Leading Article: A kick in the teeth from the dentists

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The Independent Online
THE plight of Britain's National Health Service dentists has received a sympathetic hearing. This newspaper has highlighted how fee cuts by the Government have put unreasonable financial pressure on many, particularly those working in inner-city areas. Dentists have been credited with fighting to protect NHS funding, even as their protests led to patients being turned away.

Yesterday, they betrayed that faith. In an extraordinary volte-face, the British Dental Association made clear that it would happily abandon much NHS dentistry as long as its members could line their pockets. In essence, it offered the Government this cynical but tempting pact: 'We will hold down costs to the taxpayer if you give us free rein to squeeze as much money as we can out of patients.' This stance is especially disillusioning given the poor state of Britons' teeth: one in five people over 16 years of age has none.

At the moment most people - apart from groups such as children and those on income support - pay 80 per cent of dental fees, which are set according to a strict schedule. If treatment costs exceed pounds 250, the Government chips in the rest. So the NHS offers non-exempt patients two supports: a subsidy and tight control over the charges dentists can make.

The dental association wants to abolish the subsidy and the fee schedule. Instead the Government would pay the costs of bringing the patient into the surgery: check-ups, X-rays and emergency treatment would be free. After that non-exempt patients would pay all the dentists' unregulated fees.

Thus NHS patients would be delivered unprotected into the market-place. The association knows the dangers they would face. Last year its own survey revealed that private dental charges are five to 10 times higher than the NHS schedule rate. And there were great variations within the private sector. A crown (NHS cost pounds 32.25) could cost between pounds 60 and pounds 600 within the same area.

Consumers are virtually powerless to control prices in health markets. When people are ill they put their trust in a professional to define the problem and prescribe the best treatment. They are in no position to argue with the diagnosis, the treatment plan or the cost. Thousands of papers have been written on health care in the United States, proving just this point, and President Bill Clinton is struggling to reform that system as costs have spiralled.

When the internal market was introduced into NHS medical care, purchasing power was deliberately not given to patients. The Government recognised that people were neither powerful nor sufficiently knowledgeable and could be exploited by professionals. A proper market would be one in which a patient could gain quick access to the range of prices in his or her area, high-quality information that ranked dentists, plus the expert knowledge to evaluate a dentist's diagnosis. Dentists would hate such a real market. Instead they advocate a phoney version at the expense of their patients and the NHS. Virginia Bottomley, Secretary of State for Health, should resist the temptation to join in this betrayal.