PRIVATE HEALTH A SPECIAL REPORT: Producing the capital to cap it all at the dentist?

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Indy Lifestyle Online
BY ALISON EADIE

The White Paper on the future of dentistry is expected soon and dentists are waiting with bated breath to see if their criticisms of the earlier Green Paper have been taken on board. If not, many dentists may reluctantly abandon the National Health Service and switch to private practice.

The Green Paper published last July incensed many dentists, because of its recommendation to make most non-exempt adults pay 100 per cent of their treatment costs. According to a survey carried out by Denplan, the UK's leading private dental care programme, a majority of dentists were unhappy about the recommendation. They felt it would cut the number of patients coming forward for essential work.

Some 88 per cent reported that under the current system NHS dentists were unable to spend enough time with patients to provide satisfactory care and some 80 per cent said NHS dentists could not uses the quality of materials they wanted. Many dentists have already quit the NHS and deregistered their patients.

Others have developed a "halfway house" and treat children and other exempt patients on the NHS and non-exempt adults privately.

As NHS dentistry shrinks, capitation payment schemes to pay for private treatment expand. Unlike insurance, which is taken out in the hope it will not be needed, capitation gives patients what they pay for. The different plans vary in how they charge and what they cover.

Denplan, owned by medical insurer Private Patients Plan, pioneered capitation in 1986 and is the market leader with 5,500 dentists and 560,000 patients.

Dentists assess the state of a patient's teeth and charge a monthly amount to cover long-term preventive care. Denplan has five categories of payment, with discounts for children and other groups. More than 90 per cent of its patients pay between £5 and £15 a month.

Denplan stress that unlike some of its competitors, it does not offer lower prices for less care. Each patient is put in a fee band according to needs and the location of the practice.

Supplementary insurance cover includes up to £300 per claim for emergency treatment, up to £5,000 per claim for treatment resulting from injury and £50 cash for every night spent in hospital due to dental treatment. There is also a 24 hour telephone helpline providing help for emergencies outside surgery hours.

Capitation schemes are also offered by Complete Direct Care, BUPA, Norwich Union, Clinident and Densure. Many dentists working in the private sector offer patients the choice of more than one capitation scheme.

CDC, with more than 60,000 individual patients, stresses its low administration charges at 98p a month per patient and its lack of a joining fee.

Dentists set their own fees, either charging each patient a different amount or everyone the same rate. CDC will also advise on fee bands. It says the average monthly charge to patients outside London is £7.97 and inside London is £10.50.

BUPA DentalCover was introduced more than a year ago and has signed up 26,500 patients. It has five fee bands, with dentists choosing what to charge according to the state of a patient's mouth and their own overheads. Harley Street practitioners tend to charge more.

Patients can also opt to exclude expensive treatment like major restorative work, if they want to reduce the monthly payments.

Now into its second year, the accreditation phase of BUPA's dental programme is underway. A year after joining, BUPA dentists' practices are checked for correct clinical procedures, including the use of equipment and treatment planning.

Norwich Union capitation scheme, also launched at the beginning of last year, operates differently in that it determines fee levels, rather than the dentist. It offers three levels of cover and three cost areas depending on the location of the dental practice.

Plan One, which does not include dental fitness assessments, covers check-ups, scale and polish, X-rays and worldwide emergency cover.

Patients have to be dentally fit to opt for Plans Two and Three. Plan Three includes fillings and root-canal fillings, simple extrac-tions, non-surgical treatment of gum disease and crowns. The main exclusions are braces, dentures and bridge work.

Clinident, unlike rival plans, levies no administration charge. It makes its money through the £24 annual insurance fee providing payment protection against accident, sickness, redundancy or trauma to teeth. Monthly payments for treatment are agreed between patient and dentist and are governed by the practice concerned. Patients do not have to be dentally fit to join.

Dental treatment is also covered under the more expensive private medical insurance policies like Clinicare's Carte Blanche policy,

And employers are increasingly offering dental cover as an employee perk. Cigna is one of the main players in this expanding market and will offer corporate cover for as few as 20 employees.

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