Approximately 1.5 million dental patients are being exposed to a lifetime of embarrassment, decreased nutrition and loss of well-being according to the chief executive of the Irish Dental Association, Fintan Hourihan.
Mr Hourihan made the remarks as part of his evidence to the Oireachtas Joint Committee on Health Review of the Operation of the Medical Card Scheme.
The Irish Dental Association also told the Committee that the express view of its members, who are the dentists operating the scheme on a daily basis, is that the State scheme for the approximately 1.5 million eligible medical card patients is in crisis and on the brink of collapse.
Mr Hourihan said that the past year has seen an unprecedented crisis develop as a quarter of all participating dentists have withdrawn from the medical card scheme with serious repercussions for patients across the country:
“Total spending on the scheme fell from more than €63 million in 2017 to barely €40 million last year. The implication of this is that large numbers of patients are no longer accessing treatment as the scheme is a fee-per-item structure.”
The Dental Association say that the origins of the current crisis go back to 2010 when the HSE imposed unilateral cuts to the scheme to reduce costs.
Those cuts which were implemented “without consulting the association, dentists or patients” fundamentally altered the scheme from “a demand-led scheme to a budget-led scheme.”
This was done by removing access for many patients to treatments under the scheme.
According to Mr Hourihan, this also restricted access for the majority of patients to one examination annually, a maximum of two fillings irrespective of circumstances. However, no such limits were imposed on the number of extractions that could be carried out.
The IDA says this has meant that the medical card dental scheme no longer supports the oral health of medical card holders; rather it enables them to lose their teeth and to rely on dentures:
“Only those who have a significant medical condition from a narrow, prescribed range are enabled to access more treatment of items on application. The net effect is that any adult over the age of 16 can no longer access the dental care he or she requires to maintain dental health.”
The Joint Committee also heard that the Department of Health’s refusal to redevelop the medical card dental scheme and its utter refusal to acknowledge the reality of the crisis suggested “a level of disrespect, if not contempt, for the profession, the importance of dental and oral health and the patients who rely on this scheme.”
The HSE was also accused of maintaining inaccurate records on the true number of dentists operating or available within the Scheme:
Mr Hourihan gave the example of a dentist he had spoken to who said that five dentists in his practice held contracts under the medical card scheme until quite recently but that this was now down to just one:
“However, when he checked the database published on the HSE website, he saw all five were still listed as being active, so we believe the official statistics are grossly overstated. My best guess is fewer than 1,000 dentists are currently participating in the scheme.”
In concluding her remarks to the Committee Dr. Caroline Robins, chair of the IDA general practice committee said that the HSE’s current model of care was “fundamentally inhumane” to dental patients, while Dr Clodagh McAllister, president-elect emphasised that it is the most vulnerable in society who are not being looked after:
“More importantly, the Government has a duty to look after them, so what it is doing is wholly unequal. It means that one section of society can access care and another section cannot.”