Gunz Dental Insight

Major change in any established health profession is a prolonged process. It does not have to be but that is how it is. 

 

 

It is the embedded culture of peer group pressure, ego and ambition, plus the inertia of members

 

Health professional executive roles are often short term, leading to poor decision making and short horizons.

 

This is often compounded by office bearers striving to gain recognition from their peers through individual objectives achieved during their term of office.

 

To achieve change in any large organization requires a corporate approach that has a clear vision, a set of achievable objectives that others have assessed, and endorsed, long-term planning.

 

This vision should have a 10-year projection plan with clear time frames and action plans to assess progress. Clear accountability and measurement should be in place to make sure things are on track.

 

We can apply the above criteria to dentistry and look at the major area of concern - the level of health insurance fund penetration into dental. We can see an obvious need for concerted long-term planning, a series of clear objectives and a realistic and detailed action plan focused on the following three concerns:

 

1: The preferred provider scheme that pits dentist against dentist and enables health insurance funds a level of influence in practices.

 

2: The Bupa model of discrimination against its own members - by paying lower claim benefits to patients who chose to see a dentist of their own choice. An obvious attempt by Bupa’s to enhance control and increase profit.

 

3: A clear conflict of interest as health insurance funds are both the insurer and the medical treatment provider.

 

Of the above concerns no.2 is the obvious choice to start with. This is because it opens the door for patients to rally for change and counters the negative perceptions of dentists being greedy and profit driven.

 

Current action on this issue is being driven by the Independent Dentist Network (IDN) who have been actively meeting with and lobbying all federal politicians. The most recent development is that their successful in having a Private Members Bill introduced into the House of Representative by independent MP Andrew Wilkie

 

You can view the bill at: http://andrewwilkie.org/private-healthinsurance-bill-to-be-tabled-today/

 

Regarding concern no.3 - IDN has raised this issue with all federal politicians and the ACCC. The ACCC stated that they could not interfere because it was allowed under the current health legal act and could only be amended by parliament.

 

IDN is now pressing political parties to commit to rescinding the Bupa practice as part of their party policy and pressuring the health minister to amend the Health Act - to prevent an insurance fund being both insurer and provider of the service.

 

Finally, concern no.1 can only be rectified by dentists. The problem exists because many dentists weren’t fully educated on the consequences of a Preferred Provider Scheme. Many joined hoping to get an additional flow of patients without effort. Others joined because they feared being left behind would leave them disadvantaged.

 

Dentists who foresaw the real implications that could arise and stayed independent, have suffered considerable patient loss due to active health insurance fund marketing directing all fund members to fund owned or contracted clinics.

 

However, despite patient loss independent dentists are now benefiting. They have found their loyal patient base and are able to focus on patients who want quality dentistry and are willing to pay for it.

 

The ideal situation for all dentists should be a level playing field where service and ability defines outcomes and they have full control of their practices.

 

To achieve this, they must show courage and a willingness to stand together and challenge the terms and conditions put forward by health insurance funds. IDN has observed a recent incident where a practice legally challenged the result of a Bupa audit and had a refund demand of $1,000,000+ dollars reduced to ZERO.

 

As observed above, the historic Bupa audit process is clearly flawed, and the door may be open for a class action by dentists who have had to refund large payments to Bupa.

 

Dentists could approach the ADA seeking action to legally challenge the validity of Bupa’s audit process – as there will be many cases of dentists with historic audit reports for use as a research basis for legal grounds.

 

The fact that a single dentist has been successful in his challenge should justify such action.

 

Finally, dentistry – a once highly respected profession - must work collectively to regain public trust and respect. Current public perceptions of dentists as greedy and over-servicing can only be changed through reinstatement and adoption of high ethical standards and honest business practices.

 

Merv Saultry

Managing Director

Independent Dentist Network

M: 0405-691-845