The Cedar Lounge Revolution

Open wide and say… 2008 levels of dental expenditure are not equal to 2008 levels of service provision. January 18, 2010

I’m still a bit… I guess… gobsmacked… by the reduction in financial support to PRSI payers in regard to dental treatment. The idea that an examination alone is sufficient unto the day each year seems woefully, or even willfully, misconceived. I’m fortunate with my teeth, so far so good. But others I know, and many of us, aren’t so lucky. Life becomes a never-ending trial where teeth that are particularly susceptible to decay despite assiduous flossing and brushing require almost continual patching up.

It’s fascinating then to read that the dentists are on the march. So to speak. With a meeting this weekend at Croke Park where a good third of those in private practice turned up to vent their ire.

And I can’t say I disagree with the Chief Executive of the Irish Dental Association, Fintan Hourihan, who argued that €110 million in cuts [including €30 million from medical card patients and €29 million in removal of tax reliefs] was astronomical.

Nor, and this is particularly invidious, do I think he is wrong when he argues that this will lead to ‘rationing’. What in effect will happen is a rationing by money.

Given that dental treatment is expensive – ask anyone who isn’t covered by PRSI, including public service employees and self-employed (by the way, I consider both of those groups exclusion to be unjust) – the dynamic, given most peoples aversion to getting there in the first place will most likely be to put off costly remedial care.

That free examinations are a good thing, even simply as a preventative measure, and that following on from them free or low cost treatment is a good idea, makes the current policy approach seem merely perverse. Add to that Hourihan’s very telling point that…Ireland was the only EU member state not to have a chief dental officer, reflecting its lack of concern for dental health.

This is a public health issue and one which requires continual supervision and monitoring in order to maximise positive outcomes.

You’ve got to laugh, though, reading the response from the Ministers office…

[he] said that the cuts had brought dental spending to 2008 levels. He added that the budget had to be delivered against the background of the current economic situation. The €30 million in the dental treatment service for medical card holders was out of €400 million in non-pay expenditure cuts that had to be made this year, and the reduction in the PRSI-related schemes was a social welfare cut.

This then is the reality of what many glibly talked about when they argued prior to the Budget that cuts would simply be rewinding the clock back to 2008, or 2005 or whenever. Dental spending may be in total at 2008 levels, but it is clear that provision of services have now shifted to a position that I haven’t experienced in my working lifetime as someone who has been a fairly assiduous user of those services across a decade and a half or so.

And the bigger picture? Well Michael Taft has a piece on that here which demonstrates that this is just the beginning.