Wednesday, August 5, 2009

Why British teeth are even worse than before

I come from a country -- America -- where your standard teeth-cleaning can last upwards of an hour and entails all sorts of extensive prodding, soaking and polishing. In the U.K., in contrast -- at least with the NHS -- you're in and out of a standard check-up in under 20 minutes. For kids, it takes less than five. ...

The heart of the problem appears to be the system of dental reforms introduced by the British government in 2006. Under the old contract system (in place since 1948), dentists were paid by the government for every NHS treatment carried out. The criticism of this system was that it encouraged a "drill and fill" culture in which dentists did a lot of purely cosmetic (non-clinical) work, with no emphasis on preventative care. ...

As of April 2006, everything changed. Contracts are now agreed upon with the local PCTs (primary care trusts), which have responsibility for overseeing NHS dental care in their area and guaranteeing access. The PCTs are allocated money each year by the government that must be spent on NHS dentistry, which is then divided up among dentists willing to carry out NHS work. And unlike the previous fee-per-treatment system, dentists are now paid a flat rate covering the amount of work they are contracted to do each year...

While these reforms were supposed to increase access to NHS dentists, in practice, they've had the opposite effect. NHS estimates suggest that nearly 1 million fewer people have access to an NHS dentist than they did three years ago. According to a citizen's advice survey carried out in early 2008, approximately 7.4 million people hadn't been to an NHS dentist since April 2006 because of difficulties in finding one. ...

The incentives set up by the new system also mean that dentists are more likely to "under-treat," i.e., to fail to provide complex (and costly) treatment, even if it's clinically necessary. ...

I witnessed this dilemma personally when I was in need of a root canal myself. My dentist told me that I had the choice of pulling the (otherwise healthy) tooth for the flat NHS rate of $76 or going private and paying 650 pounds (roughly $1,070) to do a root canal. He wasn't willing to run the risk of doing the root canal himself for the NHS fee. As he put it starkly, why risk a lawsuit doing a root canal that takes several hours to do properly when you could just pull the tooth and be done with it? I went private.
--Delia Lloyd, Politics Daily, on capitation in U.K. dentistry. HT: Freakonomics

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