By Health Editor Jeremy Laurance.
Dental treatment in England is the most expensive in Europe, according to an unprecedented survey which is likely to fuel the exodus of patients seeking treatment abroad.
The survey of nine European countries found the total cost of a standard filling ranged from €156 (£117) in England to €8 in Hungary. That total included the cost of x-rays, materials, drugs and overheads, as well as the dentist’s time.
The findings come amid growing dissatisfaction with dentistry in Britain and shrinking NHS provision. The Government admitted last March that two million patients who wanted NHS treatment were unable to get it, eight years after Tony Blair pledged at the Labour Party conference in 1999 that everyone would have access to an NHS dentist.
Dentists have dramatically increased their private work over the past decade, at the expense of their NHS work, and when a new NHS practice opens, desperate patients queue to register.
Dentists with their own practices earned an average of £105,000 in 2004-05. More than half their total income (52.4 per cent) came from private work, up from 41.8 per cent in 1999-2000. In 1990 it was 6 per cent.
While England topped the table as the most expensive country for dentistry at €156 for a filling, it was closely followed by Italy (€135) and Spain (€125). Costs in the other western European countries were less than half as much, ranging from €67 in Germany to €46 in France. In all European healthcare systems, the greater the cost of carrying out dental work, the greater the level of government subsidy required to keep the price of dental treatment down for patients.
The cheapest countries for treatment were Poland (€18) and Hungary (€8), the main destinations for dental tourists from Britain. Savings of thousands of pounds are promised by agencies that arrange treatment in these countries, even after paying the cost of flights and hotel bills.
It is the first time that the cost of carrying out a dental filling has been compared across Europe. Siok Swan Tan, of the Institute for Medical Technology Assessment, at Erasmus University Rotterdam, and lead author of the study, said differences in dentists’ earnings were the most important reason for the variation in costs. “Without exception, labour costs were the most important cost driver in all countries and practices,” she said. “They accounted for 70 per cent of total costs in England. They ranged from €0.09 per minute in Hungary to €2.88 a minute in England.”
The figure for England included material costs which “makes straightforward comparisons difficult”, she said. The procedure was a filling in a molar tooth in a 12-year-old child.
High costs and the difficulty of finding NHS dentists have combined to make dental tourism the fastest growing category of medical tourism. Of 77,000 travellers from the UK who went abroad in 2006 for medical treatment recorded in the International Passenger Survey, an estimated 43 per cent sought dental care, according to the agency Treatment Abroad.
Keith Pollard, its managing director, said: “Dentistry is the biggest part of the business. The number of providers targeting the UK at the moment is phenomenal. It is driven by the high prices charged in the UK and the difficulty of finding an NHS dentist. When you find a private dentist the prices are shocking.”
NHS patient charges are in three bands ranging from £15.90 for a check-up and x-ray to £43.60 for one to six fillings, to a maximum of £194 for crowns or root treatments. Private charges are two to three times higher.
The British Dental Association rejected the research as “deeply flawed”. Peter Ward, its chief executive, said it was based on a sample of four practices out of 10,000, and was “riven with problems”.
“It is a very small sample, it is not representative and it is not comparing like with like,” said Mr Ward. “The dentists selected were community dentists who normally care for patients with special needs who need more staff and take longer to treat. It is impossible to make a sensible comment on a set of flawed data.”
The survey is part of a wider study, commissioned by the European Commission, comparing the cost of a range of medical procedures among the nine countries and is published in the journal Health Economics.
Professor Reinhard Busse, of the department of health management at the Berlin University of Technology, who led the research, said: “We wanted to see if we could explain differences in the costs. The aim of the research is to help governments plan what levels of reimbursement may be necessary if, as we expect, cross-border medical tourism increases.” The European Commission is due to publish draft plans which would open EU borders to medical tourists, allowing citizens of any of the 27 member states to seek treatment in a neighbouring country with the home country, in certain circumstances, picking up the bill. If the proposals are approved, it will focus attention on the performance of the NHS against other health systems.
The dentistry survey showed that in all cases the total cost of providing a filling exceeded the charge to the patient and in most it exceeded the payment from patient and government combined.
‘I had to ask if the treatment was really needed’
Kath Diamond says her daughter Meg, aged 10, has “great teeth”. So when she took her for a routine check-up at an NHS dentist in Putney a month ago, she didn’t expect to embark on a series of appointments that would end in a bill for several thousand pounds.
But that’s what happened after Meg was referred to an orthodontist in West Hampstead, who “immediately” said her teeth were not of the standard to qualify for further NHS treatment. According to the orthodontist, Meg had an “overshot” jaw and “mild crowding” in the lower jaw.
The proposed solution? A night-time head-brace and a removable day-brace for six months, plus 12 to 18 months of “railway track” braces on the upper and lower jaw.
After that she would need another brace every night for a period, followed by a day-brace a couple of times per week for the next decade – until she was 20 years old. After a “long consultation process”, a bill was presented for £2,500 on Tuesday.
Mrs Diamond was staggered. “In the end,” she says, “I asked, ‘Is there a physical need for this treatment?’. They said Meg’s teeth would be difficult to clean when older, and I think that is probably not true. It was all to give her the ‘perfect’ set of teeth.”
With understatement, Mrs Diamond adds: “But that would have involved invasive treatment.” Reflecting on the episode, she says: “There wasn’t a sense of openness about it being what was, essentially, cosmetic surgery”.