Should we pay more for dentistry?

Interesting piece by Prof Jimmy Steele on the BBC website.

Professor Jimmy Steele, author of the Government’s last dental review, says the over 40s are straining the NHS dentistry budget.
Many of the complex procedures they want, like root canal and crowns, are not really “needed” and higher patient charges may allow the NHS to provide a more extensive service to a larger number of people.
So what does NHS dentistry do for you?

“Not enough” might be the response, both from aspiring NHS patients and some NHS dentists.
Health planners might take a different tack and answer “too much of the wrong sort of stuff”.
Lets ask the question again, in a different way.
What does NHS dentistry do for the citizen?
For those who choose to and can access services, it provides free dentistry, for some, and a slightly subsidised service for the rest.
The service is not truly comprehensive, but when delivered in the spirit of the dental contract it can still cover a wide range of care.
So far so good, but it does something else which is much less obvious.
By setting both the prices for consumers and the pay rates for dentists it keeps the lid on costs and prices.

Much of the strain on the system comes from those of us aged over 40 (myself included).
You may beg to differ, but check out some private rates for crowns or root treatments, or for that matter the cost of care or insurance amongst many of our comparator countries.
Some people would argue that this control of price is at the cost of quality.
So we may be cheap, but could we be more cheerful?
The problem is this.
If NHS dentistry is to be available to all who want it (which is the aspiration if not always the reality) and if it is even to approach being “comprehensive”, there has to be enough money to spread around.
There is more spending on NHS dentistry than ever before, but if the money going in (£2.3bn from the taxpayer for England, plus around £0.5bn from patients) gets too thinly spread, the attempt to provide everything to everybody fails as both dentists and patients move out of the service or new technologies are not adopted.
For example, implant care has never really been adopted by the NHS, whilst access to other complex treatments is sometimes restricted by the dentist at the point of delivery, particularly if the incentives are deemed inappropriate.
Much of the strain on the system comes from those of us aged over 40 (myself included).
We are a demanding but technologically aware bunch of ageing baby boomers.
Our high disease, high treatment (courtesy of the NHS) past is catching us up, our maintenance costs rise every year and we would quite happily consume everything that the taxpayer could throw at us to save our progressively damaged dentitions from failure and our collective horror at the prospect of dentures.
As we age there are some tough choices about the filling of the inevitable and growing financial cavity, excavated by a combination of demographics, expectation, technological possibility and a limited budget.

So that leaves us with the rather awkward prospect of higher patient charges within the NHS as a way of keeping a broad dental healthcare system viable.
Tighter controls and more efficient incentives are essential, but in the long run may not be enough to preserve the principles of universality and comprehensiveness which are under strain.
We could restrict access to the service or the range of services provided.
This would be obvious and easy, but unfettered health markets don’t work well for the citizen, as President Barack Obama would testify.
Turning parts of our previously managed dentistry out to the entirely free market might be good for dentists pockets, but the experience of other systems would suggest it could be divisive and very expensive for the citizen – not really a vote winner.
By keeping to a tight budget it may cost a lot elsewhere.
So that leaves us with the rather awkward prospect of higher patient charges within the NHS as a way of keeping a broad dental healthcare system viable.
Higher costs for prevention and dental disease management, a basic part of health, may not be good for the nation’s health either.
But the concept of need is tricky in dentistry.
Many of the more complex procedures such as root treatments and crowns are not really “needed”, you can survive and function without them, and they are subject to big variations in personal valuation.
What would you be prepared to pay to save a tooth if the alternative is extraction?
Higher NHS patient charges applied selectively may allow the NHS to provide a more extensive service to a larger number of people.
They would be unlikely to approach private fees and may be the lesser and least costly of several competing evils.
First we need to tighten up what we have, but if we can get that right there may still be tough decisions.

Published by Alun Rees

Dental Business Coach. Analyst. Troubleshooter. Consultant. Writer. Presenter. Broadcaster.

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