Ouch! British dental care the most expensive in Europe
Europe-wide study reveals huge gulf in dental prices
Dental treatment in England is the most expensive in Europe, according to an unprecedented survey which is likely to fuel the exodus of patients seeking treatment abroad.
The survey of nine European countries found the total cost of a standard filling ranged from �156 (�117) in England to �8 in Hungary. That total included the cost of x-rays, materials, drugs and overheads, as well as the dentist's time.
The findings come amid growing dissatisfaction with dentistry in Britain and shrinking NHS provision. The Government admitted last March that two million patients who wanted NHS treatment were unable to get it, eight years after Tony Blair pledged at the Labour Party conference in 1999 that everyone would have access to an NHS dentist.
Dentists have dramatically increased their private work over the past decade, at the expense of their NHS work, and when a new NHS practice opens, desperate patients queue to register.
Dentists with their own practices earned an average of �105,000 in 2004-05. More than half their total income (52.4 per cent) came from private work, up from 41.8 per cent in 1999-2000. In 1990 it was 6 per cent.
While England topped the table as the most expensive country for dentistry at �156 for a filling, it was closely followed by Italy (�135) and Spain (�125). Costs in the other western European countries were less than half as much, ranging from �67 in Germany to �46 in France.
In all European healthcare systems, the greater the cost of carrying out dental work, the greater the level of government subsidy required to keep the price of dental treatment down for patients.
The cheapest countries for treatment were Poland (�18) and Hungary (�8), the main destinations for dental tourists from Britain. Savings of thousands of pounds are promised by agencies that arrange treatment in these countries, even after paying the cost of flights and hotel bills.
It is the first time that the cost of carrying out a dental filling has been compared across Europe. Siok Swan Tan, of the Institute for Medical Technology Assessment, at Erasmus University Rotterdam, and lead author of the study, said differences in dentists' earnings were the most important reason for the variation in costs. "Without exception, labour costs were the most important cost driver in all countries and practices," she said. "They accounted for 70 per cent of total costs in England. They ranged from �0.09 per minute in Hungary to �2.88 a minute in England."
The figure for England included material costs which "makes straightforward comparisons difficult", she said. The procedure was a filling in a molar tooth in a 12-year-old child.
High costs and the difficulty of finding NHS dentists have combined to make dental tourism the fastest growing category of medical tourism. Of 77,000 travellers from the UK who went abroad in 2006 for medical treatment recorded in the International Passenger Survey, an estimated 43 per cent sought dental care, according to the agency Treatment Abroad.
Keith Pollard, its managing director, said: "Dentistry is the biggest part of the business. The number of providers targeting the UK at the moment is phenomenal. It is driven by the high prices charged in the UK and the difficulty of finding an NHS dentist. When you find a private dentist the prices are shocking."
NHS patient charges are in three bands ranging from �15.90 for a check-up and x-ray to �43.60 for one to six fillings, to a maximum of �194 for crowns or root treatments. Private charges are two to three times higher.
The British Dental Association rejected the research as "deeply flawed". Peter Ward, its chief executive, said it was based on a sample of four practices out of 10,000, and was "riven with problems".
"It is a very small sample, it is not representative and it is not comparing like with like," said Mr Ward. "The dentists selected were community dentists who normally care for patients with special needs who need more staff and take longer to treat. It is impossible to make a sensible comment on a set of flawed data."
The survey is part of a wider study, commissioned by the European Commission, comparing the cost of a range of medical procedures among the nine countries and is published in the journal Health Economics.
Professor Reinhard Busse, of the department of health management at the Berlin University of Technology, who led the research, said: "We wanted to see if we could explain differences in the costs. The aim of the research is to help governments plan what levels of reimbursement may be necessary if, as we expect, cross-border medical tourism increases." The European Commission is due to publish draft plans which would open EU borders to medical tourists, allowing citizens of any of the 27 member states to seek treatment in a neighbouring country with the home country, in certain circumstances, picking up the bill. If the proposals are approved, it will focus attention on the performance of the NHS against other health systems.
The dentistry survey showed that in all cases the total cost of providing a filling exceeded the charge to the patient and in most it exceeded the payment from patient and government combined.
'I had to ask if the treatment was really needed'
Kath Diamond says her daughter Meg, aged 10, has "great teeth". So when she took her for a routine check-up at an NHS dentist in Putney a month ago, she didn't expect to embark on a series of appointments that would end in a bill for several thousand pounds.
But that's what happened after Meg was referred to an orthodontist in West Hampstead, who "immediately" said her teeth were not of the standard to qualify for further NHS treatment. According to the orthodontist, Meg had an "overshot" jaw and "mild crowding" in the lower jaw.
The proposed solution? A night-time head-brace and a removable day-brace for six months, plus 12 to 18 months of "railway track" braces on the upper and lower jaw.
After that she would need another brace every night for a period, followed by a day-brace a couple of times per week for the next decade �Euntil she was 20 years old. After a "long consultation process", a bill was presented for �2,500 on Tuesday.
Mrs Diamond was staggered. "In the end," she says, "I asked, 'Is there a physical need for this treatment?'. They said Meg's teeth would be difficult to clean when older, and I think that is probably not true. It was all to give her the 'perfect' set of teeth."
With understatement, Mrs Diamond adds: "But that would have involved invasive treatment." Reflecting on the episode, she says: "There wasn't a sense of openness about it being what was, essentially, cosmetic surgery".
Know the drill about dental care abroad
One of the biggest health worries facing many people today is dental care – or the lack of it.
The lack of NHS dentists and the high cost of private dentistry in the UK mean more of us are now going abroad to find cheaper treatment – and this trend looks set to continue.
In 2004, the number of Brits visiting foreign dental clinics was around 11,000; in 2007 the figure had risen to 49,000. This year it’s estimated that the number will rise even further to 60,000.
According to consumer organisation Which? the most common dental procedures abroad include crowns, implants, bridges, veneers and cosmetic dentistry like teeth whitening.
But is it safe to go to a foreign country for dental work? Yes, if you follow a few simple rules.
My advice is don’t be led by price alone – what’s more important is the dentist’s experience, qualifications and your rapport with them. Here’s how to get the right treatment at the right price.
Check out a few clinics then narrow them down to the best one.
(1) Use a search site such as treatmentabroad.com to find a few suitable dental clinics you can investigate in further detail.
(2) Google each clinic to check out its reputation.
(3) Contact the clinics directly and ask if their dentists are members of the country’s medical statutory body (in the UK it’s the British Dental Association). To be extra sure, double-check with the relevant body.
(4) Ask what qualifications the dentists hold.
(5) Find out which clinics have dentists who speak English. If possible, ask to speak to the dentist directly to get an idea of how good his or her English is.
(6) Ask if the clinic has a complaints procedure. If so, request a copy.
(7) Ask how many of the relevant procedure the dentist performs each year. If it’s fewer than 500, it’s
too low, so choose another specialist.
(8) Book an initial consultation if you feel comfortable. I’d strongly advise going with companies that carry out consultations in the UK because you’ll feel pressurised into going ahead with treatment if you’re already abroad. If you’re in the UK, you’re more likely to walk away if you’re unhappy with what’s being offered.
(9) Don’t forget to tell your own dentist about your plans. He or she may offer advice based on your dental history. They also need to be aware of the treatment in case of complications later.
(10) Stay away from any website without a telephone number or address, anyone not registered
with the country’s equivalent of the BDA and any clinic or dentist that insists on you paying in full before your treatment.
What to expect
/ A qualified dentist, not a nurse, should give your initial consultation. Ask for their full name.
/ If your consultation is in the UK, ask if the dentist is registered with the General Dental Council – if not, they’re working illegally in the UK. You can check the dentist is registered later by visiting gdc-uk.org
or calling 0845 222 4141.
/ You need a good rapport with your dentist – if you don’t have this and something goes wrong, you’ll find it very hard to resolve the situation.
Vital questions to ask
/ Will you be carrying out my treatment?
/ What qualifications do you have and can I see a copy of your certificate of qualifications?
/ Does the dental team speak English?
/ Do you have any testimonials from previous patients and before-and-after pictures of your work?
/How many times have you carried out this procedure?
/What are the risks?
/Is the work guaranteed, and for how long?
/What aftercare do you provide?
/What happens if I’m unhappy with the results? Who pays for the extra flights, a hotel and remedial work?
/Do you have a dentist in the UK who will carry out emergency work on your behalf?
/Do you have any insurance to cover this procedure?
/If, at any point, the dentist refuses to give you the information you ask for, you should walk away.
What the dentist should ask you
At the consultation:
/ Your full medical history.
/ If you smoke.
/ Whether you’ve had any surgery or general anaesthetic in the past.
/ A list of the drugs you take, including aspirin.
/ Whether you have a history of cardiac or respiratory diseases or diabetes.
/ If you bruise easily.
/ If you have a history of bleeding when your teeth are taken out.
Last-minute checklist
GET A QUOTE: If you’re happy with the consultation, ask for a written quote and exactly what it covers (for example, X-rays, clinic costs and anaesthesia.) Ask for a copy of your cost and treatment plans, contract, guarantee, complaints procedure and record of treatment.
Check the payment method: Find out if you need to pay in cash, by credit card or a lump sum at the end of your treatment. Check whether you will be refunded if you decide not to go ahead with the treatment or are thought not to be suitable.
Consider special insurance: Normal travel insurance is for emergency cover and is unlikely to protect you if something goes wrong during planned treatment abroad. So it’s worth taking out special health insurance for the trip. But make sure you specify to your insurer that you need it for dental work abroad.
Know the law: You should know that UK law and regulations won’t protect you if you go
abroad for treatment.
What you save
• Dental implants in UK £2,000: price in Hungary £665, saving £1,335.
• Bridges in UK £1,000: price in Poland £110, saving £890.
• Crowns in UK £570: price in Spain £136, saving £434.
• Teeth whitening in UK £560:price in Croatia £317, saving £243.
•Veneers in UK £500: price in Greece £185, saving £315.
•Root canal in UK £220: price in Poland £35, saving £185.
Prices supplied by Treatment Abroad,
UK costs for private dental surgery.