Seanad debates

Tuesday, 8 December 2009

7:00 pm

Photo of Rónán MullenRónán Mullen (Independent)
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Cuirim fáilte roimh an Aire. Táimid uilig ag súil le cloisteáil cad iad na himpleachtaí dá Roinn ón cáinfhaisnéis amárach. The background to the matter I am raising is the proposal made in the McCarthy report that the dental treatment benefit scheme, DTBS, or the PRSI scheme as it is commonly known, should be abolished. The scheme is an insurance scheme that operates on the basis of contributions made by workers in the expectation that they will receive benefits in return. I have benefited from it myself. It is crucial that the Government rejects the recommendation set out in the McCarthy report and instead upholds the DTBS.

Approximately 2 million workers and their family members are entitled to dental benefits through their contributions to the PRSI scheme. The DTBS offers them the highest standards of quality care and valuable discounts to the market rate for any items not covered fully under the scheme. Last year over 400,000 people visited their dentist for an annual examination under the scheme. In addition, there were over 1.5 million treatment items such as fillings and extractions availed of by patients.

Oral health and oral health preventive measures are important to the overall health of a person and contribute to a reduction in the down the line cost to the State. Annual examinations and regular dental treatment provided under the DTBS can help in identifying early indicators of systemic diseases such as oral cancer, diabetes, heart disease and gum disease and can help to indicate low birth rates and premature births. Oral cancer causes more deaths nationwide than melanoma, leukaemia or cervical cancer. On average, three new cases are identified by dentists every week. Early detection of abnormalities can make a huge difference to a person's life expectancy, as oral cancer can be cured at a rate of 90% when discovered early. In recent decades the dental health of the population has improved immensely. The DTBS is the single best scheme available for the nearly 2 million people that it serves and is arguably the single greatest contributor to this improvement in dental health.

Abolition of the scheme would have a negative effect on public health and cost the Exchequer €112 million a year, as estimated in the research of Dr. Brenda Gannon, a health economist at NUI Galway. The Irish Dental Association commissioned Dr. Gannon to conduct a cost-benefit analysis of the scheme. Her analysis shows the significant benefits that accrue from the scheme and that its abolition would eventually double the cost to the State. Her research also shows that the return on investment is extremely beneficial and that the benefits outweigh the cost of the scheme by a multiple of between two and 2.6. This means the return on investment is roughly 2.5 times the cost to public finances.

The abolition of the DTBS would result in a deterioration of the dental health of citizens. It would intensify the divide between those who can afford dental care and those who are indebted to the many advantages the scheme has to offer. It would also contribute to a lengthening of waiting lists in many areas, while in others people would forgo seeking private insurance, leading to a lack of work for dentists. Furthermore, the ESRI has found that there is a markedly lower attendance rate at dental clinics among lower income groups, a situation which will only be exacerbated by the abolition of the DTBS. Its abolition would be hugely unfair. It would be akin to paying house insurance for years and then being told cover was being withdrawn. If the McCarthy report recommendations proceed, despite the many years of significant contributions by hard working individuals, they will be deprived of the benefits provided under the scheme.

The main aim of Government intervention, as well as the goal of the dental benefit scheme, is to improve overall dental health of the population and allow access to everyone to oral examinations and basic treatments. I request, on behalf of the Irish Dental Association - I acknowledge the excellent material I received from its chief executive, Mr. Fintan Hourihan - and those who have participated in and benefited from the scheme - ordinary citizens - that it remain active and be left intact.

I was recently in a popular shop, Past Times, a shop into which I like to call frequently to indulge my taste for nostalgia. I looked at an old compilation journal of sports magazines for young people. I find it interesting to look at old photographs, including old sports photographs. People now look different. Often in old photographs we can see that people in past generations suffered from poor health. Sometimes the effect of illnesses such as TB is visible in people's faces and often one notices that people had poor teeth. We have moved on so much in terms of the overall health of the population and it is visible that people now enjoy better dental health. I would hate to think we would take regressive steps and return to a situation where we would see increasing numbers with inferior dental health. I hope the Government sees the value in the scheme and recognises the good it does for the population. I also hope it recognises better dental health is one of the many benefits we enjoy as a result of improved health care and that the scheme should be left intact.

8:00 pm

Photo of Mary HanafinMary Hanafin (Dún Laoghaire, Fianna Fail)
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I thank the Senator for raising this issue. As mentioned, the PRSI scheme goes towards dental benefits but also towards optical benefits. However, its main use is that people can qualify for unemployment assistance and other benefits, the most valuable of all being a pension. The DTBS is a PRSI-based scheme that provides assistance in the provision of dental treatment for those who satisfy the qualifying conditions and their dependent spouses. Eligible customers receive assistance towards the provision of services such as annual examinations and biannual scaling and polishing and a grant towards the cost of fillings. To be eligible to benefit from the scheme, a person must have paid a certain number of PRSI contributions.

The scheme is one of a number through which the State supports or directly provides dental care. The Senator was right when he mentioned the improvements made in recent years in the standard of dental care and oral hygiene. The scheme sits alongside the provision by the Department of Health and Children of dental care under the medical card scheme for customers on low incomes.

The qualifying PRSI conditions vary with age. For the majority of customers, those aged between 25 and 66 years, the requirement is a minimum of 260 qualifying contributions paid, plus 39 paid or credited in the governing contribution year, which for this year would be 2007. Slightly different rules apply to those under 25 years and over 66 years. Anyone qualified at aged 60 years retains his or her entitlement for life. Pay related social insurance is a contribution towards much more than dental treatment. It also covers other entitlements such as pensions, disability, invalidity and unemployment benefits, etc.

The dental treatment benefit scheme operates on the following basis. Any insured person or a dentist on his or her behalf must check with the Department if he or she is qualified to receive treatment. This can be done by telephone, fax, e-mail or completion of a claim form. Once approval has been given, either verbally or in writing, treatment may be provided by a contracting dentist. Treatment must begin within three months of approval being given and be completed within nine months. Once treatment has been completed, the dentist submits a final application form detailing the treatments provided and the customer's confirmation that treatment has been completed. Payment is then processed and issued directly to the dentist concerned. More than 675,000 applications, relating to 1,450,000 treatments were received in 2008 and an increased number of applications are expected by year end. The scheme cost €60 million in 2008 with more than €13.5 million expended on examinations, €16.2 million on cleaning teeth and gum treatments and €17.5 million on fillings.

The dental treatment benefit scheme is paid from the social insurance fund, SIF. Although the fund has operated a surplus since 1996, this position began to change last year when expenditure had to be partially funded from the accumulated surplus. Expenditure continued to exceed PRSI and investment income to the fund this year and it is expected that the accumulated surplus will be completely exhausted in the first half of 2010. It is estimated that the Exchequer will be required to subvent the fund by around €1.2 billion next year.

The expenditure pressures on the fund will continue in the future. In the short term there are increased demands on jobseekers benefit, estimated at €1.7 billion in 2010, and on insolvency and redundancy payments, estimated at €318 million next year. The progressive aging of the population is another factor leading to increasing expenditure on the State pension contributory and transition. It is estimated that there will be only two workers for every pensioner in 2050 compared to six for every pensioner now.

The McCarthy report of the special group on public service numbers and expenditure programmes specifically refers to the scheme and took the view that given the other pressures on the social insurance fund continuation of the scheme is no longer affordable.

Dúirt an Seanadóir as Gaeilge ag tús a chuid óráid go raibh sé ag súil go ndeirfinn leis go díreach cad a bheadh san cháinfhaisnéis amárach. Tuigfidh sé go maith nach mbeadh mé in ann é sin a dhéanamh agus aon cinneadh san cháinfhaisnéis a bhaineann leis an scéim seo nó le scéimeanna eile, fógrófar é amárach.

Photo of Rónán MullenRónán Mullen (Independent)
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Ba mhaith liom buíochas a ghabháil leis an Aire. Tá brón orm nar thug sí oiread agus leid dom fé céard a bheadh i gceist ag an Aire amárach, ní amháin maidir leis an scéim seo ach le go leor scéimeanna fiúntacha eile. Fanfaimid le h-aghaidh an scéal amárach ar aon nós.