PPE: A new way to extract money from patients?

By Dr Muattar Hanif

The pandemic of Coronavirus has affected every domain of life. With the economic sector being majorly affected, thanks to restricted Standard Operating Procedures (SOPs) and reduced working hours. But a new beam of life has finally shined, as many businesses have started to re-open among which included dental practices.

The provision of dental care is still limited. The majority of cases being dealt via teledentistry, only two or three cases of emergency dental cases are being catered in dental clinics and that too on an appointment basis. These clinics are trying their best to follow guidelines as suggested by International dental bodies and that on a national level. The much-awaited list of recommendations directed by the Ministry of National Health Services, Regulation and Coordination (NHSRC) jotted down each aspect of aerosol spread and ways to avoid it. The main focus of any guidelines, whether its ADA, BDA, or even NHSRC one, is to utilise maximum protection through protective equipment.  Hence many oral health professionals are seen donning extensive Personal Protective Equipment (PPE), such as N95 masks, face shields, gowns, and foot coverings, in addition to the need for additional infection control procedures. But the question arises, who will bear the cost of these safety measures?

The most effective way to compensate for the financial damage being done during pandemic lockdown is to start levy surcharge fees on customers. This is the technique that the majority of dental clinics have applied. To help replenish stock supplies and ensure the safety of patients and staff, some practices have started to charge extra fees with around 2-10% increase per patient.

While sharing the reasons behind increment in the rate of PPEs, Prof. Dr Arshad Malik, Principal/Dean HBS Dental College said, “PPE is a mandatory item to protect the professionals. Unfortunately, it is either not available, deficient, or unaffordable. Imported ones have different qualities. So the rates vary from brand to brand, but it is without any doubt that prices have generally increased a minimum of about ’30 %’ since April 2020.”

In their defence, many dental professionals blame the shortage of PPEs and the increase in their prices from suppliers, the real reason to increase fees. Dr Asher Jamelle, Head of Department of Periodontology, Fatima Jinnah Dental College, who also has his clinic set up, said, “In this time of crisis and inflation, we would urge suppliers to bring prices of PPEs lower. If not, [then] we are forced to increase the prices of procedures.”

Such an increase in cost has affected patients. A lady from Karachi said, “I am charged more than usual for my treatment and already suffering from unemployment. How can I put up with this much fees? It seems as if dental care has become the new luxury.”

Another patient commented, “I don’t think all these fancy Halloween costumes in the name of PPEs work. It’s just a new way to steal money from our pockets!”

Dr Aqib Mudassar, Head of Department, Oral Hygiene and Safe Dentistry, Institute of Prevention and Control, Lahore commented over the situation, “I think that dental clinics should bear the additional cost of PPEs to provide safe dentistry. Without safe dentistry, we will end up closing our practice. PPEs provide protection not only to the patient but to ourselves as well.”

Unfortunately, in Pakistan, the concept of insurance carriers with policies or programs for PPE has not been developed yet, which ultimately pushes clinics to take such extreme steps.

Commenting on the issue, Prof Dr Nisar Khan, Secretary-General, Pakistan Dental Association said, “The cost of PPE has increased considerably, resulting in some dentists charging an extra fee to cover the increased expense. PDA (Center) in its recent council meeting has decided that we will offer free of cost PPE to dental professionals working in the emergency department of Public sector dental hospitals, all over Pakistan. The private setups should disclose any additional fees upfront to patients and document these changes in the patient record.”

In light of the above situation, it is high time that Government bodies should take charge of this situation and provide free-of-cost PPEs for healthcare professionals. This step will not only minimise the burden load on the general public but will facilitate dentists, who are working, even in tough times of pandemic.