The Australian dental profession is beginning to ask serious questions about itself as the brave new world of dental travel, highlighted by the recently announced nib Options business, becomes a reality. Chris Sheedy reports
When nib launched its nib Options business in March this year, there was little celebration within the Australian dental profession. A package that assisted Australian dental patients in seeking treatment overseas was seen as a threat, as something that would stimulate the growth of the already increasing numbers of patients seeking cheaper dental work in other territories.
But in the few months since that launch, as the loudest voices of dissent have died down, a more balanced point of view appears to have settled over dentistry in Australia. Change is being recognised as opportunity, including the opportunity for positive change within the local industry in order to stem the flow of patients to foreign shores. And as dentistry becomes globalised, the patients from other territories such as China, Indonesia and India could well see Australia as a place to which they would like to travel for best-in-class treatment.
“I have no doubt that medical and dental treatment can become Australia’s greatest export,” says Mark Fitzgibbon, chief executive officer and managing director of nib and spokesperson for the nib Options business. Having briefly been the target of the various voices speaking out against medical travel packages, Fitzgibbon is developing a reputation as a straight-shooting visionary.
“Most people think patients travel across borders to seek cheaper medical work, but it is not only about cost,” he says. “Cost is a factor, but it is also about privacy, quality, reliability and safety. Our value proposition is not just around cost, but also around quality of care and increased choice.
“The industry was originally sceptical of our offering. But part of our mantra is that you’re either on the train that is rolling through the industry, or you’re under it. This trend is not going to slow down and now is a good time to decide whether you’re going to be a part of the borderless medical model or whether you’ll compete against it. A value chain in dentistry is being created and within that chain there are great opportunities for Australian dentists.”
John Gibbs is chief executive officer and managing director of Pacific Smiles Group, a network of 42 clinics, seven of which carry the ‘nib Dental Care Centre’ title. In visible partnership with the nib brand, Gibbs and his team have well and truly boarded the train. “A group like ours could perceive overseas dental services as a threat,” Gibbs says. “After all, it’s competition for services which might otherwise have been provided in our country. But it also may offer opportunities for dental services providers in Australia.
“Patients who return to Australia following services overseas may be more inclined to want to develop good oral health habits, including regular visits to the dentist. No-one knows for sure whether it will play out this way, but there’s certainly no stopping the globalisation of services like dentistry,” says Gibbs.
Fitzgibbon says there are various dollar figures being used to describe the value of the dental travel industry. “Some say the worldwide figure currently stands at $US4 billion,” he says. “In Australia, some say, it’s worth $A300 million. But it’s early days right now. The burgeoning demand for cross-border dental work is not unique to Australia and we plan to sell travel packages within several territories globally.”
This will include the massive Chinese and Indian markets whose middle and upper classes could be attracted to having work done in a medical environment as admired and respected as our own.
“Part of our mantra is that you’re either on the train that is rolling through the industry, or you’re under it. This trend is not going to slow down. A value chain in dentistry is being created and within that chain there are great opportunities for Australian dentists.” Mark Fitzgibbon, CEO and managing director of nib
Fitzgibbon says he has been observing and analysing the medical travel trend (he doesn’t call it ‘medical tourism’ as that denotes a holiday, and people travelling for medical reasons are usually not combining it with a holiday) for several years. Once a decision was made within nib to develop a package to satisfy the increasing demand, the company spent two to three years bringing an offering together. The nib Options business includes the cost of treatment in Australia or overseas, all medical facility and post-op care costs, airfares, transfers, accommodation and a ‘12-Month After Care Promise’.
At the time of this interview, the ‘Overseas Dental’ package only offered treatment in Phuket, Thailand. But Fitzgibbon says nib Options will continue to expand, including soon-to-be-introduced services in Malaysia and Indonesia. International medical facilities go through a stringent process of analysis by nib, including the clinic’s standards, practices and patient case studies, site inspections, document reviews, third-party audits and a clinical audit of the practice including its equipment, processes, policies and people.
Back to basics
One medical expert who is keen for the Australian dental industry to learn lessons from dental travel is Dr Markijan Hupalo from Sydney Prosthodontics, and president of the Academy of Australian and New Zealand Prosthodontists. Hupalo says the cost of dental treatment is a significant motivating factor for patients seeking treatment overseas but the trend is not unique to the Asia-Pacific region. Travel for dental treatment has also become big business in Europe, with patients crossing borders to eastern bloc countries.
“We cannot stop patients seeking care overseas but we can refocus our efforts in providing quality dental care and re-establishing our relationships with our patients. The challenge is clearly one for the Australian dental industry,” Dr Hupalo says. It is a matter of trust, he believes.
With increased corporatisation of dental practice, the business model for many in the dental industry in Australia has shifted away from being a dental care provider, Dr Hupalo says, towards a model in which the driver is profit.
“This is the reason so many corporates are entering the dental business. There’s money in it,” he says. “Issues such as patient number targets, sub-specialisation, generating ever-greater revenue targets and cutting costs are now all-important. Patient care is assumed but can be compromised by an unbalanced focus on these business factors.
“We have become a commodity provider, not a care provider. Australian dentists used to be number two or three on the trust scale in terms of professions trusted by the public. Now we’re at 14. Where have we lost that confidence and trust? It happened when we lost focus on patient care. We need to go back to developing a relationship of trust with our patients.”
Patients need to make informed decisions about their dental care, Dr Hupalo says. Information and advice can only come from somebody they trust and who bothers to spend time speaking with them from the perspective of a dental care expert.
“We’re trained to provide great dental health care but many dentists in Australia have forgotten this,” he says. “Comprehensive check-ups and cleaning have been delegated to auxiliaries and some patients rarely meet their dentists except fleetingly or when complex treatments are considered. That is not dental care. On the other hand, if you do it right and you gain the trust of the patient then they will never go anywhere else for their dental services, including overseas.”
Dr Hupalo says patients need to be made aware of the risks of overseas treatment, including who is responsible and what it could cost should something go wrong. Many overseas dentists are very well trained and produce excellent work, he says, but there is also a greater opportunity in some territories for unscrupulous operators to thrive. One of the main concerns in relation to treatment provided overseas, he believes, is who assumes responsibility for the ongoing care and maintenance of the restorations, or repair of the restorations, in the event of a complication or failure.
Another concern of overseas treatment is what effect it may have on the patient’s rights within the public health system in Australia, says Dr Jason Pang, director of Cosmic Smile Dental in Sydney’s Neutral Bay. “It is possible that if a patient in the public system has work done overseas then they may no longer be eligible for work within the public health system,” he says. “If anything goes wrong, or if they require or want any follow-up work, they may find it suddenly costs a lot more to have that work done.”
Patients should also be wary of over-servicing in foreign markets, Pang says. If you’re travelling to have work done and it is considerably cheaper, then it is easier to be talked in to extra work that is not absolutely necessary.
“Avoid having a large amount of procedures in a short time,” Dr Pang says. “This is one of the issues with work being done overseas—it is not about a long-term relationship. If you have implants done, that is the beginning of a long-term relationship with your dentist. They are not something you can just forget about.
“And be sure to check the underlying problems are fixed. I have seen patients that have had crowns done on several teeth but the underlying problems have not been fixed. Those problems have simply been covered up.”
Face the change
As globalisation increases the choices for patients, as the internet and other technologies offer greater opportunities to research overseas dentists, and as the number of patients travelling for dental surgery continues to rise, any service that makes the journey safer and more successful for those patients is a positive one. The nib Options offering could certainly be described as visionary, and we’ll likely see other providers scrambling to catch up with the health fund’s medical travel packages.
“We’re not creating the demand right now—we’re responding to it,” Fitzgibbon says. “But there’s no doubt crossing borders for various procedures will become the new normal. We currently have packages for dental and cosmetic work, but we intend to broaden our offerings to knee and hip replacements and beyond. We’ll utilise our supply chain as is necessary to cope with demand.
“The increasingly global environment for medical services will provide enormous opportunity for our world-class doctors and dentists, as long as they get on board with the change.”