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 – until 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".

Via The Independent