sou · GVB319 · 2008-01-01 00:00:00 — The new support system will however have consequences for the individual. Under the commissions proposed high-cost protection scheme, dental care compensation will be available from a lower level; 000 instead of the current 700. This means that compensation will be available to more people, i.e. not just those who have very extensive dental care needs, but also those who have moderate needs. The level of compensation will be lower than the current high-cost protection, but compensation will cover the costs of certain materials that are not currently included in the dental care support system, implying an improvement compared to the current system. Furthermore, all dental care, including basic dental care, will be included in the high-cost protection scheme. One consequence will be that the price for a patient who is 65 or over for more extensive prosthodontic treatment, e.g. implants, will not change to any great degree but the price for the patient for less extensive prosthodontic treatment, e.g. a crown or , will be significantly lower. Administration, control and follow-up The new dental care support will be paid out retroactively to the care provider by the . The system will be administrated by care providers registering details electroni- cally of all the reimbursable dental care measures they perform. The resources allocated to the for control activities will be maintained but will change focus. Ret- roactive control measures based on electronic data processing, ran- dom sampling and suspicions of irregularities shall be given higher priority, whilst the number of prior assessments shall be greatly restricted. will be given an ex- plicit responsibility for the statistics, monitoring and evaluation relating to adult dental health and be assigned the task of main- taining a dental health register for adults. shall be given an explicit responsibility for statis- tics, monitoring and evaluation of dental care costs, patient prices and dental care consumption. An evaluation programme concern- ing the new state dental care support system shall be implemented. Special dental care quality registers shall be established. A register for dental implants shall be prioritised. Care providers will be pro- vided with special feedback as part of the continuous monitoring activities. Care providers shall prepare documentation for monitoring pur- poses and for the calculation of state dental care support for all the reimbursable treatment measures they perform on a patient and submit this to the . The documen- tation shall include: the patients personal ID number and the date when the treat- ment measure was finalised, diagnosis and treatment codes, the number of the tooth or in the event of tooth loss, the equivalent position, the car providers price for the performed treatment measure, date when any dental care voucher was used whether the care provider has a subscription agreement with the patient. In connection with disbursement of dental care vouchers, the care provider shall submit information on how many healthy teeth the patient has left. Care providers shall also submit information as to which price list they use. The commission is of the opinion that the obligation to supply information placed on the care provider as part of the new dental care support system, in accordance with what is specified above, should be considered sufficient to create the conditions for effec- tive control of state expenditure. A crucial factor in the use of the abovementioned information as an effective control measure is that it is submitted electronically. Collecting the information in an electronic database will enable the to carry out considerably more automated checks than is the case with the present dental care sup- port system. efficient automated checks will raise the mini- mum level of the checks made on every disbursement of state den- tal care support. In addition to this, efficient control instruments need to be developed which include checks on random samples and advanced targeted checks. The information that care providers will regularly submit to the , in accordance with the commis- sions proposals, so that the amount of compensation can be cal- culated, will fulfil a twofold purpose, as it will also help to drasti- cally improve the statistics used to monitor and evaluate dental health and dental care consumption in the adult population. The commission proposes that the obligation to supply infor- mation in accordance with what is specified above shall also apply to subscription dental care, with the exception of the supply of in- formation pertaining to the price charged by the care provider for a performed treatment measure, since compensation in the case of subscription dental care is not payable per treatment measure. In addition, information pertaining to subscription agreements shall be submitted at the same time as the agreement is sent to the . State dental care support in the form of dental care vouchers and dental care compensation shall be disbursed on condition that the request for compensation has reached the Ad- ministration within two weeks of the treatment measure being finalised. There should be a similar obligation imposed on the So- cial to disburse the compensation within two weeks. Under special circumstances, the Ad- ministration can disburse compensation even if the request arrives later. Documentation for monitoring and calculation of the state dental care support shall be submitted within two weeks of the treatment measure being finalised. will be able to withhold compensation from the state dental care support system until care providers have fulfilled their obligation to submit the necessary shall also be able to serve notice on a care provider, who seems not to be abiding by the state dental care support regulations, that all requests for com- pensation for a particular treatment measure performed by the care provider in question shall undergo prior assessment by the . Such an injunction shall apply for a maximum of one year. If prosthodontic treatment has to be redone by a care provider other than the one who originally performed the treatment, the shall be allowed to reclaim the state dental care support disbursed to the care provider for the original treatment. In such a case, the Admini- stration shall instead be able to deduct the amount from another compensation claim submitted by the care provider in question. The amount reclaimed can be used by the Admini- stration to compensate the care provider who performed the repeat procedure. The need for a repeat procedure shall undergo prior as- sessment by the when it is to be performed by a care provider other than the one who performed the original procedure. If the care provider, after having performed a treatment measure, has received a lower amount in compensation from the state dental care support system than he or she has requested from the , the difference may not be demanded from the patient. This shall not apply, however, if the lower com- pensation amount received from the dental care support system is due to the patient submitting incomplete or incorrect information. There shall be no equivalent in the new state dental care support system to the current age limit for dentists and dental hygienists as regards reimbursable care within the dental care insurance system. In order to create the conditions to be able to assess the degree of competition neutrality on the dental care market, all county coun- cils need to disclose their public dental services revenue and expen- diture separately. If this does not happen within the next two years, the government should consider legislation aimed at forcing them to do so. The government should task the for to monitor the accounts of the public dental services and where necessary propose measures. A crucial step in improving competition on the dental care mar- ket is to empower the patient. To this end, the commission sub- mits a number of proposals for providing better information etc., to the patient. Care providers shall give their patients a price list of the dental care treatment measures they perform. The price list shall also give details of the guarantees offered by the care provider as well as the reference prices for the different treatment measures. Furthermore, the price list shall include information about the patients right to written proof as to the materials used in prosthodontic work and in tooth fillings. If a patient needs treatment on more than one occasion, the care provider shall give the patient written price information. In the case of more extensive treatment, the care provider shall give the patient a written treatment plan, including price information This plan shall give details of the diagnosis, the proposed treatment and information as to whether it is reimbursable, the care providers price and information about the reference price, the reasons for the proposed treatment, and alternative treatment suggestions and in- formation on whether these are reimbursable, the care providers price and the reference price for them. If a revised treatment plan is necessary, the care provider shall state the proposed treatment plus the relevant price information and reference price. The care provider shall quote the reference price and his or her price for each treatment measure performed plus the compensation payable in accordance with the dental care support system on the patients receipt. In the event of dental technology work being part of the treatment, the care provider shall attach a copy of the docu- mentation submitted by the dental technicians laboratory, and detailing the costs of such work, to the patients receipt. The care provider shall write an examination report after each examination. This shall be given to the patient in connection with the examination. shall be given the task of pro- an electronic price comparison service for the dental care sector. A patients advice for dental care shall also be set up. This will work as an information service for patients and will provide details of prices, types of treatment and regulations. should be tasked with taking the initiative for establishing such a in cooperation with the dental care in- dustry. Implementation aspects and entry into force The proposals presented in this report shall enter into force on 1 2008. The commission wishes to emphasise the importance of the government creating a special implementation task force within the Swedish Government Offices in order to coordinate and man- age the measures that are needed prior to the new system entering into force. The total cost of the state dental care support system, in accor- dance with the commissions main alternative, is estimated at billion per year.TPF1FPT Of the total costs, about billion will go to funding the dental care voucher and about billion to financing the high-cost protection scheme. The value of the dental care voucher will be every second year for the 30–74 age group and every second year for the 20–29 and 75+ age groups. Under the high-cost protection scheme, compensation equal to 50 percent of dental care costs between 000 and 15 000 and 85 percent of costs in excess of 000 will be pay- able. The compensation will be based on the reference prices. The commission has also calculated the costs for a second alter- native, in which the total costs for dental care support amount to about billion. In this alternative, the costs for the dental care voucher will be the same as in the main alternative, about billion, whilst the costs for the high-cost protection scheme amount to about billion. There is therefore scope within the second alternative to increase the voucher amount for the 30– 74 age group as well. Under the high-cost protection scheme in the second alternative, compensation equal to 50 percent of costs be- tween 000 and 25 000 and 85 percent of costs in excess of 000 is payable. 1TP PT The costs are calculated based on 2006 prices. The commission deems that the cost of including certain stan- dard material in the reference prices amounts to about million in the main alternative and about million in the second alternative. As regards the consequences for the government agencies in- volved, mainly the and , the commissions proposals will increase costs by million in 2007, million in 2008 and million in 2009 and 2010. Most of these costs will go to a new IT system, a special dental care support committee, the development of national guidelines and strengthening dental care monitoring and evaluation activities. It is the commissions assessment that the proposals for improved competition and better information to patients will lead to a vast improvement in the conditions for meaningful price information and price comparison. The reference prices will comprise base prices recommended by the state, which will act as a guide for pa- tients to see whether their care provider is expensive or cheap. The reference prices are specified in several places and in several differ- ent contexts, which will hopefully increase price awareness among patients. In the commissions assessment, this will lead to more patients becoming dental care consumers, leading in turn to greater downward pressure on prices and increased competition. Furthermore, the commission also believes that the proposals will lead to more patients questioning care provider prices, which in turn will increase mobility on the market. The proposals should also lead to more patients becoming aware of the risks to their dental health and what they can do to reduce them. According to the commission, the current dental care support system causes unnecessarily high administrative costs for care pro- viders. The key points are as follows: The current dental care support system is too complex and contains many detailed regulations. system for dental care support is insufficiently user-friendly and poorly adapted. A large proportion of dental care bills are submitted manually. payments of dental care com- pensation to care providers are not disbursed fast enough. Dental care compensation is normally paid after as many as 30 days. Prior assessments lead to high administrative costs as there is a large amount of information to be processed in each individual case and sometimes it takes an unacceptable length of time for the to handle them. The commissions proposed design of the new dental care support system takes all these problems into account, and solves them by implementing the following changes: The design of the new dental care support system is straight- forward and is mostly based on general rules. It is proposed that the develop a user-friendly and more appropriate IT system. Electronic communication between care providers and the Social Insur- ance Administration will create the conditions for efficient in- formation supply and lower administrative costs for care pro- viders. shall pay compensation from the dental care support system to care providers no later than two weeks after a request for compensation has been submitted, provided there are no special needs for extensive in- vestigation prior to making a decision. Prior assessments to be totally abolished in principle. The com- mission instead proposes a clearer regulatory framework that makes it possible for the care provider to work out which den- tal care measures are reimbursable and which are not. The commission feels that free pricing on the dental care market should be retained. This will allow small companies to continue to set their own prices, an issue deemed by the commission to be of considerable importance to the care providers. The commissions proposal to impose an obligation on care providers to provide their patients with information on prices and dental health aims to em- power the patient and improve competition. A more efficient den- tal care market will also benefit care providers. In the commissions opinion, this proposal will only marginally affect care providers administrative costs, mostly because they already provide this in- formation to their patients. The difference now will be that they must provide it in writing. Regarding certain aspects, care providers will have more obliga- tions as a result of the commissions proposals. This will mainly be caused by the fact that the new dental care support system, in ac- cordance with the commissions directives, will contain forms of compensation that are based on the patients previous dental care consumption. This is very similar to the existing high-cost protec- tion scheme for e.g. prescription drugs. Such systems presuppose that up-to-date information on the patients dental care consump- tion is constantly registered. The directives also state that a dental care voucher shall be granted every year or every second year and the date when the voucher is used will also have to be registered. Regardless of how this information is to be registered, the com- mission forms the opinion that the way the scheme is constructed will per se lead to more administration for the care providers. In a high-cost protection scheme where all reimbursable measures are to be added up for a certain period, with the aim of finding out whether and when the patient has consumed care in excess of a certain specified amount, all performed measures for all patients will have to be registered. This will have an unavoidable effect on the care providers administration. Under the commissions proposal, care providers will register information by continuously submitting the necessary data to the in order to ensure that the dental care compensation is calculated correctly. The fact that the data is to be submitted electronically in a new IT system customised for this exact purpose means that the care providers administrative burden should not increase in connection with the introduction of a high-cost protection scheme and a dental care voucher. The re- quirement for electronic communication will imply an investment cost for those care providers who do not currently have the rele- vant equipment. This cost is deemed to be relatively limited, how- ever. In order to improve control and monitoring in the dental car sector, the commission proposes that care providers shall submit further information in addition to the data needed to calculate dental care compensation amounts. This additional information will be of a very limited nature, however, and will be easy to com- pile from patient records and the care providers price list. All in all, the commission believes the administrative costs to companies should decrease as a result of the proposals. In connec- tion with the introduction of the system, however, the administra- tive costs are likely to remain unchanged compared to the current situation, even though the content will be different. In this context, the commission wishes to stress the crucial role played by the new IT system being developed by the Social Insur- ance Administration. Further, the commission wishes to emphasise the importance of the developing the IT system in good time prior to the new dental care support system coming into force and in close cooperation with care pro- viders. lag om statligt tandvårdsstöd Lagens syfte och omfattning m.m. 1 § Statligt tandvårdsstöd lämnas för förebyggande tandvård och tandvårdsbehandlingar som patienten behöver och som syftar till smärtfrihet och frihet från sjukdomar i munhålan, förmåga att äta, tugga och tala utan större hinder, ett utseende utan tydliga, estetiskt störande inslag. Vården skall syfta till att så långt möjligt bevara munnens vävna- der. Behandlingens kvalitet och hållbarhet skall vägas mot kostna- derna. 2 § Statligt tandvårdsstöd lämnas i form av 2.stöd till abonnemangstandvård, och 3.skydd mot höga kostnader genom tandvårdsersättning. Regeringen meddelar föreskrifter om vilka tandvårdsåtgärder som kan berättiga till ersättning från tandvårdsstödet. Tandvårdsstödet betalas ut till vårdgivaren av . 3 § I denna lag förstås med vårdgivare fysisk eller juridisk person som yrkesmässigt bedriver tandvård. Vårdgivare som bedriver verk- samheten vid mer än en mottagning får uppdra åt en befattnings- havare inom verksamheten att fullgöra de uppgifter som åligger vårdgivaren enligt lagen. Bestämmelser om skyldighet att erbjuda tandvård finns i tandvårdslagen (1985:125). Allmänna bestämmelser för rätt till statligt tandvårdsstöd 4 § Statligt tandvårdsstöd lämnas för den som fyller lägst under det år då vården ges. Om avgiftsfri tandvård för den som är yngre föreskrivs i tandvårdslagen (1985:125). Tandvårdsstöd lämnas inte för åtgärder vid vilka enligt 15 a § tredje stycket tandvårdslagen bestämmelserna om vårdavgifter enligt hälso- och sjukvårdslagen (1982:763) gäller. 5 § Statligt tandvårdsstöd lämnas endast om den som vården avser omfattas av bosättningsbaserat socialförsäkringsskydd enligt 3 kap. 1 § socialförsäkringslagen (1999:799). 6 § Gemenskapsrätten inom Europeiska unionen (EU) eller inom Europeiska ekonomiska samarbetsområdet (EES) eller avtal om social trygghet som ingåtts med andra stater kan medföra begräns- ningar i tillämpligheten av bestämmelserna i denna lag. 2 kap. Tandvårdscheck, abonnemangstandvård och tandvårds- ersättning 1 § Som ett stöd till regelbundna undersökningar och förebyggan- de åtgärder har var och en som är berättigad till statligt tandvårds- stöd rätt till en årlig tandvårdscheck. Patienten kan använda checken från det att den ställdes ut. Tandvårdschecken får även användas för att betala annan tand- vård än som avses i första stycket. 2 § Statligt tandvårdsstöd för abonnemangstandvård lämnas i form av tandvårdscheck som avses i 1 §, om en patient har slutit ett avtal med en vårdgivare om att denne av till ett fast pris skall utföra den ersättningsberättigande tandvård som patient- en behöver i form av 1.undersökningar och utredningar, 3.behandling av sjukdoms- och smärttillstånd, samt Avtalet får även omfatta annan ersättningsberättigande tandvård än som sägs i första stycket. 3 § Som skydd mot höga tandvårdskostnader lämnas tandvårdser- sättning med en viss andel av patientens sammanlagda tandvårds- kostnader . Kostnaderna för tandvården beräknas enligt en åtgärdslista med referenspriser som fastställs av regeringen. Kostnaden för en utförd åtgärd får dock högst beräknas till det pris som vårdgivaren har begärt för denna. Ersättningsperioden påbörjas i och med att en första ersätt- ningsberättigande åtgärd slutförts. Vårdgivaren kan på patientens begäran anmäla hos att en ny ersättningsperiod skall påbörjas innan den tidigare ersättningsperioden har löpt ut. Den nya ersättningsperioden gäller från det anmälan har kommit in till . 4 § Tandvårdsersättning lämnas inte för tandvård som omfattas av ett avtal om abonnemangstandvård enligt 2 §. 5 § Har vårdgivaren efter utförd behandling fått ett lägre belopp i ersättning från det statliga tandvårdsstödet än vårdgivaren begärt av , får mellanskillnaden inte krävas ut av patienten. Första stycket gäller dock inte om den lägre ersättningen från tandvårdsstödet beror på att patienten lämnat ofullständiga eller oriktiga uppgifter. 6 § Om en protetisk behandling görs om av en annan vårdgivare än den som utförde den ursprungliga behandlingen, får Försäk- ringskassan återkräva det statliga tandvårdsstöd som lämnats till vårdgivaren för den första behandlingen. sådant fall i stället räkna av beloppet från en fordran som denne har på annan ersättning från tandvårdsstödet. Ett belopp som mot- svarar det återkrävda beloppet skall använda som betalning till den vårdgivare som utför omgörningen. Innan en behandling görs om av en annan vårdgivare än den som först utförde behandlingen, skall behovet av omgörning förhands- prövas av . Förutsättningar för statligt tandvårdsstöd