Exodus of dentists from the medical card system leaving vulnerable households without dental care


DENTISTS CONTINUE to abandon the state medical card system, leaving the elderly and those living in low-income households without access to basic oral care.

Talk to The newspaperFintan Hourihan, CEO of the Irish Dental Association, said that in recent years there has been “a significant exodus of proportions” from the scheme due to the low level of fees paid by the state and related frustrations to the operation of the scheme. .

According to the HSE, the number of dentists with Dental Treatment Services Scheme (DTSS) contracts is now 1,082. However, figures from earlier this year show that only 660 dentists across the country were actively treating patients with a medical card.

The number of dentists holding DTSS contracts increased from 1,660 in 2017.

“That means the number of eligible patients has stayed the same, but the number of dentists available to provide care has halved,” Hourihan said.

“The consequence of this is that it is more difficult for people to get a dental appointment.

When patients are told that their dentist is no longer on the scheme they should be advised to contact the HSE to direct them to someone else local in the scheme but if you take even a medium sized town it There used to be six dentists in the program in the locality and now there are only two or three and they have to potentially double the number of patients with medical cards that they see.

“They can’t handle that so there are waiting lists, people have to travel further and we know a lot of people only call to make an appointment when there’s a problem and they are already suffering.”

The HSE said there had been reports of “deficits in the capacity of DTSS contractors” in many parts of the country, and within every region there are areas which have been more affected than others.

He said he was aware that some medical cardholders have had difficulty accessing dental care under the scheme and when he is informed the case is being followed up with local community services who seek to help medical card holders.

“You can’t blame the dentists”

Pensioner Tom Fennelly recently received a letter from his dentist advising him that surgery will no longer participate in the scheme in the future.

He said he does not believe other local dentists where he lives in County Dublin are taking part in the scheme and although he does not need immediate dental treatment, he has relied in recent years on his medical card for dental services.

“Two years ago I went with my card, I needed three fillings but I was only allowed two under the scheme,” he said. “I had two, one fell off a few weeks later and the dentist couldn’t replace it under the plan because I was only allowed two.”

He said he had to wait a year to have the filling replaced.

“There is not a single dentist here who will accept the medical card and you can’t blame the dentists, they are not paid enough,” he said. “It’s not their fault, it’s the system.”

Fintan Hourihan said dentists have for years raised questions about how the scheme works, both in terms of fees and the type or amount of dental treatment covered.

“Until recently the HSE would have said you couldn’t offer white fillings on the back teeth, you could only offer silver fillings, you’re limited to two fillings a year even if the person needs it more and that it only pays for the use of certain technologies,” he explained.

Dentists have always seen this as an interference in their treatment of patients. Usually you see a patient, make a treatment plan and proceed based on that, but if you can only do half of what you think they need, that’s not good enough for the dentist or the doctor. patient.

He said the fees paid by the state for services under the program do not cover the full costs for dentists and many no longer see it as operationally viable. Additional costs incurred during the Covid-19 pandemic without adequate government support also added to frustrations, he said.

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To deal with the crisis, the government recently approved new measures to expand dental health care for medical cardholders and raise fees for dental providers under the scheme, in hopes that more dentists will see more patients with medical cards. The expansion of services included the reintroduction of scaling and polishing for all medical cardholders one per year.

The combination of these measures represents an additional investment of 26 million euros in the system this year compared to 2021.

In a statement to The newspaperThe Department of Health acknowledged that “a significant number of contract dentists have opted out of the Dental Treatment Services Scheme (DTSS), citing a variety of reasons including the range of treatments available and the viability of fees payable in framework of the regime”.

“To respond to these concerns, the Minister has committed to in-depth reform of the oral health offer in accordance with the National Oral Health Policy, Smile agus Sláinte, which was published in 2019″, a- he declared.

“Improving and facilitating public access to oral health services is a key element of this policy.

As part of the policy, it is proposed that dental care packages will be provided to medical cardholders over the age of 16. The packages will be provided at a local primary care facility by oral health practitioners contracted by the HSE. HSE Community Oral Health Services will provide additional supportive care as needed.

The program’s recent expansion and fee increase was designed to address the immediate problem faced by medical cardholders trying to access the service.

The changes to the scheme came into effect in early May and the ministry said they are designed to guarantee services to medical cardholders pending more substantial reform of dental services.

Significant changes in the provision of services for children are also expected under the proposed reform, the ministry said.


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