The universal challenge

Grouping dental care under the umbrella of mandatory insurance would be a radical - and unwelcome - step.

The news that Dubai is soon to introduce mandatory health insurance has prompted a knee-jerk reaction from the emirate's dentists.

Last month, Dubai Health Authority (DHA) announced that employers will be expected to fork out for expatriate staff and their dependents. In a move scarily reminiscent of the UK's national health service, Dubai residents will have to sign up to a primary care clinic, which in turn will receive a flat fee for every patient it registers. The idea, reports the DHA, is to ensure every resident has access to basic healthcare.

This scheme in itself is an admirable initiative. What has got Dubai dentists hot under the collar is the possibility that dental clinics might find themselves grouped under the same deal. While there has - as yet - been no talk of dental care being included in the plan, it hasn't stopped local dentists scrambling to register their disapproval.

As the botched NHS contract in the UK has shown, managed care plans rarely work out well for dentists. It typically means more patient traffic, less return, and a permanent spot on the dreaded dental ‘treadmill'. But while it's easy to deliver bad press on government-subsidised schemes, there is no arguing that they deliver an essential service for those unable to afford private dental care.

At last count, caries prevalence in the Middle East was rampant, particularly in small children. While there are various lifestyle factors that help account for this, the leading cause is a lack of access to dental care. Treadmill concerns aside, including a degree of dental cover in the scheme would offer some care to patients priced out of the private market.

While not a total solution, it could make in dent in decay rates. On the flip side, dentists - particularly those with experience of government-run schemes - argue that substandard care is equal to no care. To steal a phrase from a dentist I interviewed recently, it will "lead to a circle of failure, repair and failure".

So which way to jump?

As it currently stands, most employer-subsidised policies cover basic healthcare and steer clear of dentistry all together. As the evidence to link oral and systemic health grows, the question is less, ‘Who should pay for dental care?' and more, ‘When will oral health be recognised as a key part of overall health?'

There is no definitive answer to the need for universal access to dental care. One thing is certain though; there must be some move to tackle the Middle East's soaring caries rates. The discussion that has opened up in the wake of the DHA's announcement might just provide the straw to get the camel's back creaking.

James McCarthy is the editor of Middle East Dentist.

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