There are various problems associated withan open market, which would remove the NHS status of some dental patients andencouraging patients to take dental insurance. This would essentially compelmany patients to seek private dental care. There are n...
There are various problems associated with an open market, which would remove the NHS status of some dental patients and encouraging patients to take dental insurance. This would essentially compel many patients to seek private dental care. There are numerous problems with the private dental sector, which include the lack of competition in the market. At the moment, there is a wide variation in cost for seemingly comparable services in a market, indicating that charges levied are not governed by the prices charged by other suppliers or by the costs of doing business, and therefore it can be concluded that the market is not subject to effective competition. This is a major problem for patients, as they are often overcharged for oral care, which could be reduced by effective competition between private dentists.
Secondly, there is a lack of price transparency in the private dental market. Price transparency is essential to enable consumers to make rational choices between
dentists and types of treatment on offer. It is a prerequisite for effective competition
either between private dentists or between NHS and private treatments. There is a need for further investigation into the availability of price information for private dental treatment. A Warwickshire Trading Standards Service (WTSS) survey found that only two out of 20 dental practices provided a list of prices that was made available to private patients. The relevant authorities must address this problem, in order to allow patients to have a comprehensible choice between dentists.
A further problem with the private dental sector is a failure of new entry to the market for private dental provision, which could bring down prices. In many markets new entry imposes a competitive restraint on the behaviour of suppliers. However, in the private dental sector, the entry of new high street dental chains and the fact that this has not resulted in a reduction of charges or greater price transparency in private dentistry. While there has been some new entry into the sector, this has been at a time of growth in the demand for private dental treatment, which is, at least in part, related to the difficulty in some areas of the country in obtaining NHS treatment. There has also been some growth in demand for cosmetic dentistry (such as tooth whitening) and this forms a larger part of the work of some dental chains than general dentistry. Such chains may not therefore be in direct competition with other dentists in the same locality. Despite some increase in the number of outlets operated by dental chains, a significant growth in supply of dental services by corporations has been prevented by dental legislation, which restricts entry to those corporations that were incorporated before 21 July 1955. As a result, there are only 27 dental corporations. The Department of Health (DoH) has indicated that it will abolish this manifest restriction on competition. This will open the market to potential new service providers.
While the proportion of private dental treatment provided under capitation schemes has increased (now accounting for almost one fifth of private dentistry), it is not clear whether this has improved competition. Capitation schemes are a type of dental insurance plan involving a scheme provider, which collects regular monthly payments from individual dentists' patients registered under the scheme and makes payment to individual dentists for treatment undertaken. Such schemes are primarily concerned with the method and process of payment for treatment, rather than the provision itself.
Capitation schemes may have had the effect of increasing the amount of ...
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While the proportion of private dental treatment provided under capitation schemes has increased (now accounting for almost one fifth of private dentistry), it is not clear whether this has improved competition. Capitation schemes are a type of dental insurance plan involving a scheme provider, which collects regular monthly payments from individual dentists' patients registered under the scheme and makes payment to individual dentists for treatment undertaken. Such schemes are primarily concerned with the method and process of payment for treatment, rather than the provision itself.
Capitation schemes may have had the effect of increasing the amount of private treatment, as dentists might have found it easier to get patients to switch from their previous arrangement, where they can offer this by means of a regular monthly payment. It is possible that capitation schemes could in future constrain dentists' fees through buyer power exercised by the providers of such schemes, and this must be examined in more detail by the Department of Health.
An additional problem is the impact that the lack of access to NHS treatment would have on competition in the provision of private dental treatment. In principle, NHS treatments could act as a constraint on the prices charged for private dentistry, although this depends on the patient having access to the appropriate NHS treatment. In many areas of the country, reduced access to NHS treatment is likely to have decreased the competitive pressure on private dentistry. Where there are limited competitive pressures from NHS dentistry, effective competition between dentistry suppliers becomes all the more important for consumers. The increasing demand for private dentistry results in part from many dentists no longer taking on new NHS patients and no longer treating adults on the NHS. A survey undertaken by the British Dental Association in 1993 found that 75 per cent of dentists in the General
Dental Service received at least three-quarters of their income from the NHS, and just twelve per cent received less than a quarter from that source. By 1999, those figures had changed to fifty eight per cent and eighteen per cent respectively. Such figures demonstrate the extent to which dentists are now spending their time providing private treatment. In the DoH strategy paper on dentistry, 'Modernising NHS Dentistry' (September 2000), it was stated that at that time approximately one third of Health Authorities reported serious problems in finding dentists for at least some of their residents. Research published in the British Dental Journal in February 2001 provided further evidence of access problems in some parts of the country. This research indicates wide regional variation in the proportion of private treatment. The median percentage of private patients was around 50 per cent in the south east and south west, 30 per cent in London, 20 per cent in the West Midlands and eastern counties and less than 10 per cent elsewhere. Although there has been some improvement in the level of access to NHS dental treatment, the fact that some patients are unable to obtain NHS treatment does nevertheless increase the importance of ensuring effective competition in private treatment. In light of these problems, it would be unfavourable to employ an open market, which would remove the NHS status of some patients and encourage patients to take out dental insurance.
The present NHS dental system consists of a two-tier system, consisting of the NHS and private dental care. This system has caused various problems, notably with the provision of NHS dental care. This has led to an overwhelming 28 million adults and 4 million children who do not have access to an NHS dentist, and this problem was highlighted in February 2004, when hundreds of people queued from before dawn to register at a NHS dental surgery in Scarborough. This makes it evident that a major overhaul of the present system is required, in order to allow all UK citizens to have adequate and affordable access to dental care.
There are various predicaments faced by the present two-tier system. These include NHS remuneration and funding. In both primary and secondary care sectors there are serious shortfalls in funding. The funding for the provision of NHS dentistry in all sectors must be increased substantially. Specifically, the British Dental Association believes that the cost of funding the NHS General Dental Services at the current level of provision of service should be in the region of £520m, and any new funding system must offer flexibility and suit the needs of the patient. It should also provide proper incentives for dentists and discourage the treadmill work pattern. Furthermore, the bureaucracy surrounding fees is complex and is difficult to negotiate for both dentists and patients.
Secondly, there is a shortage of trained dentists, as well as dental nurses, dental hygienists, dental therapists and dental technicians. There is also inadequate provision and distribution of specialist and consultant services in the dental sector. This has led to major problems as the need to deliver high quality oral healthcare is linked to a need of sufficient dental professionals.
A further problem faced by NHS patients is that it is becoming increasingly difficult to access NHS dental care. This has led to dentists working in all areas of oral healthcare provision being placed under increasing pressure from the difficulties they face in providing high quality care for their patients within the NHS. There needs to be a substantial increase in the number of specialists, both hospital, or practice-based, in all the dental specialties, with appropriate premises and ancillary staff in order to improve equity of access and support those practising in primary care in relatively remote and rural areas. Part of that support should include a contribution to continuing professional development. There is a manifest need to develop access to high quality consultant led secondary care and/or specialist services in all parts of the UK. Better information should also be provided to patients to make them aware of what is, and what is not, available through the NHS.
A further problem with the present system is that many people who cannot access NHS dental treatment cannot afford the prices charged within the private dental sector. As with most chronic diseases, oral health is related to the socio-economic circumstances of individuals. This has led to significant inequalities in dental care, based on poverty.
The present system is set to be changed in April 2005, although there will still be a two-tier system. This will include a system of banded charges, which would lead to an increase in treatment costs. Whereas patients are currently charged per treatment, under the new system charges will be made per patient. Furthermore, patients will be charged a maximum of £120 per treatment, a figure that is decidedly lower than the £378 at present. A further change will be with regards to the dental budget, which is currently held by local government, and will be given to local primary care trusts. This will reduce the amount of paperwork, as the care trusts will have contracts with the dentists. The Liberal Democrat Shadow Health Secretary highlighted the problems of the NHS by stating that, ' finding a NHS doctor is like finding a needle in a haystack. It seems that those lucky enough to find a NHS dentist will have to pay more for the privilege of doing so'.
In view of the above arguments for and against the NHS and private dental sectors, it would seem that the government requires a system, which balances the rights of all patients, regardless of income. There is an evident need to recruit more dentists into the NHS, and private dentists must have an acceptable level of competition in order to reduce prices. From the three systems, the present system is probably the most viable option, although there is a need for a more modernised structure, which will allow all patients' access to a NHS dentist. An alternative system could be to introduce a system similar to the tuition fees system in place for higher education, whereby dental patients would be charged in accordance with their household income. This would dispose of any inequalities in the system, with regards to poverty.
