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Seanad Éireann debate -
Wednesday, 23 Jun 1982

Vol. 98 No. 5

Adjournment Matter. - Dental Benefit Scheme Payments.

An Leas-Chathaoirleach

Senator West has given notice that he proposes to raise on the Adjournment the unreasonable delays in payments under the dental benefit scheme by the Department of Social Welfare. I call Senator West.

I will remark before I start that it is rather like the old days when we used regularly meet until 10 o'clock in the evening.

I am pleased to have the opportunity to raise the problem of unreasonable delay in payments under the dental benefit scheme by the Department of Social Welfare. I raise this not in a critical spirit. There is an important criticism to be made but I want to try to make constructive criticisms of the difficulties that arise. At the moment something like 825,000 of our citizens qualify for this scheme. The delays in payments to the dentists who treat patients who come under this scheme stretch as far as 18 months. I am aware of this because I was shown a form by my own dentist in Cork during the week. First of all the payment was queried, then the application was queried, then it was passed without change. The total delay between the treatment and the receipt of payment by the dentist from the Department of Social Welfare was 17 months.

I was told by the Irish Dental Association that this is not an isolated case. My own dentist had a large number of these slips. Some of them had been returned from the Department of Social Welfare. He said he was no longer prepared to operate the scheme. There was too much trouble, so much form-filling, and when he filled in the forms he did not see the pay-off at the end of the line, so he was going to opt out of the scheme. On inquiry it appeared that a number of dentists feel similarly about the scheme. The Irish Dental Association's Annual Report 1981, on page 4 makes the following comments. It said that the entire administration of the scheme was poor. Identification of patients' eligibility is non-existent. Processing of approvals and claims is far too slow. It is unreasonable to expect dentists to undertake costly treatments which they may never be reimbursed for. It also said that no other profession or, indeed any supplier of services is expected to deliver without positive identification of the recipients' entitlement and that it is essential that eligible patients have some form of identification card valid for a specific period and guaranteeing the patients' entitlement for that period.

That is the view of the professional body representing dentists in this country, and they have a point to argue. Their members are being paid very tardily for their services. In some cases they have not been paid at all because there are disputes about eligibility. I would like the Minister to look into this.

The problem is that the people who will suffer if payments are held up indefinitely or even for long periods and dentists opt out of the scheme, are the less privileged members of our community. Most of them are in the lower income bracket and they will be the people who will be penalised.

I would like also to make the following point: I believe that we have a very good dental service and, in spite of criticisms such as this, our standard of dental care is high and our general dental maintenance is also extremely good. The dentists quite rightly advocate prevention rather than treatment, and one important administrative change that is needed is that the preventive side of treatment be encompassed in any sort of scheme as well as the treatment which involves actual operative procedures, If we concentrate more and more on prevention, it will lighten the burden of correction at the far end.

I want to say to the Minister that it is absolutely unreasonable to expect dentists to wait for up to 18 months for payment of their bills by the State. Something should be done to straighten out the problem of entitlement, which should be a straightforward problem. I believe that the Department of Social Welfare are doing their utmost to rectify the situation, but some more administrative changes may be necessary before this scheme works fluently. It is a very important aspect of our total health service and it is very important that it should be seen to progress rather than regress, I would like to bring the problem to the Minister's attention.

Mayo West): First of all, as Minister of State at the Department of Social Welfare I am only too delighted to hear from any public representative in relation to irregularities of the kind which Senator West referred to. From the information I have from my Department the facts are not as stated by Senator West. I would submit at this stage that in the case he put before the House he has taken what may be an isolated case and generalised.

Dental treatment under the dental benefit schemes is provided by the dentists who are on the dental panel. It is open to any qualified dentist to apply to have his name placed on this dental panel. To do so he signs an agreement under which he undertakes to treat insured persons in the same manner as private patients and he agrees to a set scale of fees for the various treatments provided.

The dental profession is represented by the Irish Dental Association and in recent times to a minor degree by the Medical Union. The fees are increased periodically in line with the general fee increase and in recent years have been increased each year from 1 April, and are negotiated with the two representative bodies. There are approximately 620 dentists on the dental panel and 234,659 claims for dental benefit were made last year. In the first five months of this year, from January to May 1982, 108,253 dental claims were received. The Department pay the full cost of extractions, fillings including acidetch, composite and pin-retained amalgam fillings, certain treatments, X-rays, scaling and polishing and portion of the the cost of dentures, repairs and crowns. To obtain dental treatment an insured person must attend a dentist whose name appears on the dental panel.

Under present arrangements a dentist may proceed and complete any treatment in respect of which the Department pay the full cost provided the dentist is satisfied that his patient is qualified for dental benefit. If, however, the treatment, such as supply of dentures, requires the insured person to pay a portion of the cost, then prior approval must be obtained so that the Department may have the opportunity of informing both dentist and patient of the amount the patient will have to pay as his contribution. If, however, a dentist has any doubts as to the eligibility of his patient he may seek Department sanction before he proceeds with any treatment.

This is the point as far as the Senator is concerned. When treatment is completed the patient signs a certificate of satisfaction and the dentist submits the claim for payment. If the insured person is qualified according to the Department's records the claim is then listed for payment. This is normally done within 21 days of receipt of his claim. Payments for the month are totalled in respect of each individual dentist on the last day of each month and a cheque for the total amount due is issued to each dentist between the 10 and 15 of the next month. Each cheque is accompanied by a schedule setting out the individual amounts which comprise the total, and the payments procedure is computer-based.

About 80 per cent of all dental claims received for payment fall into the straight flow category. However, about 10 per cent of claims require further investigation regarding the insurance record of the patient concerned. This usually involves writing to the patient for particulars of insurance. Frequently the person concerned is slow in responding, thus causing delay in payment of the claim for the dentist concerned. In a further 10 per cent of claims, no PRSI number or an incorrect number is quoted, thus giving rise to further investigation and delays. In the vast majority of dental claims the dentist involved is paid promptly. When dentists submit lists of claims which they claim are unpaid it is usually found on investigation that the majority have already been paid and that the dentist's records systems are at fault. The Irish Dental Association who represent the interests of dentists are well aware that the Department are always most willing to co-operate in streamlining the system in any way possible in the interests of both the dentists and the insured persons. The Department are not aware of any widespread complaints regarding delays in the payment of claims, and The Irish Dental Association have not made any representations to the Department on behalf of the profession on this matter.

On the transfer of the contribution record system to pay-related social insurance, that is PRSI, in 1979 using computer produced data, certain difficulties arose but these have now been ironed out and the system is running smoothly. The total allocation in respect of dental benefit for 1982 is £7 million. From the information I have received from the Department they are quite satisfied that, in general, the scheme is operating fairly successfully. On average, about £11,000 per dentist is paid out. As in all schemes, there may be situations where there are isolated cases of mistakes or faults. I accept the Department's word that of all the schemes operated by the Department, this would have to be regarded as one of the most satisfactory.

The Seanad adjourned at 9.30 p.m. until 2.30 p.m. on Wednesday, 30 June 1982.

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