One of the things which is not fully understood is the cost of being a dentist, he said.
“The dentist fully funds his own surgery and the fees that they get from the Government, €55,000, is only a quarter of that given to GPs. We have commissioned research which shows that for many items covered by the medical card, the fees do not meet the costs of the treatment,” he said.
David McCaffrey, an accountant with Med Account who works with a number of dentists, said the average dental practice turns over around €320,000 a year. That gives dentists a taxable income of between €100,000 and €140,000 a year.
He estimates that their revenue will be down by 15 to 20 per cent this year.
“It is hard work and there is a lot of stress in the profession. The overheads tend to be fixed so they are very sensitive to any decrease in income. It is going to have a detrimental effect on the bottom line,” he said.
The fixed costs include wage bills, energy and rental of a premises. “They have a lot of equipment to finance,” he said.
Dr Maurice Quirke, a dentist in New Ross, Co Wexford, said dentists’ incomes are down by between 15 per cent and 40 per cent and the biggest decreases are in poorer areas.
Quirke said elective procedures are very much down, as patients put off work that is not absolutely necessary.
“It is not rocket science to state that when people are feeling the pinch, they cut the things that they feel are discretionary. Some of the more advanced cosmetic procedures could be regarded as discretionary, but your routine dental treatment such as fillings and cleanings should not be regarded as discretionary,” he said.
Quirke said it does not pay dentists to treat medical-card patients and he said the Government must go beyond citing the Competition Act as a reason for not negotiating fee increases with dentists.
“The tin hat was put on this with the emergency measures which essentially have given dictatorial rights to any minister who is in the chair at the time,” he said.
“If you were 100 per cent in public dentistry, you may as well close the door. Reducing the level of private dentistry means our profit margins are goosed,” he said.
“I absolutely appreciate that times are difficult for everyone. We would like to be in a position where we can at least discuss the problem and we have not been able to do that for three years.”
Hourihan acknowledged looking for extra resources now is problematic but he says the thrust of the IDA submission is to make more efficient use of existing resources.
The IDA has called for the immediate appointment of a chief dental officer to direct services throughout the country.
It says investment in ICT (information and computer technologies) and better monitoring of at-risk patients can save money without costing the State.
“If you build the capacity to bring in better services, if you bring in better management and leadership of the services, the vast majority of what we are proposing would lead to better management of the services.
“We could just have said that we wanted X million more into the service,” he said.