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Dentists gnash teeth over bid to cut fees for patients

Many patients opt out of dental treatment as the costs are too high – but dentists say better fees for preventive treatment would bring down fees for prosthetics such as crowns and make a real difference

Plans to pay dentists more for preventive treatments while cutting prices for crowns have sparked anger in the profession.

Strikes and legal action are threatened to halt new fees being imposed that dentists say come nowhere near meeting their costs.

With one in five people forgoing dental work because of high costs, the government decided to cut fees and started talks with dentists. They charge high fees for crowns to make up for the low payments they get for the check-ups, fillings and descaling work that makes up 80% of their business.

Assurance Maladie’s payments to dentists for this basic work have been the same since 1988 – so they get €16.87-€40.97 for a filling, €28.92 for a descale and polish, €81.94 for a root canal, €33.44 for pulling a tooth. These prices are capped.
But with expensive modern dental equipment plus staff costs, dentists say they cannot make enough from the capped prices.

Assurance Maladie pays €107.50 for a crown  but, with no ceiling on what dentists can charge patients, many charge €1,000 or more, relying on doing enough crowns and implants at inflated prices, to make a living.
Patients, however, as with the other treatments, get only a 70% refund of the basic cost, so 70% of €107.50 for a €1,000 crown (outside of any mutuelle refund, if held).

Worse, some dentists say patients need crowns when other treatments may be possible and Philippe Denoyelle, president of Union-Dentaire admitted: “We know certain dentists advise patients to get crowns because they’re profitable – but dentists lose money doing fillings and root canals.”   

All sides are agreed the system has to change: Paying higher prices for routine treatments and capping the cost of crowns would reduce costs for many patients.
Acrimonious talks between dentists and the health authorities failed, with dentists saying the offer cost them money. Then Health Minister Marisol Touraine sent the scale of tariffs to arbitration to decide and the decision set the new fees even lower than those offered in negotiations.
It will mean ceilings on prosthetic work with ceramo-metal crowns costing no more than €550 (€660 in Paris), and reducing to €510 (€570) in 2020. Reimbursements will rise from €107.50 to €120 in 2019.
Fees for preventive work will rise, with dentists getting €67 for a large filling (up from €40.97) – which Ms Touraine said would give each dentist an extra €7,600 between now and 2012.

Dentists’ unions said they were being punished for not having agreed the earlier offer and Mr Denoyelle said: “We will take legal action to block this, but frankly, after the election she will be gone, and then we shall see. We will have a new health minister and we hope that sense will prevail.”

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