The dental care subsidy scheme – A structure with gaps

The position of patients in the dental care market needs to be strengthened. Patients lack knowledge about prices, treatments and dental care subsidies. Few patients switch dentists. Furthermore, patients are at an informational disadvantage, allowing healthcare providers to charge high prices.

At present, information to patients is fragmented and the dental care subsidy system is complicated. The Swedish National Audit Office considers that the responsibility for making essential and easy-to-understand dental care information readily available should be brought together under a single government agency. The Dental and Pharmaceutical Benefits Agency (TLV) needs to improve the dissemination of its price comparison service, which needs to be supplemented with information on what different procedures entail.

Today, patients lack a benchmark on what is a reasonable price and therefore are not aware when it might be justified to complain. The Swedish National Audit Office considers that the Swedish Consumer Agency should aim to specify how much a price is permitted to deviate from a previously stated approximate price quote in the agency’s agreement with the industry. The Government should also consider introducing a regulation that requires all dentists to join a complaints service.

The Swedish National Audit Office notes that the inquiry proposal being prepared on providing patients with tailored information via the Swedish Social Insurance Agency’s website is a step in the right direction. It would help patients understand the dental care subsidy and anticipate their costs. It can also serve as a distribution channel for a survey to dental care patients.

The structure of the dental care subsidy needs to be reviewed for two main reasons:

The dental care subsidy scheme should benefit patients more. The current high-cost protection limits costs for those with the highest dental care costs. However, the Swedish National Audit Office considers that this protection has also contributed to higher prices and thus does not benefit patients as intended. This audit shows that the higher the subsidy, the worse the price competition seems to perform.

Therefore, the Government should ensure that high-cost protection benefits patients more. Possible ways of achieving this are presented below.

1. Lower the subsidy and raise the personal contribution for the most costly procedures to increase price competition and ensure that a larger proportion of the subsidy is awarded to the patient. However, at the same time, those with the highest dental care costs would receive less money, as the reduced compensation would probably not be fully offset by greater price competition.
2. Regulate the prices. However, this also poses risks, such as poorer access to dental care.

The dental care subsidy should be directed more toward preventive dental care for people with major dental care needs. Today, the dental care subsidy is not directed to preventive dental care for this group, even though they have the greatest need for it. Today, their dentist visits are too infrequent. When preventive dental care is lacking, minor problems risk becoming major problems, requiring costly treatments. This leads to increased costs for individuals and society as well as unnecessary suffering. Such an initiative could be financed by redistributing funds from the general dental care subsidy, which the audit has shown does not effectively encourage regular visits.

A number of actions can make decisions on the dental care subsidy more effective:

The dialogue between the TLV and the dental care industry needs to be improved. The TLV does not receive sufficient data from the industry for its calculation of reference prices. The ‘reference price’ is an estimated norm price for each dental care procedure and determines the patient’s compensation. At the same time, the industry has little confidence in the reliability of reference prices. This audit shows that while the TLV on the whole manages the reference price calculation well, it needs to develop methods to estimate the time taken for different procedures.

The National Dental Care Subsidy Board should be phased out as it does not fulfil its intended role. The Board’s responsibility for determining the amount limits at which the high-cost protection should apply will no longer apply once indexation is introduced in 2026. Likewise, the Board does not, as was intended, make clear priorities and considerations about which procedures should be included in the dental care subsidy. These should instead be decided by the Director-General of the TLV, providing better prospects for dialogue with the industry and clear responsibility for the entire decision-making process.

The Government should ensure that the TLV (or the actor who will decide on the dental care subsidy in the future) is also responsible for performing an overall analysis of the dental care subsidy. Expertise on analysing the dental care subsidy is divided between several government agencies. There is a need for a regular overall analysis and assessment of the development of the dental care subsidy, especially concerning cost trends.