WHY DENTAL COVER BY SA’s MEDICAL AID SCHEMES ARE INSUFFICIENT

The South African Dental Association (SADA) today said in a statement that the actual cover for dentistry by South Africa’s Medical Aid Schemes in many instances does not even reimburse the costs of the actual material in dental treatments let alone pay for the professional time of dentists.

According to the statistics reflected in the annual reports of the Council for Medical Schemes (CMS), medical aid scheme payouts to dentists and dental specialists have declined from 8.4% in the late nineties to 3.5% in 2012.

Visits to dentists by medical scheme beneficiaries - at least once a year - decreased during 2011 from 233.2 per thousand to 227.6 per thousand. This translates to only 0.4 per cent of medical scheme beneficiaries visiting a dentist at least once a year! This is particularly unnerving in view of the minimum recommendation of two visits a year required to maintain basic oral health.

Maretha Smit, Chief Executive Officer of the South African Dental Association, says that despite the high percentage of GDP allocated to health in our country the health outcomes are extremely poor and there is an urgent need to focus attention on prevention and primary care in dentistry.  “Very few patients understand the limitations of dental cover through their Medical Aid Schemes. Also, scheme rates offered to dentists, in many instances, fall way below the actual costs of treatment and service.  The inadequacy of current funding models to provide sufficiently for dental care might ultimately lead to the demise of the profession.”

Maretha emphasized that it is time that medical scheme members – and, especially prospective members – start asking serious questions and demand that benefits in this area of basic medical care be re-structured. She further pointed out that, in the context of the current economy and the pressure brought about by medical schemes’ insufficient cover for essential dental procedures, that the man in the street is placing dentistry low on the list of essential needs.

Statistics released by the Government Employees Medical Schemes recently revealed that 41% of women and 31% of men suffer from oral disease in South Africa, with 64% of women and 56% of men having lost some of their teeth. Such alarmingly high statistics underscores the urgent need for dental services to receive a higher priority by Medical Aid Schemes.

“It is extremely short-sighted of Medical Aid Schemes to ignore the irrefutable fact that there is a direct correlation between oral health and very serious systemic diseases, such as cardio vascular, pregnancy, respiratory as well as multitude of other serious ailments,” says Maretha. “These conditions, which in the long-run cost a fortune to treat, may very well be avoided if cover was provided for the relatively much lower costs of effective and preventative dental treatments.”

Further complications arise in the dentist/ patient relationship when medical aid schemes, in their effort to offer a competitive package to their members, give the impression that their scheme benefit for dentistry is in fact a fair fee for the procedure. Says Maretha: “Some schemes even go as far as to inform members that the practitioner is “overcharging” if he/she charges more than the scheme benefit!”

When considering a medical aid scheme, the prospective member must also be aware of the whole issue of network agreements. These agreements state that the patient is obliged to go to a specified network of providers where he/she will be guaranteed a contracted low fee per procedure. Maretha says that it is unfortunate that these fees mostly are not determined through any scientific cost studies and “network fees” in many instances are below cost price for the procedure. The practitioner is not allowed to refuse treatment on such contracts and is therefore often incurring losses on such procedures.

Maretha adds:  “During 2012 there has been a huge amount of publicity regarding the cost of private healthcare and the Minister of Health is on record for being very critical about the cost of private healthcare - to such an extent that he intended to launch an investigation into the cost drivers in the space.”

SADA’s response to the investigation is extremely positive. “We would welcome such an investigation as we very well know that it is not the coal face practitioner – your family doctor and dentist – who are driving the cost of private healthcare.  The problem resides in the administration of healthcare and particularly in the bureaucracies of the hospitals, medical schemes, scheme administrators and, especially, in the commissions paid to brokers.”

 

Maretha backs up her statement by quoting from the 2011 annual report of the Council of Medical Schemes: “It is quite obvious where the money goes.  Of the total R93.2 billion spent by the schemes in 2011, it emerged that R34.1 billion went to private hospitals and R12.124 billion went to non-healthcare costs such as administrator and managed care fees.  Medical specialists received R 21.3 billion, while general practitioners and dentists received a mere R6.8 and R2.6 billion respectively of the total pie.

“There is huge wastage in the system especially the exorbitant funds paid to brokers. And, these brokers are not in effect bringing any significant number of new patients to the market but rather just move members around from scheme to scheme.”

The Professional Provident Society (PPS) recently conducted a survey of dentists in which the professionals were also asked if they would remain in South Africa for the foreseeable future. Shockingly, there was a 4 percentage point decrease from a previous survey to 73% in 2012.  When paired with recent data released by the Pondering Panda survey - which revealed that the overall number of youths between the ages of 18 - 34 who want to emigrate had increased from 25% to 36% over a period of three months – this change in outlook by dentists is most worrying and indicates an attitudinal shift which could cost the country dearly in the long-term.

“Dentists in South Africa are by no means being remunerated in line with the years of study and the excellent skills they are taught at universities,” Maretha continues. ”The high outlay for basic equipment, and the staggering costs of materials, most of which are imported from abroad, leaves very little room for a fair profit. And, very few patients understand that their Medical Aid Schemes are responsible for this failure for basic dentistry to be made accessible and that the scheme rates offered to dentists, in the majority of cases, fall way below the actual costs of good average treatment and service.”

Maretha concludes: “It is time that the public is made aware that medical aid schemes in South Africa is not covering dentistry as a basic healthcare need. One only needs to do a quick internet search where websites such as Hellopeter.com lists a myriad of complaints from members in respect of insufficient cover for dentistry. And, without decent cover for dental services medical aid members are at risk of developing far more serious diseases which, in the end, cost the medical schemes a great deal more than sufficient dentistry and, which also put their members’ health at the risk of serious and long-term impairment.”

Johannesburg, Friday, 28^th December 2012

NOTES TO EDITORS:

1.    To understand the scope of dental services – and especially in a country such as South Africa where relatively few people have access to basic dental services – the public needs first understand the differences between general dentistry and cosmetic dentistry.

2.    General dentistry focuses on your oral well-being and taking excellent treatment of your teeth so dental troubles do get a foothold. Essentially, general dentistry provides preventative procedures and a good dental care program and it is therefore essential for people to have regular dental check-ups and expert cleanings performed. A general dentist is also consulted for root canal treatment, tooth whitening, gum problems and the preparation and fitting of dental crowns, the application of dental sealants and, if all else fails, tooth extractions.

3.    Cosmetic dentistry is a somewhat more specialized area of dentistry that requires innovative teaching that goes over and above the training of general dentistry. While it is not recognized as a separate specialty within dentistry – which means that there is no restriction on any dentist performing cosmetic dentistry – professional cosmetic dentists normally require extensive additional training that can take years. This means a heavy commitment of time, money, and energy for the dentist and, in terms of the actual profits made in South Africa through performing elective surgery on patients, it scarcely merits acquiring such additional skills.

4.    Most people will go to a cosmetic dentist to improve the appearance of their smiles. Cosmetic dentistry treatment options consist of porcelain veneers, dental crowns, tooth whitening, tooth-coloured fillings and dental implants.

5.    The single biggest difference between general dentistry and cosmetic dentistry is the variation and application of different technologies. For each of these areas of dentistry there exists state-of-the-art technology; for the former apparatus to assist in keeping your mouth functional and trouble-free and for the latter equipment to artfully craft tooth restorations.

FOR FURTHER INFORMATION:

1.   Maretha Smit

    Tel: (011) 484 5288, Mobile: 084 627 3842, Fax: (011) 642 5718

e-mail: msmit@sada.co.za

2.   Mixael de Kock

Tel: 011 646 8501, Mobile: 083 651 4424/ 071 226 8063/

Fax: (011) 646-8501

e-mail: coq@mweb.co.za

The Big Teeth of Small Business

Clem Sunter, in his keynote address to the South African Dental Society (SADA) Congress 2012, themed Dental Dignity for All and, which conference concluded in Cape Town this weekend, said that one of the key indicators of South Africa’s economic growth will be government’s attitude to small business.

Sunter had the dentists in sutures when he started out his talk by saying that he was the cabaret before the congress got into the serious business of teeth. But, the laughter soon died down when he got his teeth into a world scenario most likely to play out in the foreseeable future. The growth period of the past decades has resulted in too much credit and, as a result, the world now finds itself in a hangover period. It is a world in which he observes an aging population and, it is a world in which there will be greater demand for services and a concomitant decrease in productivity.

According to Sunter the whole investment game has changed and he said that “it is now a race between poverty and death.” Therefore, globally, if there isn’t an “upswing” in sight, then professionals such as dentists would have to decide what they should do to stimulate their businesses. It is essential to rethink the core business requirements of all professions against a background of reduced disposable income and where the focus is shifting from niceties to necessities.

Sunter’s view is very much in line with the congress theme of Dental Dignity for All and which, amongst other issues,  also addressed oral health considerations in an aging population. In this respect Dr. Michael I. MacEntee, professor of Prosthodontics and Dental Geriatrics, ELDERS Research Group reminded dentists that they are treating patients and not only teeth. This is particularly true for older people as well as those of lesser social economic means. “Often there are times when less advanced treatments are required in order to make patients feel comfortable and, to maintain their dignity as opposed to the application of advanced dental technology.”

“It was important for SADA, in presenting this conference to strike a balance between the basic needs in dentistry and the need for dentists to be fully informed about emerging trends in digital dental technology,“ says Dr Paul van Zyl, scientific convener of the congress, featuring 12 international and 15 local speakers.

Sunter believes that in every sphere of South Africa we have pockets of excellence and said these pockets gave him hope for the country. “Whereas in America individual excellence is celebrated, in South Africa we tolerate mediocrity and cut down the tall poppies.”

In conclusion Sunter suggested to the gathered dental fraternity that what the world is missing is the fact that the Chinese economy is being built on small business and entrepreneurship and not on state-owned enterprises or big business. It is a pity that South Africa has a most ambivalent attitude to small business – red tape and labour laws inhibit rather than stimulate the emergence of this sector. In reality, it would be far more profitable for all if the State created one million small businesses instead of promising to create five million jobs. The exponential affect of a stimulated small business sector would result in a real solution to the problems of unemployment in this country.

Maretha Smit, Chief Executive of SADA says, “This conference addressed the actual issues within dentistry as it moves into a future South Africa. All the speakers and topics highlighted the central theme of self-respect for both the dental professional and for the patient. We need to recognize all who work in the dental team and, especially those professionals who operate businesses, employ people, pay taxes and deliver services that will bring dental dignity to all.”

Johannesburg, 8^th November 2012

FOR FURTHER INFORMATION:

1.     Maretha Smit

    Tel: (011) 484 5288, Mobile: 084 627 3842, Fax: (011) 642 5718

e-mail: msmit@sada.co.za

2.    Mixael de Kock

Tel: 011 646 8501, Mobile: 083 651 4424/ 071 226 8063/

Fax: (011) 646-8501

e-mail: coq@mweb.co.za

The Riddle of the Missing Tooth Faerie

The South African Dental Association (SADA) today warned that during the last number of years, once thriving dental practices have been going bankrupt while emigration continues to void the profession.

Maretha Smit, Chief Executive of SADA said in a statement that payouts to dentistry from medical aid schemes have been reduced from 8.4% in the late nineties to 2.2% last year. “It is time that members of Medical Schemes start asking serious questions and demand that benefits in this area of basic medical care are re-structured. If not, there will be very few dentists left in a country that can hardly afford the further loss of any of its medical services, let alone dentists.”

Maretha further pointed out that in the context of the current economy and the pressure brought about by medical schemes which are not providing adequate cover for essential dental procedures, the man in the street is placing dentistry low on the list of essential needs.

“Dentists in South Africa are by no means smiling. The high outlay for basic equipment, and the staggering costs of materials, most of which are imported from abroad, leaves very little room for a fair profit. And, very few patients understand that their Medical Aid Schemes are responsible for this failure for basic dentistry to be made accessible and that the scheme rates offered to dentists, in the majority of cases, fall way below the actual costs of good average treatment and service.”

Maretha Smit also expressed SADA’s dismay at the way in which reality television shows are distorting the perceptions that the public holds of dentists and dentistry and how, in a developing country such as South Africa, these shows are diverting the attention from the real need for good general dentistry and dental services to our communities.

“We are gravely concerned about media reports that South African dentists are smiling because of the profits they are making. These reports are distorted out of context and the impression is created that dental practices are making huge profits. This is simply not true of a profession which is known be struggling to keep its doors open to the public.

The reality of the matter is that true profits on cosmetic dentistry - the more profitable of the dental services – run between 10 – 20% only!”

Maretha continues: “Most serious businessmen will smirk at such low profit margins which, in themselves, again are much higher than the profit margins for most dental specializations in South Africa and, significantly higher than that for general dentistry! If the profit margins in elective dentistry is this minute then one can very well understand why so many dentists are leaving the country. Dentists must be allowed an opportunity at earning a decent professional income – very few people can be expected to be dedicated to a vocation without any reward whatsoever.”

It is time that the public is made aware that dentistry in South Africa is a profession under threat and that it is a threat that extends to every household and every family of this country. Unless, the crisis in dentistry in South Africa is addressed soon there will be no smiles from anyone around and the question will be as to whatever had happened to the tooth fairy.


Johannesburg, Friday 6th January 2012