Our public health service has received yet another blow with the decision of the Minister for Social and Family Affairs to exclude the majority of dentists from the PRSI Dental Benefit Scheme.
Coming in the wake of large budgetary overruns in hospitals and health boards, and an embargo on staff recruitment in the health service, it suggests a bleak time ahead for those entitled to treatment in the public system. The dispute between dentists and the Department began last March when the Irish Dental Association increased the fees for which patients are liable under the benefit scheme. Until then, 1.7 million people who make PRSI contributions, paid an agreed "top up" fee to their dental practitioner for fillings and extractions. A small number of services were completely free.
According to the Department, some patients face charges up to 64 per cent higher than normal. "The reality is that no Government Department can radically increase the fees paid to any professional group without objective justification for such an increase", the previous Minister, Mr Ahern, said at the beginning of the Irish Dental Association action. His successor, Ms Coughlan, announcing the effective "sacking" of dental practitioners at the weekend noted that "we cannot continue to do business with dentists who continue to charge more than the contracted rates". The Irish Dental Association, which has the support of 91 per cent of its 720 members, pointed out that its contract with the Department obliges dentists to treat insured workers the same way as private patients, but that this was not feasible at current rates.
An analysis of the current PRSI Scheme fee structure and typical charges for private patients lends some credence to this argument. A full oral examination, treatment plan and x-rays attract a fee of €26.22 under dental benefit. The equivalent fee in the private sector is in the region of €60. A dentist who performs a compound amalgam filling is paid almost €40 under the PRSI scheme, less than 50 per cent of the equivalent charge to a private patient. Even allowing for an additional profit margin, such a discrepancy suggests that dentists may not even be covering their costs under the Departmental scheme. As a result they face an ethical dilemma; do they provide inferior treatment reflecting actual payment rates or do they provide a quality service and "balance-bill" the patient for the short fall?
As long as both sides in the dispute maintain their present positions, it is the patient who suffers. And inevitably, it is the low income earner with a family who will bear the brunt of this action. Despite having faithfully made his PRSI contributions he is now denied public dental treatment and may not be in a position to pay the full private fee. Last year, 432,838 insured workers and their spouses availed of the scheme at a cost of €44 million, so a significant percentage of the population will be denied treatment as a result of this dispute. They will want to know why the issue was not sorted out before the general election and why the Department has now collapsed the scheme by its actions.