From bad teeth to no teeth

Back in the old days, dentists were paid a fee for each type of treatment they provided. After a contract change, dentists started receiving their income by doing a certain amount of work, known as “units of dental activity.”

You can imagine the dentist: “I need to do 15 procedures to meet my weekly quota. I could fill all those cavities… but that takes a long time and requires numbing and filling materials. Or I could just pull the tooth out. It takes no time at all and requires no medicine or precious metals.”

The NHS did not think about all this before implementing the new contract. But a damning new report from an influential MP’s committee shows how bad the situation is.

Dentists are extracting patients’ teeth rather than carrying out more complex repair work because NHS reforms have failed… The number of tooth extractions, many of them unnecessary, experts say, has risen since the new contract was introduced. At the same time, the volume of more complex work such as crowns, bridges and dentures has fallen by more than half.

The solution is not to reform the contract again, but to eliminate it altogether. We deserve health care that gets us the best treatment for our needs, but NHS contracts distort the incentive structure in such a way that dentistry works against patients. The NHS being inefficient, working against patients, and distorting the markets? Must be a slow news day if this is news.

Mr
written by ken buxton, July 05, 2008

I can speak from personal experience of the outcome of the extraction versus filling anomaly. In the early fifties as a naive trusting youth I allowed myself to be convinced that I had three back teeth needing to be taken out. I was not aware at the time that the fee recoverable by the dentist for a filling was five shillings and for an extraction seven and sixpence. Forty years later here in Australia bridges to fill the gaps cost me many thousands of dollars.

It wasn't the reason I emigrated but I am glad I did. Australians would not put up with what you suffer under the NHS.

...
written by Toby, July 05, 2008

Furthermore, it is those the NHS is intended to help - the poor - who are suffering. Those with more means take private dentistry, who like the best of Smith's teachers, are paid directly by their patients and so are trying to act in their best interests.