Dental tourism looks like it’s here to stay, with more surgeries opening up in the UK and abroad that offer this feature it is now a very real part of the dental market. Patients can chose a range of packages, some of which even include accommodation and local transport. Patients can pick a range of destinations both inside and outside Europe. Dental tourism also happens in the other direction with patients entering the UK to receive dental treatment. There are those people who may have come to the UK as economic migrants, for example people and the families from other member states of the European Union and also those people who are UK nationals but spend large periods of time in other countries, be it within Europe or abroad.
The economic migrants from Europe are a good example of how the UK dental market can be distorted by dental tourism but to a degree which we may not be able to fully appreciate. Our health planning for NHS services tends to be based on the population we know about or what we assume about that population. Health policy makers do not seem to be able to predict who is going to arrive in the UK, where they will come from and what their needs will be. If health planners could carry out this sort of predictive risk modelling then there is a chance that UK health services could be designed to meet the needs of the entire population. What we seem to have at the moment is an oral health service based on existing population profiles.
Patient choices are not always influenced by clinical quality; in fact it’s probably the least available indicator when it comes to selecting a clinic or dental practice. It is unlikely most patients will be able to compare their dentist other than on factors such as qualifications and possibly length of service. Our patients know relatively little about clinical quality standards between clinicians; this is as true in the UK as it is abroad. The NHS brand in itself can be an attractive feature; it is almost like a pseudo British Standard and it may be one feature that people originally from outside the UK chose when selecting healthcare.
The UK population has seen rapid change in the last 10 years and within England there are now growing communities of economic migrants. The oral health status of the people coming to the UK will be more similar to that found in their country of origin, which may be quite different to the oral health status of the underlying UK population. This difference will have an impact on NHS services and could mean that there will be some parts of the UK where the proportion of interventional treatment is actually increasing rather than decreasing because of economic migration. Another impact is those people that mix their treatment, where they may have some NHS treatment but chose to have certain elements of care provided privately either in the UK or abroad. Economic migrants may be more likely to undertake complex treatment outside of the NHS, especially if the cost is lower in another country.
These are all new uncertainties that face the health system in which we operate. It’s unlikely that our predecessors could have predicted such vast population changes when the Treaty of Rome was first signed. In my view, health planners must consider these factors when designing services and contract managers should recognise the challenges facing dentists in certain parts of the UK as a result of these population level changes.