Independently commissioned research paper by Professor of Health Economics at Queens University Belfast, Professor Ciaran O’Neill, says a ‘credit or voucher’ scheme would “remove perversities in the current system and help rebuild relations between the public, providers, and Government.” Click here to view the report.

• According to the research paper, a ‘Dental Credit Scheme’ would bring the necessary reform to the current practices and fee structure, bringing them up to modern standards.
• The annual cost of a scheme offering a voucher or credit towards dental care of €100 to €500 would be €108m and €232.5m respectively, giving medical card holders access to increased care and treatment that is currently only available to them in emergency circumstances.
• Welcoming the research paper, President-Elect of the Irish Dental Association, Dr Caroline Robins said: “Dentists want an entirely new scheme that reflects modern dental practice, one that allows vulnerable groups to access routine dental care in their community.”
• Fintan Hourihan, CEO of the Irish Dental Association said: “There is currently one dentist per 2,000 medical card patient – this cannot be allowed to continue. It is incumbent on the Government and HSE to reform this scheme urgently and the model set out by Professor O’Neill deserves serious consideration by all parties to the current scheme.”

The Irish Dental Association (IDA) has today published an independently commissioned research paper outlining an alternative proposal to the medical card scheme or Dental Treatment Service Scheme (DTSS), to bring about its urgent reform.  

Prepared by Professor Ciaran O’Neill, Professor of Economics at Queens University Belfast, the research paper sets out a model for a credit or voucher scheme that provides an entitlement of a given value for a specified period of time to cover a given range of services and care.

In his report, Professor O’Neill estimates that the annual cost of such a scheme offering a voucher for €100 towards dental care would be approximately €108 million. His report also estimates the costs associated with vouchers of a higher value, between €200 and €500, as a total cost per annum of €93m and €232.5m respectively.

“This scheme would provide coverage for commonly required services at levels of reimbursement that reflect the cost of care,” says Professor O’Neill in his report. “It would afford a degree of clinical autonomy that would remove perversities in the current system and help rebuild relations between the public, providers, and Government.”

In Portugal, a scheme of this type was shown be associated with improved oral health outcomes.

Welcoming the paper, President-Elect of the IDA and Chair of the GP Committee, Dr Caroline Robins said: “Dentists want an entirely new scheme that reflects modern dental practice and care, one that allows vulnerable groups to access routine dental care in their community. We have never understood the rationale behind a scheme that restricts the number of preventative treatments allowed, such as fillings to save a tooth, while permitting an unlimited number of extractions.

“In addition, the latest suggestion from the Department of Health that dentists would consider providing a scale and polish and an expanded examination as an interim response has no prospect of retaining dentists in the scheme either. In fact, proposals which effectively require dentists to enhance further the existing subsidisation of the costs of providing treatment will only have one outcome and that is a further migration of dentists from the scheme.”

Reimbursement levels to dentists were reduced following the financial crisis of 2008 and treatments available to medical card holders suspended or available in emergency cases only. This has not changed in the 13 years since.

Prior to the pandemic, between 2017 and 2019, expenditure on the scheme had significantly fallen, while between 2015 and 2020, there was a drop of 31% in dentists holding DTSS contracts, continuing the downward trend in participating dentists that preceded the pandemic.

There are now believed to be just 750 dentists treating medical card patients, which is less than half the number of DTSS contracts held by dentists up to two years ago.  To put it in context, that is one dentist per 2,000 medical card patients and parts of the country where there is just one dentist covering an entire town or region.

Fintan Hourihan, CEO of the Irish Dental Association, said: “What this paper shows is that an entirely new scheme is required, and the model set out by Professor O’Neill deserves serious consideration by all parties to the current scheme.

“The spend on the medical card scheme in 2021 was €39.6m and a far cry from the €86m spend in 2009. Despite the suggestion of an extra €10m being made available this year, it is not nearly enough to solve the underlying problems associated with the scheme or have any substantial impact on the rapid exodus of dentists from it.

“Without any meaningful plan or roadmap to reform coming from Government, it is becoming increasingly difficult to see how the medical card scheme can survive, which means more and more of our most vulnerable patients will lose out on important access to dental care. Ultimately, a new model has to move away from a system which allows restrictions to be placed by the state on treatments which are covered. A new scheme will only succeed if it attracts sufficient numbers of dentists as a professionally appropriate and economically viable alternative, and, most importantly, it has the confidence of the patients it is designed to serve.”

 “While we remain deeply frustrated, we invite the Government to engage with us to explore new ways of improving access to dental care, including this proposal from Professor O’Neill. Ultimately, patients, Government and dentists require a more sustainable solution that ensures access to care for those who need it most.”