Two stories about British dental care sound a tocsin about government involvement in health care

This is a matched set of stories from the London Times, both about British dental care, and both warning of the travails when the government both controls much (not all, but much) of the market.  The first story involves the horrible teeth British children enjoy under national dental care.  You’ll note that the culprits aren’t only diet and culture (which are, of course, very real concerns), but are also rationing’ the system’s past inability to entice people into being dentists, a problem offset now by enticements unrelated to the marketplace; and, significantly, the absence of a true free market to control the type of treatments dentists provide:

Children have had nearly one million teeth pulled out in a year as sugary diets and poor dental care took its toll. The number of tooth extractions carried out on children aged under 18 has risen by 12 per cent in five years, the NHS Information Centre said.

The figures support recent warnings that thousands of children are ending up in hospital because of their teeth, with many requiring a general anaesthetic. The latest data — the first to compare clinical activity before and after the Government’s recent overhaul of NHS dentistry — also showed that there were two million extractions carried out on adults in 2008-09, a rise of 220,000 on 2003-04.

Bad diets, poor brushing and shortfalls in the provision of dental care have all been blamed for the sharp rise in teeth pulling brought on by dental caries. The figures raise questions about the Government’s efforts to improve access to preventive dental care, including regular check-ups and fluoride treatments.

An overhaul of dental contracts was introduced three years ago to boost the number of NHS dentists and to end the “drill and fill” culture in which dentists were paid for the number of treatments carried out. The new contract was designed to allow dentists to spend more time on preventative work by paying them a flat salary.

An average dentist’s take-home pay is about £90,000 and many earn more than £200,000. They receive this wage regardless of whether they carry out simple or complex treatment.The figures revealed a sharp drop in more difficult procedures, such as crowns, bridges and root canal work. Crowns fell by nearly 50 per cent between 2004 and 2009 to 750,000, while the number of root canals fell by 40 per cent over the same period.

[I snipped here the competing statements about dental care from liberal and conservative politicians. I’ll wrap up with the article’s concluding fact.]

Earlier this year ministers agreed to a further overhaul of NHS dentistry after it emerged that it had led to even fewer patients accessing care. A review led by Professor Jimmy Steele of Newcastle University recommended that income should be determined by patient list size, quality of care and the number of courses of treatment.

The second story involves the bizarre system that has developed in Scotland, once again a landscape that doesn’t have entirely Communist health care (that is, only government controlled care), but that tries to provide a weird amalgam of public and private care in a government controlled environment (emphasis mine):

When Alfred Huynen was preparing to open a new dental practice he was forced to rip up the rulebook on marketing. Instead of advertising the service that he intended to provide, he concealed it, fearing that his acceptance of NHS patients would prompt huge queues.

Mr Huynen’s practice in Cove, Aberdeen, opened three weeks ago, spurning private patients in favour of those who are subsidised by the health service. During the five months that it took to build the surgery he kept the function of the building secret in an attempt to prevent long queues from forming outside. He even let some neighbouring businesses think that it was a takeaway. Now that word has leaked out, the practice has registered 3,000 people in three weeks.

Scots have long had a problem with accessing NHS dentists as practitioners often choose to go private instead of carrying out less lucrative health service work. The SNP government has worked hard to address the shortage by boosting the salary of NHS dentists, who can now earn up to £65,000. The poor provision means that surgeries who accept health service patients can look forward to lots of work.


Mr Huynen said that people were travelling hundreds of miles because they were so desperate for an NHS dentist. “I can’t believe the distances people are coming from,” he said.

You’ll note from the last story that, when people have a choice, they don’t want government provided care.  They’re willing to pay twice — once by way of taxes that are taken from them by government coercion and once again by way of exercising their choice in the marketplace.  All that the government option does is suck money out of the marketplace without actually increasing patient care.