Main

BDJ Open 2017;3: 17001 http://dx.doi.org/10.1038/bdjopen.2017.7

Credit: ©Anders Sellin/Moment/Getty

Sweden is in fashion. Not only is it seen as one of the most gender equal and politically progressive countries across the globe, it also gave us the Volvo, ABBA and fika. Its healthcare system is globally revered; however, to what extent does this include dental healthcare, and how has this changed over the last 42 years? In their BDJ Open paper, Franzon et al. have studied the origins of dental health as part of the Swedish welfare system in 1974, and how the policy has developed over the course of three reforms since then.

By studying the reforms, of 1999, 2002 and 2008, the authors have observed that paediatric dentistry has consistently been an important issue since the system changes in 1974 and equal competition (the right to choose a dentist has been fundamental to Swedish dentistry) has been a key issue since 1999. The authors show that the reform of 1999 was critical and brought about the most radical changes in dental welfare, as demonstrated by the significant changes in the system of dental care subsidies. The authors have compiled a very helpful table (see Table 2 in https://www.nature.com/articles/bdjopen2017) highlighting the key issues throughout each reform.

By Jonathan Coe

Credit: Author Q&A with Bengt Franzon Malmö University

Why did you research the dental subsidy systems in Sweden?

Due to my background as a private dental practitioner for almost 40 years, being the President for The Association for Private Dental Care Providers in Sweden during (1999-2007) and appointed by the Swedish Government as member of The Board for Dental Benefits rules at The Dental and Pharmaceutical Benefits Agency during (2008- 2011), I gradually got more interested in how decisions related to financing of dental care were made. In 2008 I was given the opportunity to cooperate with people at Malmö University sharing my interest which resulted in this study.

Can you briefly explain how the Swedish dental system works?

The Swedish system for adults is a free market within a welfare system, characterised by:

  • Freedom of choice of dentist

  • Fee for service

  • State reimbursement for dental fees linked to a reference price list determined by the state

  • A list of therapies approved within the system

  • Free pricing

  • High cost protection linked to the reference price list. The patient pays 100% up to 3,000 SEK (£250), 50% between 3,001 and 15,000 SEK (£ 250-£1,250) and 15% for costs over 15,000 SEK (£1,250). If the price of the dentist is higher than the reference price, the patient has to pay the difference

  • Ex-post control

  • Computerised communication between the dentist and the state where the state pays for the therapies within a week

  • Freedom of establishment for dentists.

Dental care for ages 3-23 is free for the patient. Dentists are paid using a capitation system.

What was the main thing you learned from this work?

Dental politics in Sweden may be described as based on two principles: a will 'to do good' and a need to know how much this will cost. The political solutions are also depending on the zeitgeist and political ideologies. Thus dental care as a free market system with the choice for the patient to freely choose a dentist and linked to free pricing creates complicated systems.