DENTAL THERAPY ASSOCIATION OF SOUTH AFRICA

It has come to my attention that many medical schemes are providing a poor package of dental benefits to their clients, which even falls short of the public sector provision of services regarding basic dentistry for all people in South Africa. The minimum basic services for the public sector as prescribed by the Hon. Mantoshabalala Msimang – Minister of Health, in the White Paper on the transformation of oral health care in South Africa clearly describes a minimum basic dental package that is in line with global preventative measures regarding dental care where individuals may have the provision of primary dental care which include fillings, scaling and polishing, dental x-rays and extractions as well as the application of fluoride and preventative agents . “ a) Minimum package of oral health care A defined minimum package of oral health care should be provided to the priority groups listed above. This package should consist of examinations, bitewing radiographs, cleaning of teeth, simple 1-3 surface fillings, fissure sealants and emergency relief of pain and infection control. Oral diseases, especially dental caries and periodontal diseases, are among the most common diseases affecting South African society. More than 90% of adults in South Africa suffer from dental caries, and 93,5% from periodontal diseases. It is worth noting that oral diseases are increasing among major sections of the population, especially the disadvantaged and urbanized groups.” Excerpt - White Paper for the Transformation of the Health System in South Africa Department of Health April 1997 I must commend the minister in taking such a step toward the fight against the two most prevalent conditions in our country, dental caries (+-92%) and periodontal disease (+-95%), by adequately providing these services that are direly needed by all South Africans to ensure good oral health .As dental practitioners in the country, it is becoming frustrating in dealing with the vast playing fields that are being created by schemes with no consideration for the primary dental care needs of their members ( our patients ) . Each scheme seems to ignore the industry standards that were initially set out by the Board of Healthcare Funders and are on a quest to minimize patient benefits in order to maximize profitability or sustainability of the scheme itself. Basic Conservative Dentistry is not an auxiliary service, it is a basic health right of all South Africans which must be made part of the prescribed minimum benefit (PMB)for all patients. If the state can afford to provide these basic dental services for South Africans, surely the private sector should be able to for their members, who may, as a result of the current systems, become a burden to the public health sector – these schemes then become a contradiction to private healthcare and their existence. Our second and principal concern however, is the blatant discrimination of our profession in terms of benefit structure allocation. The blatant expulsion of Dental Therapists from the consultative process, web site, information brochures, benefit guides, smile programme, dental literature and every other activity at DENIS (dental information systems) and associated schemes, shows disrespect of the profession as well as autonomous decision making by executives and advisors at DENIS that are wholly dentist managed and owned – there is no representation of Dental Therapy, no consultation with our association or notification of guidelines for Dental Therapists. DENTASA – Dental Therapists Association of South Africa, on behalf of all dental therapists would not tolerate such obvious and bold dictatorship from DENIS. As an example DENIS pays dentists twice the NRPL consultation rate whilst excluding, limiting and reducing NRPL rates for Dental Therapists. Dentists are “allowed” to perform fillings per patient without limitations whilst Dental Therapists may not do more than three fillings for a patient and not more than ten per year for a family. It is quite apparent that DENIS is looking after the economic interests of Dentists at the expense of benefit allocations to Dental Therapists and our patients. This sort of unethical business practice is undesirable and constitutes professional discrimination to which DENIS and the schemes associated are liable and accountable. The conservative dental category is a scope that spans both professions. It is unethical for DENIS to choose which profession to grant more freedoms to practice whilst limiting another. Our patients, and not a dental administrator, must make the decision on whom to visit for conservative dental treatment. This anticompetitive behaviour is in contravention of the competitions council and constitutes unfair and unethical business practice. Both a dentist and dental therapist are able to perform the same end result and function in conservative dentistry. (SCALING & POLISHING, XRAYS, RESTORATIONS, EXTRACTIONS ETC.) It is a routine with DENIS that a Dental Therapist must submit x-rays for every patient since every patient needs motivation, this does not apply to Dentists. Yet our requests are never taken seriously with 80% of them being denied procedures, for essential fillings to save teeth. Denis excludes vital codes for the practice of Dental Therapy such as the provision of sterilised instruments (are we to use unsterile) , indirect pulp therapies, three or more surface restorations, abcess drainage, oral health instructions and others … - these vital procedures are excluded for Dental Therapists, as a result our patients are either not charged for (provided free to patients) or patients then have to pay for these exclusions. As a result of this discrimination many of our patients are visiting Dentists where their bills are promptly settle by Denis. We have requested a set of rules in writing from DENIS on several occasions but were denied this, as they do not give such information in writing. We have also tried on several occasions to speak to the dental advisor whom the operators inform is Dr. Dunn as well as addressed these concerns to the executive directors (Dr Gareth Hayton) but these individuals refuse to take our & our members calls. Moreover, numerous formal requests to engage DENTASA in resolving the matter has fallen on deaf ears – copies of correspondence sent to DENIS – EXECUTIVE is attached. DENTASA on behalf of its members hereby submit that:- 1) In terms of section 61 of the Act, the Registrar has the ability, with the concurrence of the Council and the Minister, to declare a business practice as undesirable for all or a particular category of medical schemes, or all or a particular category of persons who render contractual, administrative or intermediary services. 2) It is undesirable to discriminate between the providers of health care services on an arbitrary and contrived basis, and to limit a patient’s freedom of choice in respect of his or her preferred health care provider. 3) It is undesirable to permit the perpetuation of a practice, which artificially and unjustifiably manipulates the market for health care services, where no rational explanation exists in order to justify either the distinction or the prejudice caused to both Dental Therapists and their patients. Medical Schemes Act, Act No. 131 of 1998 (“the Act”). Furthermore the schemes / Denis advises our patients to see dentists as their accounts would then be settled as dentists can do more for them as per the discriminatory regulations set out by DENIS. This discrimination as well as unethical behaviour of DENIS needs to be addressed as we as Dental Therapists in South Africa feel prejudiced. The Dentist to Dental Therapist ratio in SA is 10:1. This discrimination, that is negatively impacting our business as private practitioners is not tolerated and is regarded as an unfair business practice by the competitions council. Dental Therapists are wholly black practitioners that are being discriminated against by a majority white controlled DENIS and other schemes, from our inquiries we found only one black executive member who is a clinical auditor in the executive at DENIS. This sort of discrimination is clearly against policies for black economic empowerment as it places black Dental Therapists in an anticompetitive environment through market controlled tactics by medical schemes. Most Dental Therapists currently service rural and outlaying regions that Dentists seem to ignore, as they are mostly located in lucrative dense urban regions. The aggressive limitations poised by DENIS and schemes against Dental Therapists are ultimately relating to a disparity in benefits for majority of black patients in rural areas that are mostly affected. This racial demography is characteristic of historical Apartheid. We as Dental Therapists must provide our patients with quality and service they come to expect and simply cannot ensure our business survival through such blatant and compromising pricing structures promulgated by DENIS and associated schemes. Whilst we are faced with such irritate discrimination and oppression from your scheme, we must state that no other scheme in the country has these discriminatory attitudes to our profession. We hereby call on the executive board at your scheme to; 1. Supply reasons why discrimination exists for Dental Therapists 2. Put an end to professional discrimination and anti-constitutional corporate behaviour 3. To comply with the medical schemes council, bhf and competitions council rules and regulations regarding ethical business operations and anti discriminatory regulations. 4. Engage DENTASA on consultation and involvement in the pricing/ regulation process. 6. Representation at DENIS and your scheme as a stakeholder profession & clinical advisors in dentistry for Dental Therapy. 7. Observe the Dental Therapy profession as a sovereign profession – not a “stepchild” of DENTISTRY and Dentists. 8. To settle our accounts timeously and end the professional bigotry. Should you wish to engage in further deliberation regarding this issue, Feel free to contact DENTASA by email - denticare@vodamail.co.za. Yours for Equality in Dentistry Lesley Sebastian Naidoo (B.Dent.Th), (Pg.Dip.Pub.Adm.) (MBA) Dental Therapist Chairman DENTASA Po box 561646 Chatsworth 4030 KZN denticare@vodamail.co.za telefax: 031 - 7085797