Dentists say Medical Card Scheme is unfit for purpose

Dentists say Medical Card Scheme is unfit for purpose

(22 Apr 2016)

Dentists say Medical Card Scheme is unfit for purpose

New report shows that while the number of eligible patients is up 17%, the number of treatments is down 20%

9 out of 10 dentists have had to prescribe multiple antibiotics for patients on oral surgery waiting lists

‘The HSE has effectively overseen the introduction of dental apartheid for the 37% of the population who have a medical card’

IDA calls on new Government to examine merger of medical card and PRSI schemes into one universal patient focused scheme

Download 'Unfit for Purpose - HSE Dental Care for Patients' here.


The Irish Dental Association has described the medical card scheme as being wholly unfit for purpose and called for it to be replaced as soon as possible.

The IDA said the dental profession has no confidence in the operation of the Dental Treatment Services Scheme (DTSS) by the HSE because it has manifestly failed the patients it was designed to serve.

According to a new report as of Dec 31st 2015, the number of patients eligible for dental care under the Scheme stood at 1,734,853 representing 37% of the population. This is an increase of 256,293 or 17% since December 2009.

However despite the fact that the number of eligible patients has increased significantly, the number of treatments has actually fallen by 20%.

This is due to unilateral cuts to the Scheme which the HSE imposed in 2010 without informing or consulting with patients, contractor dentists or the Irish Dental Association.

The cuts mean it is essentially an emergency care only scheme with patients only entitled to an annual exam, two fillings and unlimited extractions.

The amount of cleanings has fallen by 97% and the number of protracted periodontal treatments (for gum disease) has fallen by 80%, while the number of fillings has also fallen by over 33%. On the other hand surgical extractions have increased by 53% and routine extractions have increased by over 14%.

Prolonged use of antibiotics

As a consequence of the cuts to preventive treatments there has been an increase in the number of medical card patients forced to use antibiotics for prolonged periods.

Nine out of ten dentists have had to prescribe multiple antibiotics for medical card patients on these waiting lists. The average number of repeat prescriptions issued for antibiotics was three per patient, with some dentists having to issue five antibiotic prescriptions to a single patient.

There has also been a 38% increase in the number of people with severe dental infections requiring hospital admissions since the cuts were made.

The irony here of course is that the HSE has mounted several campaigns urging people not to use antibiotics unless absolutely necessary.

Dentists’ anger

The CEO of the IDA Fintan Hourihan said it was not possible to overstate the anger and concern for patients felt by members. As a consequence the Association cannot continue to endorse the Scheme. He noted that two thirds of dentists said they had changed the way they are practising dentistry due to the way the medical card scheme operates.

Comments by dentists included the following;

I am more or less just doing extractions now
A patient presented with a number of decayed teeth, all sore. I was not able to treat them all and had to choose two
There is an inability to provide the correct treatment
Emergency patch up jobs only for DTSS patients, no comprehensive care, this is very damaging to long-term health
It is horrendously stressful trying to explain to patients routinely that you cannot provide the basic care that they require

‘The medical card scheme pre 2010 was not perfect, but it was effective in treating a wide range of patients in a cost efficient way. Now the gross inadequacy of funding and rising demand means it simply cannot cope. The failure of the HSE to approve treatments deemed necessary, to prioritise preventive treatments and to heed dentists concerns regarding the impact on patients have taken their toll on patients and dentists’ Hourihan said.

‘Given our members complete dissatisfaction with the administration of the Scheme and the high number of treatments provided by dentists that remain unpaid it’s not surprising that 8 out of 10 dentists favour a complete renegotiation of the Scheme’ he said.

Proposed new scheme

‘The HSE has effectively overseen the introduction of dental apartheid for medical card patients. That is why we are calling for the introduction of a new state funded dental scheme where the medical card and PRSI schemes would be merged and one universal scheme would prevail for the benefit of both medical card and PRSI eligible patients over 16. We will be presenting a copy of our report and our proposals to the Minister when he attends the conference later today for consideration by the new government’ he concluded.