There are few universal truths that bind us all together, few common threads that link people of different nationalities and beliefs – but fear of the dentist must be one. The interrogatory light overhead, the assembled tools of torture and the sinister-sounding drill are the stuff of nightmares however old you get. And it’s not just the thought of syringes that people have to worry about: going to the dentist can leave holes in your wallet as well as your teeth.
Anyone lucky enough to find a nearby National Health Service (NHS) dentist – recent figures show that 52 per cent of people in south-east England cannot, and this is spreading across the country – should not assume that treatment will be free. Only people under 18 (under 19 in full-time education), pregnant women or those with a baby under one, and those on income support, family credit or jobseekers’ allowance are not liable for their dental bills. Everyone else has to find 80 per cent of the cost of NHS treatment up to a maximum of £354, which covers everything but the most serious surgery.
Faced with such large on-the-spot costs, it’s hardly surprising that people are turning to private dental plans to protect themselves. Dental care is one of the fastest growing areas of UK healthcare, and the private sector market is now worth around £2.6bn – a 33 per cent increase in 10 years. Demand for private plans has been increasing over the past three decades in line with widespread improvement in dental hygiene. And almost 54 per cent of people in the UK now go to the dentist once a year, as opposed to 40 per cent back in 1968.
But despite their growing popularity, these plans have come under fire recently, primarily from brokers, for not giving policyholders value for money.
One area of the market to come in for particular criticism has been the capitation plan. This is not traditional insurance but a scheme arranged through a dentist that allows people to pay for dental care in fixed monthly instalments rather than lump sums. The monthly amount depends on the patient’s oral health and policies usually cover routine dental work such as check-ups, fillings, X-rays and general preventative care.
Most capitation plans – and full dental insurance, which does not require an initial examination but only reimburses a percentage of costs – also cover accident and emergency treatment. But IFA Penny O’Nions from The Onion Group warns that there are different categories of accident and emergency treatment and people need to make sure they know exactly what their policy will provide. “Most dental policies will cover minor accidents such as a chipped tooth,” she says. “But when you get into major accidents, after which people might need major reconstructive surgery, it’s not quite so clear-cut as treatment will often fall within private medical insurance (PMI). Policyholders certainly need to know where the line is drawn on their own plan but I’d say anyone with a dental policy needs PMI as well if they want to guarantee the most comprehensive cover.”
But if someone only goes to the dentist for a couple of check-ups a year, intermediary Michael Payne, from Essex broker Health Plan, says that capitation-type dental insurance hardly seems worth taking out.
“Paying for the appointments individually, even at a private dentist, won’t be much different in price from a year’s capitation plan,” he explains. “Likewise, if you need some extensive treatment the monthly premium depends on dental health, and if this is poor, the amount will be higher. People won’t be much worse off if they just pay for the treatment themselves.”
Most monthly capitation plan payments range from £7-20 so even if you have excellent teeth and, presumably, only have to pay £7 a month, it will still add up to £84 a year. A check-up at an NHS dentist costs around £6 and, depending where you live, a similar appointment at a private practice will set you back around £25.
But WPA communications director David Ashdown argues that literal value for money is not really what insurance is about. “With most dental plans, someone’s value for money will actually depend on their oral health,” he says. “But if people take out our Providential scheme just to recoup the cost of routine dental treatment, that’s not really insurance as they’re not taking a risk. If they buy the scheme to cover routine costs and protect themselves in case of serious dental injury on the other hand, that’s a better value for money proposition. I don’t think the purpose of insurance is just for people to cover small expenses.”
Cigna Healthcare has recently launched two new dental plans, preventative and maintenance, with value for money very much in mind. Spokesperson Lynda Hardy Maskell says: “After 30 years of better nutrition, the general state of people’s dental health has certainly improved. We’ve also seen a move towards more preventative medicine as people have started to take better care of themselves. With these changes in mind, Cigna has designed plans for people who only want cover for basic maintenance treatment, and possibly some form of discount on more expensive surgery should they need it.”
Brokers claiming that dental plans do not give good value for money underestimate how important budgeting is to many people, according to Hardy Maskell. “No one likes to be hit with a big bill,” she says, “and these plans allow people to split the costs of basic treatment into affordable chunks and have extra support available if they do need more comprehensive surgery. Cigna is very keen to offer products that give customers both value for money and maximum benefits, and we recognise that one fee to cover all aspects of dental treatment is no longer what many people want.”
The other side of private dental insurance is company-paid corporate schemes, where value for money is no less a concern, according to BCWA sales and marketing director Philip Fowles. “Premiums are around £100 a year with our Confident plan, and if someone has a couple of check-ups, a scale and polish and, perhaps, a filling, the policy covers the costs – for less than £10 a month,” he says.
Fowles believes that this type of cover is ideal for companies that move staff around the country and ask them to work, sometimes for years, in places where they may not be able to access an NHS dentist. “£100 a year isn’t extortionate, and the policy can be a useful addition to a company’s benefits package,” he says. “Everyone knows how hard it is to attract and retain staff in the current employment market, and dental plans are a high benefit, low-cost perk that many employees seem to value highly.”
One question that does remain about the future of the private dental market is how it will fit into the private healthcare picture alongside PMI and cash plans, both of which can include dental elements.
While Royal & SunAlliance and Standard Life Healthcare do incorporate dental cover in some PMI policies, Ashdown says the majority of the PMI players have never covered routine dental treatment and are now moving away from the accident and emergency side. WPA stopped including dental insurance in its own PMI plans because so many people were claiming to have impacted wisdom teeth removed.
“We feel that’s not really what we’re here for,” says Ashdown.
As for cash plans, although many do include some dental cover, Fowles points out that most only reimburse something like 50 per cent of treatment costs up to a yearly limit.
MedEx administration manager Paul Callow adds that cash plans can also often include cover for conditions that dental customers may not want. “We designed our Optident product, which combines optical and dental cover, after listening to customers who had rejected the MedEx cash plan,” he says. “That includes elements as diverse as physiotherapy, osteopathy and hospital stays. Many people said they just weren’t interested in most of those. A high proportion of our customers go to the dentist and wear glasses and simply wanted a policy to cover that.”
So the general consensus from industry insiders is that the private dental plan market can hardly fail to grow as more and more NHS dentists become private practices. Optimists among PMI providers even venture that this privatisation process might stand as a good example of how NHS treatment can transfer to an almost completely private system without too much difficulty.
But despite the sense of opportunity and confident predictions that pervade the market, at least among providers, Payne sounds a final cautionary note. “Most private dental plans are arranged and marketed through dentists,” he says, “and intermediaries are hardly involved in the process at all. Although there is growing anecdotal evidence that many people have at least some form of dental cover, I don’t think the market will really take off until insurers bring out good policies that intermediaries can market.”
Food for thought for dental plan providers at a time when circumstances give the market a real chance to grow.