The following document is published by the Irish Dental Association and may be downloaded in MS Word format here.
1. What is the Dental Treatment Benefit Scheme?
The Dental Treatment Benefit Scheme (or the PRSI Dental Scheme) as it is commonly known provides discounted dental treatment to PRSI payers.
2. What cuts have already been made to this scheme?
In the Budget of December 2009 this scheme was restricted to one treatment item only i.e. claimants can now only avail of the free annual oral examination.
The McCarthy Report (An Bord Snip Nua) has recommended the discontinuation of Scheme.
3. Prior to December 2009 what did the scheme offer in terms of dental benefits?
The DTBS provided taxpayers with some treatment for free, contributed towards the costs of most routine dental treatments and placed limits on the fees for other treatments depending on the claimant’s earnings. The following are the most common treatment items provided under the scheme.
- Dental examination and diagnosis (one free examination per year)
- Scaling and polishing, including mild gum treatment (two free treatments per year)
- Severe gum treatment
- Fillings
- Extractions
- Dentures
- Root Canal Therapy
These treatment items are all essential treatments for maintaining good oral health.
4. How many people are entitled to these dental benefits?
Approximately two million taxpayers are entitled to dental benefits arising from their PRSI contributions.
5. But what about patients travelling outside the country for dental treatment?
The range of treatment items covered by the Dental Treatment Benefit Scheme are not the kinds of items that patients go to Eastern Europe to get done. Dental tourism largely involves complex treatment items such as crowns, bridges and implants. None of these items have any relevance to the DTBS.
The DTBS covers basic items such as examination, scaling, fillings and extractions, with some contribution being made by the Scheme towards root treatments and dentures. In simple terms, the DTBS is a basic, health-sustaining dental scheme with no frills. The dental tourism situation applies to high-end dentistry.
6. How many used the scheme in visiting their dentist 2009?
In 2009 a total of 730,000 persons visited their dentist and claimed for treatment under the scheme. In total 1.3 million treatment items (such as fillings, extractions, etc.) were availed of by patients under the Scheme.
7. So what other benefits can an annual examination with your dentist bring?
In addition to helping to diagnose and identify a course of regular dental treatment, annual examinations offered under this scheme by your dentist can serve to identify early indicators of systemic diseases such as oral cancer, diabetes, heart diseases, gum disease and evidence of low birth weight / premature births.
In fact, did you know that oral cancer results in more deaths nationwide (three new cases are identified in Ireland every week and most are detected in examinations by dentists) than melanoma, leukaemia or cervical cancer?
Dentists should expect to see at least two benign-appearing lesions that should be tested each week even in low-risk patients. Nearly half of all patients diagnosed with oral cancer survive more than five years following diagnoses and when detected early the disease is often curable.
8. Is this not an insurance scheme?
Yes, this is akin to an insurance scheme and operates on the basis of contributions made by working people in the expectation of receiving benefits in return.
9. But surely this is akin to paying your house insurance and then being told your cover is being withdrawn?
Yes, it is equivalent to a house or life insurance scheme and we are effectively now being told that in spite of many years of significant contributions by working people, they are now to be deprived of the benefits afforded by this scheme.
10. Is there any evidence to suggest that the scheme contributes to better dental health?
There is no doubt but that the dental health of the population has improved immeasurably in the last number of decades and the dental treatment benefits scheme, as the single biggest scheme available for up to two million people, has been arguably the single greatest contributor to this improvement.
11. How much does somebody on the average industrial wage contribute to this insurance scheme?
Employees earning in excess of €18,304 contribute 4% of their salary (i.e. all earnings beyond the first €127 per week) towards PRSI which entitled them to dental benefits as well as other welfare benefits. In addition, employers contribute a further 8.5% or 10.75% of employee earnings towards PRSI. In 2008, a total of €7.8bn was contributed by employees and employers towards the PRSI.
A person on the average industrial wage (€32,000) contributes roughly €20 per week by way of PRSI contributions, a person earning €60,000 contributes €41 per week and somebody earning €75,000 contributes €53 per week.
12. Are many dentists involved in this scheme?
Over 1,200 dentists are involved in treating patients under this scheme throughout the whole of the country. Each of these dental practices employs just under four full-time and three part-time members of staff on average including dentists, dental nurses, hygienists, secretaries, practice managers and administrative staff etc.
14. But have dentists been making super-profits in recent times?
According to research, 92.2% of dentists have already seen a drop in their income in 2010. The average decrease in income ranging from 31-40%.
Payments under the DTBS have already been reduced by 56%. (As the contract provides for a 9 month window in which to complete treatment, the payments under the scheme are legacy payments, therefore the full financial effect is not yet apparent).
The fees payable under this Scheme were entirely controlled by the Department of Social Protection. The Government cited the competition legislation as not allowing dentists even a say in the fees under the scheme.
15. How much state support and funding do dentists receive and how does it compare with other health professionals?
Dentists are the only health profession that receive no State support. Medical GPs in Ireland receive on average €50,000 per year for practice support. Dentists in Northern Ireland receive on average €37,000 each year for practice support.
There are significant costs associated with establishing dental practices (well in excess of €100,000), employing staff and procuring materials and equipment (such as x-ray equipment costing over €50,000) rests solely with dentists and they receive no state support for these costs.
Research has shown that the cost base for dentists in this state is €100,000 higher than the costs faced by their counterparts in Northern Ireland.
16. So has state funding for dentists increased in recent times?
No, in fact, fees to dentists were reduced by 8% earlier in 2009 on top of a double digit decline in income in the past year and in addition, the (Med 2) tax relief available for dentists and patients was reduced by 50%. The reduction in Med 2 tax relief constitutes a massive reduction of €28.5m per annum in support to dental patients and practices.
17. Who controls the number of dentists participating in the scheme?
The number of dentists within the Scheme is decided entirely by the Department of Social Protection, there is no impediment to any qualified dentists participating in the Scheme.
18. What would happen if the scheme was withdrawn?
Undoubtedly, withdrawal of the Scheme would see a significant deterioration in the dental health of the population and would in all likelihood see waiting lists established in many areas of the country – currently no waiting list exists.
Undoubtedly, patients would be faced with paying the full costs of dental treatments and this is bound to cause a significant deterioration in dental health and ultimately the benefits of a preventative approach will be far outweighed by the cost of remedying the harm done.
It is also our belief that withdrawal of the scheme does not make economic sense. Independent cost-benefit analysis shows a net benefit of €111,988,579.55 and the ratio of benefits to costs is 2.64. This means the return on investment is 2.64 times the cost to public finances.
19. But are dentists willing to sit down and examine the operation of the scheme in these difficult times for the Government?
Yes, the Irish Dental Association has confirmed its willingness to sit down and discuss, in partnership with the Department of Social Protection, ways to enhance the effectiveness of the Scheme with a view to optimising value for money.
