Jan. 16 (Bloomberg) — A rebellion by U.K. dentists against the latest government contract has led more than 7 million Britons to avoid state-subsidized dental care in the past two years.
A Citizens Advice Bureau survey released today reports that 4.7 million people were forced to use private care since April 2006 at twice the cost of a state-funded dentist because so many practitioners refused to see National Health Service patients.
Another 36 percent of people, or 2.7 million, who responded to the poll by London-based Citizens Advice have gone without any treatment for almost two years. Under the NHS, every resident is eligible for care by a local dental practice.
Since the government changed its contract with 21,000 NHS dentists in April 2006, one in 10 dentists stopped offering state-funded services, saying the contract required them to increase their workloads while limiting their earnings. The U.K.’s private dental market grew 63 percent to 3 billion pounds ($5.9 billion) from 2002 to 2006, overtaking the 2.4 billion pounds budgeted by the government.
“Dentists are exiting the NHS either completely or they’re spending a much smaller proportion of their time doing NHS work,” said Sharon Grant, chairman of the public advocacy Commission for Patient and Public Involvement in Healthcare. The Birmingham, England-based group published a survey in October with similar findings.
The shortage of dentists willing to take NHS payments has resulted in an increase in the use of private dental insurance. The number of subscribers to dental plans, which cost 15 to 20 pounds a month for basic care, rose 31 percent to 2.9 million in 2006, according to London-based market research firm Laing & Buisson.
Skipping Care
Two in three Britons see NHS dentists, 25 percent use private ones and the rest, about 10 percent, skip dental care, according to an October survey of more than 5,000 patients and 750 dentists published by the commission.
“Improving access to NHS dentistry is now a national priority for the health service,” Health Minister Ann Keen said in an e-mailed statement.
The 2006 contract groups charges for 400 dental procedures into three bands and requires practitioners to meet quotas to maintain their earnings. Patients have paid for a portion of their dental care since 1951, three years after the NHS was founded.
Four years ago, NHS patients paid dentist Ian Gordon about 37 pounds per filling. Now, he’s required to fill as many teeth as needed at one time for 44 pounds.
Hitting the Target
“In the past, you looked at patients, at what they needed,” said Gordon, who just sold his NHS practices in and around Middlesbrough, England to a large chain and plans to open one that will only accept private patients. “Now you have to look at hitting the target. Working to a target culture isn’t the best thing for patient care.”
When Lorna O’Neill, 25, moved to Manchester from Liverpool to be closer to her job at a public relations firm last spring, she called three or four dentists near her new home. None was taking new NHS patients. She gave up and saw a private dentist, using a dental plan provided and paid for by her employer.
The country has about 42 dentists for every 100,000 residents, according to the Department of Health. Germany has 78 per 100,000, while the U.S. has 59, according to the World Health Organization.
Ballooning Budgets
The U.K. government, like counterparts in the U.S. and Europe, faces pressure to slow the growth of health-care spending as the cost of treatment rises and people live longer. While the NHS’ total budget grew 41 percent to 78.4 billion pounds from 2002 to 2006 in England, government spending on dentistry increased 38 percent.
The squeeze prompted private-equity firms such as Duke Street Capital Ltd. and Hutton Collins & Co. and corporate dentistry chains to buy up practices and has fueled demand for dental plans and insurance.
“We have not seen the end of this boom yet,” said Pam Whelan, corporate dental sales manager at 1.8 million-member Denplan, based in Winchester, England.
The 2006 NHS contract was aimed at encouraging preventive measures and reducing dentists’ incentives for so-called drill and fill care in an assembly-line fashion to boost earnings. A parliamentary committee plans to probe the contract’s impact in an inquiry next month.
About 58 percent of dentists who responded to the October survey said the quality of care has declined.
“If a patient comes in and needs a lot of work, there’s no additional reward for that,” Gordon said. “You get no gain for prevention. Who in their right mind is going to treat six crowns for the price of one?”
Leaving the Country
Patients’ frustration has reached the point where thousands seek dental care outside the U.K. Dublin-based Reva Health Network, a Web-based referral service, estimates 35,000 Britons a year travel to countries including Poland, Hungary, Thailand and Turkey for dental treatment that would cost more or require too long a wait at home.
Airline stewardess Noreen Fitzpatrick had dental work done during a stopover in South Africa after NHS dentists in Rickmansworth, a suburb north of London, told her they weren’t accepting new patients.
“I called the dentists and they were full,” Fitzpatrick, 44, said.
The government plans to increase the dentistry budget by 11 percent in the 12 months starting in April. Some practices stopped seeing NHS patients and sent their workers on forced vacations toward the end of the last fiscal year as government money ran low.
Last March, retirees Joan and Les Smith received a telephone call from their dentist in Rickmansworth.
“They phoned up and said they couldn’t do us on the National Health because they’d run out of funds,” Joan Smith, 73, said. “We had to wait.”
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