A retrograde and small-minded step for the dental profession

On 16 July, the report from the Special Group on Public Service Numbers and Expenditure Programmes (An Bord Snip Nua) made a recommendation to suspend the Dental Treatment Benefits Scheme with a purported saving to the Exchequer of €92 million per annum.

As I write this article a few weeks later, my initial shock on hearing the proposal still hasn’t abated.

In 1978, Charles Haughey TD, Minister for Social Welfare, in response to a question from Dr John O’Connell TD, stated that the World Health Organization’s ideal dentist-to-patient ratio of 1: 2,000 would require 1,560 dentists in the state. In 2009 there are 1,100 private dentists, of whom 90% participate in the scheme, giving 990 dentists. With the population increase we are clearly still below the ideal ratio.

Currently, over 55% of adults are eligible to receive care under the scheme. It is important to remember that this is a social insurance arrangement whereby eligible persons are entitled to certain benefits as a result of their contributing to the scheme (the scheme requires people to pay into it for a specified amount of time before they are eligible to participate).

In 2008, two million people were eligible to avail of the scheme but only 400,000 people were actually treated. As such the Government collected more money than was spent.

A brief history
The origins of the scheme date back to the National Health Insurance Act of 1911. However, the scheme as we know it dates from 1960, one year before I was born!

Following on from the dispute in 2002, on 24 February 2003 Minister Mary Coughlan stated: ‘I have rejected efforts that would have undermined the dental treatment scheme and led to the introduction of private fees for the full range of treatments’.

Part of the resolution of that dispute included a 15% discount to the Government on the private fees for the new Dental Treatment Benefits Scheme (DTBS). Both this discount and the previous statistic of too many patients per dentist show that the Government is getting a great deal in this scheme, and great value for the service we provide to our patients.

On 5 June 2005, the scheme was extended to allow treatment to be provided in other EU states, effectively depriving the state of the tax take on the treatment.

What next?
When it comes to tackling the report from An Bord Snip Nua, our initial approach must be to recognise that this is merely a recommendation, but the Government believes it will need to act on all such recommendations in order to restore the public finances.

It behoves us individually and as a profession represented by the Irish Dental Association (IDA) to oppose this draconian proposal. The ditching of a 50-year-old scheme that has resulted in excellent oral health would be a retrograde step.

We, as individuals, need to arrange to meet with our local public representatives and impress upon them that the introduction of private dentistry will result in the public putting off care, with a resultant demise in oral and general health. We need to impress upon them the job losses that will result in all our surgeries, because we will be forced to lay off associates, hygienists and ancillary staff, as well as the implications of this on the unemployment register.

The IDA will investigate the legal implications of the Department unilaterally cancelling our contracts, as well as the loss of revenue to the Government, plus the resultant tax loss from the inevitable redundancies together with the added cost of unemployment benefits.

The assertion that €92 million will be saved in this way is puerile and must be shown to be strongly refuted and logically inaccurate, so that any fulfilment of the recommendation by An Bord Snip Nua is clearly demonstrated to be a retrograde and small-minded step.

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