sou · GQB353d1 · 2003-01-01 00:00:00 — Chapter 3 deals with objectives and principles for the dental service and public financial support to it, and it also deals with organisational changes in the dental service and with the scope and content of dental training. Under the Act (1985:125) the overall objectives for the dental service are good oral health and dental care for the whole population on equal terms. The reformed dental subsidies system introduced in in 1999 meant that the dental insurance system was given a clearer health focus through increased investment in primary dental care. Future dental subsidies should also have a clear public health profile and be formulated so as to stimulate patients to take greater responsibility for their own oral health. considers it essential to ensure that those in greatest need of dental care are given precedence and that people in need of treatment need not go without it for financial reasons. Regarding dental care in connection with illness and disability, the committee considers that patients with a considerably greater need of dental care due to illness or disability should not have increased dental expenses as a result and that a uniform allowance system is needed for all dental care connected with illness or disability. considers that certain adjustments and improvements to the current dental subsidy system are necessary. This applies, for example, to improvement of the system of subsidies to primary dental measures and high-cost protection also needs to be improved so that all adults can obtain extensive dental care at a reasonable cost. It is also important to take advantage of the gains in oral health achieved through organised dental care for children and young people and to improve the situation in connection with the transition between free dental care for children and young people and adult dental care which is subject to a charge. Regarding economic support the committee presents proposals for in principle gradually extending dental subsidies when resources so permit. To be able to carry out the committees broad proposals for improvements, not only will financial resources be needed but also an even distribution of the available resources across the country. Regarding the educational system, the objectives and principles emphasised by the committee are that, after completing basic training, all dental personnel shall be capable of providing high- quality treatment and that their basic training furnishes the preconditions for continued lifelong learning. Training programmes for dental personnel shall be dimensioned with a view to meeting demand in . generally considers that no training programme should extend beyond what is necessary to meet the qualification requirements demanded by the labour market. should education programmes imply a dead- end but should lead to continued studies in the dentistry sphere or other university studies. The structure of the dental service Chapter 4 sheds light on future access to dental personnel with different types of qualifications. The possibilities are discussed of guaranteeing access to qualified dental personnel all over the country and also of promoting efficient working methods and effective cooperation in the dental sector. The distribution of work among the various professional groups in dental services is also discussed. The call for qualified personnel is affected by changes taking place in the world. Swedish health and services face major challenges and the same influencing factors that operate in those services also operate in the dental service. Several forces for a positive development are reported in the chapter and also counter forces. The population trend towards a higher proportion of elderly people who retain their own teeth with an increasing need of oral health and oral comfort will contribute to a strongly increased demand for service. A continued favourable economic development will probably also mean more and more people can have access to highly specialised dental care, which in the long term will sustain a continued strong demand for dental services. However, there are several exacerbating factors as regards access to dental care. Dental resources are already unevenly distributed over the country as it is. The major challenge to the Swedish dental service is probably supply of personnel. The chances are that the number of practising dentists will decline slightly in the next ten years at the same time as the demand for dental care in all likelihood increases. Supplementary teams that work around the patient, each member able to use his/her full skills is one way of managing the Swedish dental service so that the population will continue to have access to good dental care focusing on enhanced oral health, which are some of the dental service requirements set out in the Act. Chapter five discusses the need for reformed dental training and the future need of specialist dentists will be reviewed. The role in the dental service of dental hygienists, dental nurses and dental technicians is discussed and the need for training for these professional groups. In several contexts the committee stresses that future dental care will increasingly focus on treatment of the elderly and ill and disabled people. considers this to be a task for the majority of practising dentists, dental hygienists and dental nurses. Training programmes for this sphere of activities must therefore be extended in all dental training, including specialist programmes. In recent years criticism has been expressed that newly qualified dentists do not have adequate training in clinical skills. This applies mainly to the objectives; to be able to cooperate with other personnel in dental care, to have training in the dentists role as leader of the dental team and to have acquired an economically efficient approach in terms of health and care. The introduction of compulsory on-the-job training for dentists following basic training has therefore been discussed. proposes that two months continuous extramural clinical training be introduced within the framework of basic training for dentists. The aim should be to acquire training in a dental care team in real conditions and an economically efficient approach before obtaining a professional qualification as a dentist. To promote a better distribution of dentists across the country, the committee recommends that basic education to qualify as a dentist be extended by 20 places and that these be based at . Regarding specialist training the committee proposes that a provision be introduced into the Act clearly defining the county councils responsibility for specialist training programmes. A national dental nurses training programme: The dental nursing profession is changing. The work previously mainly consisted of lending assistance, but developments are now moving towards a broader range of duties. Work is delegated to many dental nurses and they have advanced assignments based on the real skills they possess. The dental nurses trade union organisations have expressed a for a professional qualification for dental nurses. has stated in many contexts that there is a need for competent dental nurses in the dental service. According to the committee prognoses, more than 3 000 dental nurses will retire up to 2011. Since in principle there is no formal training for this group, it will not be possible to replace them. proposes that a training course for dental nurses be established in local authority administered adult education qualifying the student for further studies at university level. A training programme for dental hygienists with the possibility of supplementary advanced courses: The dental hygienists profession has radically changed since it was established in in the 1960s. At that time dental hygienists were mainly occupied with non-surgical treatment of periodontoclasia diseases. Today their role is considerably broader and includes additional assignments. It is chiefly in dental care for children and young people that there has been a broadening of work and a similar development is on the way in dental care for the elderly. is of the view that basic training for dental hygienists should continue to comprise 80 credits. In addition different types of advanced courses should be available. These may be of varying length depending on their focus but they should be at university level. In the committees view, further training for dental hygienists should primarily be the responsibility of the employer. Organisational changes that are necessary if greater efficiency in the dental service is to be achieved are discussed in several contexts. The dental hygienist plays a key role here provided that the dentist allows the dental hygienist to work on the basis of his/her full skills. Unfortunately many dental hygienists are not given the opportunity today to tackle the comprehensive assignments for which they are formally qualified. Through basic training and the opportunity for deeper studies through advanced courses, the committee considers dental hygienists will be given the same development opportunities as dental practitioners. In a future organisation, a model of this type could be developed to the benefit of both the individual and the employer who on the basis of diversified operations will be able to adapt the cutting-edge skills needed in dental hygiene. As far as dental technicians are concerned, the committee considers the number of places in training courses for dental technicians is adequate to provide Swedish dental laboratories with personnel. Additional personnel in the form of newly qualified dental technicians cover forecasted depletion through retirement up to 2011. Economic subsidies to dental care Chapter 6 discusses economic subsidies to the dental service. The starting-point for the design and extension of future subsidies to the dental service should be that support is given in the first instance to primary dental care which is necessary in order to achieve and maintain good oral health and to prevent the occurrence of major damage in the future. In addition, there should be high-cost protection so that those who are in need of extensive prosthetic dentistry in the form of crowns, and implants can afford the treatment required. also proposes substantially improved subsidies to dental care related to illnesses or disabilities. Dental care in connection with illness or disability recommends that all dental care that is a consequence of a substantially increased need due to illness or disability be brought together in one and the same system of benefits and in the committees estimation the county councils should be responsible for all such dental service and it should be financed by the same level of charges as in the case of open health and services. The special rules in the dental insurance system that apply to people with a persistent and essentially increased need of dental care due to chronic illness and disability can thereby be abolished. also recommends that surgical treatment of infection in the case of periodontal illness and the appurtenant cleaning of root surfaces be included in the county councils area of responsibility and charge system. The proposal represents a considerable improvement in financial support to patients who have a persistent and essentially increased need of dental care due to chronic illness or disability. This applies particularly if prosthetic measures are needed. A change of this nature probably means that considerably more such measures will be performed than previously resulting in increased costs. therefore essential that, in connection with their assessments of recommendations for treatment and costs, the county councils see to it that only treatment caused by an essentially increased need due to illness or disability may be charged at health and service rates. Regarding the county councils responsibility for outreach activities and dental care necessary for patients with special needs, the committee recommends, inter alia, that Section 8a of the Act be clarified so that it is evident that it is the individual need for treatment and care that entitles patients to free outreach activities and the necessary treatment at the same level of charges as for open health and services. In spite of considerable information campaigns on the part of the county councils concerning application of the Act and Ordinance, differences between the rules and regulations of the different county councils are so great that considers there is legal uncertainty. And many county councils have requested clearer directions. considers complete up-to-date information should be available regarding what should be included in outreach activities and necessary dental care for residents of nursing homes. Legal certainty will thereby increase and the county councils for clearer directions accommodated. proposes that people leaving the free dental service for children and young people be given a voucher valid as part payment for a dental subscription with an optional dentist or dental hygienist or for individual dental care procedures. The voucher should be distributed with information from the social insurance office at the beginning of the year the individual reaches 20. The voucher should be worth largely to cover the cost of an examination and a minor preventive measure. The main reason for the committees proposal is that young adults are a financially weak group. Many have no income because they are continuing their studies and unemployment is relatively high among young people. also wants to create a system to make the transition easier from organised free dental care for children and young people to adult dental care. The system should on the one hand reduce costs for young adults in the first years after they are no longer entitled to free care and, on the other, promote continued regular contacts with the dental service. To reinforce the focus of dental insurance on primary dental care the committee proposes that N The benefit for examination and preventive measures and for pulp surgery be adjusted upwards. N A benefit for examination procedures for the age group 30– 64 be introduced. N The benefit for preventive measures be raised for all to one and a half base amounts. N The benefit for pulp surgery procedures be raised for all to one and a half base amounts. N Acrylic splints be included in primary dental care. One of the problems the committee wants to try to solve is ensuring that no one will need to forgo regular visits to the dentist because of the cost. The longer a relationship between care provider and patient, the more favourable are the effects. It is of the utmost importance that patients do not need to delay treatment for so long that the damage has become irreparable and teeth have to be extracted or extensive repair work involving crowns, and implants has to be performed. considers that the dental benefit payable for everyday dental care designed to promote health is important in a long-term perspective both for the individual purely in terms of costs and dental health and for the Swedish economy through lower costs for the dental service. Extended high-cost protection for prosthetics considers high-cost protection should be introduced for all who are in need of major prosthetic treatment aged 20 and above as soon as government finances and dental service resources so permit. In its interim report the committee has already stated it to be desirable that all people with high dental costs should enjoy the increased support recommended for elderly patients. The reason why it was not proposed that this support should apply generally was that this could not be accommodated within the then available cost framework. The decision by the Swedish Riksdag to introduce high-cost protection for all prosthetics such as crowns, and implants for the age group 65 and above, where the cost for permanent prosthetic replacements, excluding the cost of material, and primary dental care during a course of treatment amounts to 700, may be seen as a first step towards putting dental care on a par with other health care. Since this support will probably require extensive resources a careful evaluation of the effects should be carried out. The evaluation must include both cost trends for the insurance and how this benefit system will affect the behaviour of the care providers and the patients. The necessary changes can then be made before these subsidies are introduced. Chapter 7 discusses patients rights in dental care and the activities of the regional patients committees. The dental insurance system is analysed from a gender equality perspective and the possibility of introducing a dental credit system is discussed. To find out to what extent the county councils patients committees deal with dental matters and what problems have been given attention in this context, the committee carried out a poll among the countrys patients committees. The results show that complaints and dissatisfaction with dental care very often concern financial matters. considers the activities of the regional patients committees should be extended to comprise all dental care financed by county councils. does not consider these activities should cover other dental sectors also. As far as private dental care is concerned there are supervisory boards under the auspices of the private dentists associations. Regarding dental benefits there is the possibility of formal appeal under the Act, and and () receive complaints against dental personnel. it would improve the patients possibilities of receiving support and assistance if there were yet another institution to apply to. Chapter 7 also contains an analysis of subsidies to the dental service from a gender equality perspective. It is established that in several respects there are differences between women and men as regards the incidence of disease and utilisation of the dental service. However, the committee has found that neither the dental insurance system nor the forms of support administered by the county councils treat either of the sexes unfairly except in one respect. Regarding a substantially increased need of dental care as a result of chronic illness or disability within the framework of the dental insurance system, certain illnesses are strongly gender- related, for example rheumatoid complaints and eating disordors. For both these groups there is often a need for dental care in the form of extensive prosthetic replacements at high cost. The qualifying amount before benefit may be claimed, which is 500, is not deducted from the dental benefit and this is the extra subsidy in the dental insurance system for such measures. Thus, no matter what the costs of the prosthetic measures, the extra support is maximised to this amount. recommends that charges be paid for all dental care relating to illness or disability on the same basis as for open health and services, that is to say not more than per twelve-month period. The proposal means that women will no longer be unfairly treated as regards financial support for dental care. proposes a credit guarantee system be introduced. A considerable number of people forgo dental care for financial reasons. Several investigations have shown a convincing connection between poor finances and forgoing dental treatment. In the long term oral health can seriously deteriorate so that extensive and expensive prosthetic reconstructions will be necessary. is of the view that no one should need to forgo treatment for financial reasons. In spite of the improvements made in social services and which are proposed for the dental insurance system and in spite of the credit possibilities that are already available today in the dental service, there will still be financial obstacles for a large group of people to receiving the dental care needed in order to attain and maintain good oral health in the long term. therefore considers a state credit guarantee system for dental health should be introduced. However, it has not been possible within the remit of the committee to clarify in detail matters concerning state credit for dental care and the committee proposes that the Government instruct to draw up, in consultation with the care providers organisations, a proposal for a credit guarantee system. was also instructed to analyse price trends for dental care and make an assessment of future cost development in the next five years. The committees analysis and standpoint regarding cost trends in dental care are included in Chapter 8. considers that continuing price increases in dental care are of great concern. The average price increase in the in this country between 1998 and 2002 amounted to about 40 per cent and private care providers have followed the price increases in the respective county council although their prices are generally at a higher level. The average price increase in the between January 2001 and January 2002 was 8.4 per cent. Thus, there is no sign of a decline in the rate of price increases. All care providers have a major responsibility to rationalise and make their operations effective so that price rises are restrained in future. If they continue to rise at the same rate as up to now, among other things the extension of the high-cost protection for prosthetics to include all age groups will be in jeopardy. The design of support in the form of one hundred per cent allowance for fees in excess of 700 means that the care providers price increases have full effect on state costs for the insurance. Although both the Government and the Riksdag have previously rejected proposals for price regulation, the committee still considers totally free pricing is unreasonable when the state or the county councils pay the full cost. It is not in the interest of either the care provider or the patient to limit costs. Experience tells us that extensive third-part financing leads to cost increases. It is established in Chapter 9 that there is a great need to improve the statistical material required to follow up dental care regarding both the efficiency of subsidies to dental care and personnel resources. At the request of the Government, and have drawn up a proposal. does not consider the recommendations of the two authorities should be carried out without further ado, inter alia because the administrative and economic consequences for the care providers who submit the information are not yet clear. also questions whether some of the information desired could not be reliably collected in a simpler way than that proposed. therefore considers that the Government should further discuss the matter before statutory amendments are carried out. lag om ändring i lag (1998:1656) om patientnämnds- verksamhet m.m. Härigenom föreskrivs att 3. 1 § lagen (1998:1656) om patient- nämndsverksamhet m.m. skall ha följande lydelse. I varje landsting och kommun skall det finnas en eller flera nämnder med uppgift att stödja och hjälpa patienter inom 1.den hälso- och sjukvård enligt hälso- och sjukvårdslagen (1982:763) som bedrivs av landsting eller enligt avtal med lands- ting, 2.den hälso- och sjukvård enligt hälso- och sjukvårdslagen (1982:763) som bedrivs av kommuner eller enligt avtal med kommuner och den allmänna omvårdnad enligt socialtjänstlagen (2001:453) som ges i samband med sådan hälso- och sjukvård, samt 3. den tandvård enligt tand- vårdslagen (1985:125) som vårdslagen (1985:125) som be- bedrivs av landsting. betalas av landsting. För sådana nämnder gäller vad som är föreskrivet i kommunal- lagen (1991:900). Denna lag träder i kraft den .. lag om ändring i tandvårdslagen (1985:125) Härigenom föreskrivs att 8 a §, 14 § och 15 b § tandvårdslagen (1985:125) skall ha följande lydelse.