Government plans for a new dental contract could have a far-reaching effect on the dental insurance market. Jeremy Chadwick explains
With only 45% of adults in England and Wales registered with an NHS dentist and people queuing all hours to simply sign up with one, few can argue that the time is right for some fundamental changes to the State dental system. A political hot potato, there are too few dentists and the charging system seems to work for neither patient nor dentist.
Currently, NHS dental treatment is something of an enigma. Although billed as State provided healthcare, patients can often incur significant charges. Worryingly, 43% of respondents in a recent HSA survey claimed the cost of dental treatment, both on the NHS and in the private sector, stopped them from visiting a dentist. Plus, 31% actually delay dental treatment because they are confused about NHS and private dental charges. Cost of dentistry both in the State and private sector is a major limiting factor in accessing these services.
At present, those consumers that have taken the steps to help cover the cost of dental care can choose to either spread the likely charges over a full year, or insure against the cost of dental treatment.
Healthcare cash plans can help spread this cost. For a small weekly premium they re-imburse against dental charges. Insuring against the need for dental treatment is also sometimes addressed through capitation, as provided by organisations such as Denplan and Practice Plan. In this instance, the dentist will assess the level of treatment likely to be required, based on the condition of the teeth and gums. A set amount is paid each month, which should cover the cost of basic dental treatment. One of the main differences between these schemes and healthcare cash plans is that you must be dentally fit before you can join capitation schemes.
Despite the alternatives available and the wholesale withdrawal of dentists from the State sector in some parts of the country, one in two adults still receive NHS treatment.
Although the current State system is complicated for the consumer, seemingly it is not much fun for the dentist either. The present scale of NHS charges offers inadequate compensation; this can encourage 'extra' work and mischarging and there is the perception that this results in poor quality work.
Clearly both the general public and dentists would benefit from a change to the system and although these changes have yet to be formally announced, it seems they are likely to include a three tier system that replaces the current complex pricing structure, which lists more than 400 separate charges. It is believed that the new costings could look like this:
• The cost of a basic check-up could double from £5.64 to £12.00.
• Fillings and other inexpensive treatments (such as a scale and polish) could increase from approximately £8 to a flat fee charge of £40.
• Most costly dental procedures are likely to be capped at £120.
Although these proposed changes are intended to simplify the charging process and improve patient care, they have been resoundly rejected by the dental profession. According to research from the British Dental Association (BDA), dentists have little confidence in the new contract with as many as 60% claiming they will reduce their NHS commitment or quit the NHS altogether under the new reforms. Only 2% say they would increase their NHS work as a result of the proposed changes.
Recognising that the problems will not be resolved by a simple pricing re-structure, Health Secretary Dr John Reid unveiled plans in July for an 'unprecedented level of Government commitment and investment in NHS dentistry', alongside the radical reforms and a promise to recruit an extra 1,000 dentists by October next year.
Reid intends to give NHS Dentistry a £368 million funding injection under the plans, including provisions for a 25% increase in the number of undergraduate dental training places.
He said: "I want to reform the system so dentists want to work for the NHS in the future. Dental services will be properly integrated with the rest of the NHS providing better access to services and an improved patient experience."
That's the plan, but how are these changes likely to impact on the average dental patient? There is little doubt that the proposed increase in charges will hit hard on a typical wallet. A basic examination, small filling and scale and polish could cost nearly £100. The gap between State and private provisions narrows dramatically, which could go either of two ways.
With little difference between NHS and private dental treatment (in terms of cost), patients may ironically find themselves faced with more choice for their provision.
Conversely, should the new contracts work as intended, and more dentists are encouraged back into State provision, then although patients may pay more, they should find an improvement in accessing NHS treatment. The Department of Health also hopes this will lead to an improvement in the quality of care.
Whichever way it goes, the end result will remain the same - patients are likely to find themselves paying more.
Insurers will find they won't escape the effect of the dental changes either. With average charges increasing, the first impact is likely to be an increase in average claims costs. Some insurers may ultimately find themselves having to re-work their underwriting model - higher prices to accommodate increased claims value. Capitation providers may not be affected immediately since they operate exclusively in the private sector, however, overspill of treatment inflation from the public sector into the private is perhaps inevitable in time.
Another important element of the proposed reforms is improving the level of dental care through better oral health and improved patient experience. By encouraging preventative dental advice, patients may find themselves visiting the local practice more often. This is all very good for teeth, but insurers could see claims incidence increase significantly too. The worse case scenario is another re-working of the underwriting model.
Having evaluated and dealt with the initial effect of dental reform, insurers should find there is still an important function for them to deliver with regard to the future dental health of the nation. With a blurring between NHS and State provision, it is more than likely that the consumer is going to be looking for guidance on how to navigate the increasingly complex dental route and ultimately how to pay for it.
Insurers and intermediaries therefore, have an important role to play. It is imperative that consumers aren't frightened away from dental treatment because they think they simply can't afford it. Therefore the message is two-fold.
So will this bring opportunities for sales? Absolutely. Dental charges will no longer be the odd pound or two, which until now the average patient has been happy to incur as and when they arise. Should a typical appointment cost £100 as predicted, then that's not to be sniffed at by most of us and we will be looking for ways to cover the cost. With a more complex environment, the perception of quality assurance linked to powerful brands in the sector will become important to consumers trying to find the right care and funding solutions provider for their needs.
Will it bring opportunities for innovation? Lets hope so. The dental reforms are likely to impact on all those companies that already provide some form of dental cover or dental re-imbursement. It should also provide the momentum for insurers to look at their current offering and truly question whether they meet the new needs of dental patients. Are they overly prescriptive or do they restrict where treatment can be sought? Do they dictate which dentist can be used? Do they exclude certain treatments?
Against this background of change, consumers will need information and financial help to meet everyday healthcare costs such as dentistry, providing valuable new opportunities for intermediaries and insurers alike.
Jeremy Chadwick is head of PR & communications at HSA Group
COVER notes
• NHS dental treatment costs could soar if the new contract goes ahead.
• Although insurers may see a rise in claims, the changes could push more people to buy cover.
• Current dental products may have to adapt to absorb extra costs and fit with the new NHS pricing system better.
