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A STUDY FROM REBMANN RESEARCH WITH STRATEGY IDEAS FOR THE EUROPEAN DENTAL INDUSTRY.
2 | 3
CONTENTS
Introduction
S1
S 5
S 6
32
28
32
S 2
33
12
33
Does the demand for dental care fall with increasing age?
12
Growing demand and prosperity the significance of the secondary health market
13
S 7
S 3
Belgium
36
Germany
38
40
16
France
16
Netherlands
42
16
Austria
44
16
Switzerland
46
17
18
S 8
19
Denmark
50
19
Italy
52
Implants
19
Spain
54
21
United Kingdom
56
21
List of references
58
24
25
Dentists
25
Regional fluctuations
25
Supply-induced demand
25
S1
Changing
job profile
Growing prosperity
Non-vital
dental services
Quality requirements
S2
Double ageing
Complementary
dentistry
Economic situation
Legal notice
Publisher
Identification of regional
market penetration
High-quality and
basic services
Expand
cross-selling
S3
Digitalisation demands
product adaptations
Authors
Dr. med. Heidrun Sturm MPH, Dr. Bernd Rebmann
Secondary
health market
S4
Microenvironmental
analysis
under-mobilized
target groups
Design
Identification of
affluent regions
Prosperity in
the countries
S5
Growth in
the countries
Consideration of cultural
preferences
S6
2013 REBMANN RESEARCH GmbH & Co. KG, Berlin
Special
care programs
Belgium
Austria
France
S7
Germany
Netherlands
Switzerland
Denmark
Spain
S8
Italy
United Kingdom
INTRODUCTION
4 | 5
Expenditure for dental health is considerable, accounting for 610% of total health spending or
between 100 and 300 US$1 per capita per annum.
A large proportion of this has to be borne privately
in many countries. Dental health is often not regarded as part of general health and, analogously,
dental care is not considered a component part of
basic medical care. For this reason, dental care is
only covered in part by insurance systems in many
European countries. Even in the case of people with
insurance, additional out-of-pocket payments account for between 11% and 42% of their overall
health expenditure. Many people have no insurance
whatsoever to cover dental care.
The range of services provided by the German dental industry alone encompasses over 60,000 products. This study focuses on the member countries
of the FIDE2 (with the exception of Russia), thus encompassing a group of about 250,000 dentists and
approximately 150,000 dental technicians who contribute to the demand for these products. Dentistry
in this context embraces a spectrum encompassing
everything from diagnosis and prevention to restoration and covering a variety of specialised areas:
orthodontics, dental prosthetics, preservation and
surgical treatment, individual prophylaxis, periodontitis therapy, endodontics, implantology and
aesthetics.
Adjusted to take the share of dental technology of 6.5 billion as of 2011 into consideration, German dentists earned fees of 15.4 billion for treatment alone, equivalent to a slight reduction of 2%. For this reason,
more than a few dentists are considering an expansion of the value-added chain through integration of a
practice laboratory. The German dental industry is traditionally both the pace and trendsetter in Europe.
German production is so significant in this respect that European developments frequently take their cue
from those in Germany (e.g. growth in drills in Germany in 2007 was around 14% and 15% in the EU, while
the fall in Germany related to instruments of 8% was mirrored exactly in the EU).6
Normally speaking, the dental market is divided between services rendered directly on the patient and
services which are realised at a distance from the patient. Services rendered directly on the patient, the
consumer, are essentially realised by dentists, orthodontists, oral and maxillofacial surgeries and other
facilities and dental technicians. These represent the main target group in the dental industry.
Fig. 1 Division of dental services on the patient (example Germany)
1% other
The
user (patient) does not pay in every case: insurance policies cover costs to varying degrees.
The economic situation of the purchaser (doctor)
is heavily dependent on political regulations (remuneration).
Manufacturers themselves are confronted by
different national regulations governing product
approval and registration in remuneration catalogues.
This means that access to and the costs associated
with dental care are strongly influenced by health
systems, policy and the local economic situation.
Consequently, these vary considerably between European countries. All these factors shape the health
market in a particularly complex manner and make
it difficult to forecast clear trends.
Dentists
3% prophylaxis
Fig. 2 Value-added chain in the dental market
4% periodontitis treatment
9% orthodontics
Dental
industry
Upstream
Equipment, devices, products, etc.
33% prostheses
50% conservative and operative treatment
Dental
trade
The entire value-added chain begins with the dental industry and extends right up to the patient who, as a
purchaser of dental services and dental care products, primarilyin the so-called secondary health market,
plays an increasingly important role (see Fig. 2).
The dental market and the entire health market differ from other markets:
The service provider, foremost dentists as customers of the industry, is not identical to the actual consumer, the patient. As a result, rather than depending on the usual considerations, demand is governed by
further factors such as the insurance structure, approval modalities and local demographics.
Laboratories
Providers
Dentists
Dental hygienists
Orthodontists
Oral and maxillofacial surgery
Expanding on these hypotheses, this study primarilyaims to examine the structures of customers of the
dental trade and development correlations relevant
to the dental industry as an initial link in the chain.
On the basis of sound data, concrete recommendations for action will be derived from this and common assumptions critically examined.
1 OECD
Health Data (US$ calculated OECD data basis 2011),
cf. also Widstrom, 2005.
2 N
ote: FIDE Federation of the European Dental Industry. FIDE
represents 550 dental manufacturers in Belgium, Denmark,
Germany, France, Italy, the Netherlands, Austria, Russia, Spain,
Switzerland and the United Kingdom. Due to the poor situation
relating to the provision of data, no statements are made in this
study relating to the situation in Russia. The FIDE average and
overall FIDE values thus relate to all FIDE member countries
with the exception of Russia.
3 cf. WifOR, 2012.
Patients/
Consumers
S1
6 | 7
SCHEDULE ONE
STRATEGIES GOVERNED BY STRUCTURAL TRENDS
S1
Important stations
Growing prosperity
Changing
job profile
8 | 9
DENTAL CARE
PAST AND PRESENT
S1
Belgium
2.2%
Germany
France
6.4%
4.5%
Netherlands
5.4%
4.1%
Austria
5.1%
Switzerland
6.2%
Spain
UK
8.9%
4.1%
4.3%
Denmark
Italy
14.7 %
7.6%
no data
5.0%
4.1%
4.4%
Dental expenditure 1980 (% of total expenditure)
prevention. Since these changes, Germans now enjoy one of the best levels of dental health, although
expenditure is considerably lower. Dental care in
countries such as Sweden and Australia are also
regarded as good. A high level of dental health has
been attained in these countries at a relatively low
cost.
Dental health and demand
Dental health all over Europe has improved considerably and continuously in recent years. The
number of edentulous patients dropped from 30%
per annum in 1978 to 13% a year in 1998.8 Cases of
caries in children and adolescents also fell considerably.9 The WHOs target of 80% of children under 6
being free of caries by 2020 appears to be achievable
in many places. For example, this rate has already
been successfully raised to 50% in Austria.10
Despite this, major differences exist between social
groups and regions, and morbidity caused by dental
problems is not inconsiderable. It is estimated in the
United Kingdom that around 15 million working
days are lost due to dental problems.11
People who have had a higher level of education typically visit the dentist more often and enjoy better
(dental) health. However, sections of the population
are to be found in every country with poor dental
health. Some studies postulate that the differences
in dental health between social strata have become
more pronounced in recent times. Dentistry today
therefore covers a spectrum ranging from simple tooth extraction on the one hand to high-end
care which includes cosmetic dentistry and dental
bleaching.
As the two main diseases encountered in dentistry, caries and periodontitis, are avoidable in most
cases, public prevention programmes such as fluoridation, dental cleaning education and healthy
nutrition also play a central role when it comes to
dental health. Prevention measures such as public
dental care programmes are of especial relevance
for children.
The public health service plays a central role here,
and its importance is traditionally greater in the
Scandinavian countries and countries with public
health systems such as the United Kingdom. This
can attenuate social differences somewhat.
In addition to this, age plays a significant role in
the treatment spectrum. In industrial countries,
two thirds of people over the age of 55 and 84% of
people over 75 have lost at least one tooth. In the
case of those under 35, this proportion is only 33%.
Improved care also means that the younger population frequently exhibits a positive dental status (i.e.
dental care may be limited to checkups and cleaning which can also be realised by dental hygienists).
Increasingly more elderly people retain their own
teeth longer as a result, but periodontal conditions in these medium and higher age groups have
increased.12
Almost 90% of German senior citizens currently suffer from some form of periodontitis.13 This means that elderly people frequently require much greater and
more complex dental treatment than in the past.
Trend towards greater cooperation and joint practices
Less than a quarter of dentists in Europe currently work in joint practices or
other cooperation forms. In the medium term, the trend towards more joint
practices prevails in the majority of countries. This is due in part to the feminisation of professions and the accompanying increase in part-time work associated in most cases with this. Around 40% of dentists in Germany are now
women. The general change expressed in a desire to achieve a work-life balance
is also related to this development.
Belgium
Germany
Denmark
4.3%
1.4%
2.2%
0.8%
2.1%
0.6%
4.0%
1.1%
Spain
UK
2.4%
0.9%
Austria
Switzerland
4.2%*
1.2%
Italy
Additionally, technological progress means that the level of investments required for practices is rising, and sole practices find it increasingly difficult
to hold their own. Nevertheless, the size of dental practices is limited in some
countries. Advertising for dental practices is prohibited in Ireland, Portugal,
Italy, France and Greece.
6.3%*
0.7%
France
Netherlands
3.9%*
0.9%
1.3%
0.7%
3.1%
3.1%*
1985
2010
Source: OECD Health Data, 2012.
care for disabled people is also increasing in importance in the context of demography. New structures, in part involving IT networks, need to be developed
further here, and these will also facilitate the professional exchange with other
service providers.
S2
10 | 11
SCHEDULE TWO
STRATEGIES GOVERNED BY SOCIAL TRENDS
Non-vital
dental services
Quality requirements
S2
Important stations
Double ageing
Economic situation
Complementary
dentistry
Growth is determined by
the demand for non-vital
medical services
Complementary dentistry is
growing in importance in the
context of holistic medicine
New cooperation partners can enhance dental care
New therapy options and training methods
are an interesting area for dentistry
12 | 13
DEMOGRAPHIC DEVELOPMENT
AND DEMAND FOR DENTAL
SERVICES
S2
Practically every European society is confronted with demographic change, although the degree of change differs. On the one hand, the relative proportion of
senior citizens is strongly related to the birth rate and, on the other, to increased
life expectancy. The baby boomers will exacerbate the problem further in coming years. Taken together with the absolute increase in people over the age of 65,
this development is referred to as double ageing.
With their extremely low birth rates, Germany and Italy are among the most
affected countries. Practically every third person in Germany will be over 65
in 25 years.
Belgium
24.2%
20.63%
Germany
France
16.6%
Netherlands
15.45%
24.4%
25.9%
17.65%
Austria
26.1%
16.29%
Switzerland
25.2%
15.26%
Denmark
30.2%
24.1%
20.08%
Italy
16.74%
Spain
16.35%
UK
28.6%
24.8%
21.9%
are usually visited when one is healthy; the sicker people are, the less likely
they are to visit a dentist.
The lower the level of education, the more frequently medical consultations
occur, whereas visits to the dentist increase where the level of education is
greater. (73% of university graduates visited the dentist in Europe last year,
compared to only 29% of those who have attained a lower educational qualification).18
Medical consultations increase in old age, whereas dental visits decrease.
Whereas 63% of 50 to 54-year-olds visited a dentist last year, the figure for
those over 85 was only 25% (see Fig. 6). According to a new study, 15% of all
those over 55 years of age polled had not been to the dentist for five or more
years, while the figure for those younger was a maximum of 7%.19
Levels of insurance expenditure in Germany also support these assumptions.
This expenditure also decreases with advancing age. However, private expenditure is not taken into consideration in this respect.20 Dental implants and expensive dental prosthetics are in the main not covered by insurance (i.e. these
services, which are particularly important for older people, are for the most part
not recorded here).
A demographically driven expansion of services occurs as a result of intensified
treatment in the case of a fewprimarily healthy patients and is probably also financed to a greater degree outside the framework of publicly funded services in
the primary health market. This means that privately funded services increase
in importance. Sales opportunities are therefore most attractive in countries
with a prosperous (and frequently more healthy) elderly population sector and
services and products which must for the most part be privately funded. This
also means that market opportunities are less influenced by the average economic situation, and much more by the affluence of the older generation.
Patients are increasingly willing to pay for good quality. The appreciation of
quality plays an important role in this context. This appreciation can, on the
one hand, be influenced through their experience (durability, suitability, appearance) and, on the other, not insignificantly through the media.
Fig. 7 Proportion of respective age groups who have visited a dentist within the last 12 months
Belgium
Germany
Netherlands
Austria
Switzerland
Spain
100%
80%
60%
40%
20%
0%
1524 y.
2534 y.
3544 y.
4554 y.
5564 y.
6574 y.
7584 y.
85 y. and more
Colloquially speaking, the secondary health market is frequently understood to mean the extended
health economy in the field of wellness and areas
outside the core sector of curative medicine. In
2007, Roland Berger estimated the German contribution to private health expenditure to be 60 billion
per annum, with 20 billion of this being spent on
the extended market in the areas of fitness, wellness, health tourism and organic and functional
food.22 Cosmetic and aesthetic products in the dental sector are also subsumed under this figure.23
When one considers the privately funded segment,
it is anticipated that the strongest growth effects
will be encountered there as a whole in the future.
These mainly arise
t hrough prevention-oriented demand which, depending on the health system involved, is covered
to a greater or lesser degree by publicly funded
dental care. These services are primarily available in the freely funded secondary health market
in Germany. Accordingly, the share of the secondary market in the overall oral health market
would currently be 29.6% and rise to about 40%
by 2030.24
A nother trend is evident in complementary dentistry in the context of holistic medicine.25 This
includes collaborations with otolaryngologists,
pulmonologists, orthopaedic surgeons or physiotherapists.
150%
15 c f. NHS, 2008.
125%
100%
75%
50%
Men 2010
Women 2010
25%
0%
0-
1-
5-
10-
30-
35-
40- 45-
50- 55-
60-
65-
70- 75-
80-
85- 90-
S3
14 | 15
SCHEDULE THREE
STRATEGIES GOVERNED BY product technology
Identification of regional
market penetration
S3
High-quality and
basic services
Expand
cross-selling
Important stations
Monitoring of micro/
macroenvironment
Digitalisation demands
product adaptations
S3
DIGITALISATION CHANGES
STRUCTURES AND PROCESSES
Digital technologies alter the interaction between
dental professional groups
New technologies mean that many working procedures are replaced by computer-controlled processes. Necessary dental prosthetics are scanned by the
dentist personally or in the lab and either processed further in the medical
practice by dental technicians or electronically in the dental laboratory. Fully-automated manufacture in centralised facilities is increasingly possible.
Moreover, it is also noticeable that more dental technicians work directly in
medical practices. Their field of activity is increasingly characterised by computer-controlled processes. Routine work is realised by machines, with delicate
tasks remaining the domain of the dental technician. Various manufacturers
therefore recommend the combination of scanners with a centralised milling
machine capability in dental laboratories. This would also enable dental laboratories to access the latest technology without the necessity to invest in complex
and maintenance-intensive milling equipment. The quality of centralised milling machinery is well defined, enabling technicians to react in a flexible manner
to customer wishes.27
Strategic collaborations are necessary
More than three of every four dental labs are still small or medium-sized facilities. However, technical innovations and pricing pressure from low-wage
countries means that a consolidation is currently underway among dental
laboratories. Outsourcing frequently takes preference over expenditure for
new investment products when it comes to mergers. Laboratories also strive
to replace manual tasks with automated procedures. The consequence will be
a fall in the number of dental technicians. In Germany, a considerable decline
has also been evident in the employment trend in the last decade.28 Turnovers
achieved by dental laboratories will grow at a considerably slower rate in future
than those of dentists. An overall growth of 8.8% is anticipated up until 2030 in
Germany, approximately half as large as that of dentists. In dental technology,
the area outside public services is also growing considerably quicker. Whereas
16 | 17
14,283
Belgium
Germany
4,172
15,895
France
16,210
Netherlands
12,904
Austria
7,967
Switzerland
12,333
Denmark
Competition from discounters is encountered regionally and in overseas markets such as Brazil,
Korea and Israel. As a result, less well established
providers are forced to fight for their market share,
while quality providers frequently number established dental practices with a large number of
patients among their customers which are not as
greatly influenced by fluctuations in demand and,
additionally, do not switch so quickly to discounters. Equipment and material manufacturers are
particularly threatened by low-price competition.
Instrument manufacturers, on the other hand, are
not influenced to the same degree.
There are three principle types of discounter:
1.Asian broadliners (which, despite conducting
their own research, profit from low personnel
and purchasing costs, currency advantages and
lean sales and service structures)
2.Copycats (which replicate established products
by circumventing patents, are mainly small
firms and are distinguished by lean administration and an appropriate sales organisation)
3.
One stop shop distributors (which combine
their own products with established products
in distribution)31
Italy
Spain
5,126
9,599
UK
25,956
In addition, large providers offer established basic products at low prices or include a separate low-price product line in their range.
However, the demand within the EU primarily involves high-tech, innovative
products.32 Competition is also stiff in this high-end segment, a situation which
is also reflected within Europe where the dental market includes a large number
of medium-sized enterprises. Competition and delimitation in this segment are
predominantly driven by innovations. Consequently, new production facilities
invariably encompass an R&D lab. In recent years, major dental manufacturers
have increased their budgets for research and development.33 Funding in the
scientific field is also extremely important, as its loss would, for example, lead to
market losses in the area of implants and bone substitutes.
18 | 19
Technical service
After-sales service
Customer, etc.
Equipment
Dental practice and laboratory equipment
Appliances (dental X-ray equipment, ultrasonic
systems, digital intraoral scanners, etc.)
Dental instruments
6% technical service
Teeth delivered
Incl. digital prosthetics, implants
Miscellaneous
Included here arecosmetic products for customers
(aesthetic treatments, toothpaste, mouthwashes,
whiteners, etc.)
22% equipment
2% teeth
55% consumables
15% miscellaneous
In the area of consumables, demands are continuously increasing with regard to material variety,
value for money and service (i.e. innovations will
play a significant role). The market for dental pharmaceutical products in particular is regarded as
promising for the future.
Growth is also anticipated in the area of restorative
materials, as the moulding and restorative materials
business is already achieving high growth rates in
local currency in the USA.36
In the area of prosthetics, precious metals are being
increasingly replaced by industrial solutions consisting of ceramics and non-precious metals, which
lead one to expect a proportional drop in sales. In
general, classic materials and technologies will increasingly be displaced by digital solutions. This
change is also a result of the fall in turnover in the
analog X-ray film business.37
In terms of growth markets, a good example is the
implant market, and a closer look is taken at this
below.
4550% Europe
2530% North America
1520% Asia Pacific
510% rest of world
Source: Estimates from Straumann, 2012, based on data from the Millennium Group and iData
Implants
The implant market is one of the markets governed
by the economic situation. In addition to economic
framework conditions, market penetration and the
acceptance of implants are of major significance
when it comes to national market developments.
The dental implant market is divided into the premium, value and discount segments. Discount implants make up the smallest and most fragmented
part of the market. These products mainly compete
in terms of the price and not with regard to innovation. The European market is
currently dominated by a few major manufacturers who are focusing on digital
prosthetics, particularly involving high-end implants.
However, increasing market fragmentation has reduced their overall market
share to just over 40%. The increasing demand for cost-effective dental implants has enabled many low-price competitors to enlarge their market shares
in practically every European market. In particular, low-cost players from outside Europe are attracted by this. Similar to many aspiring/new European competitors, these firms also supply cost-effective products, but they combine these
with training programs, a strategy which promotes brand loyalty.38
HOWEVER
The premium market still demonstrates its stability. Despite the economic crisis, a growing number of customers still demands high-quality products that
guarantee an appropriate level of service and scientific improvements and can
only be provided by premium manufacturers, due to the equipment required
for this purpose. This can also doubtlessly be explained by the relatively low
proportion of material costs as a percentage of overall costs (1520%) which
patients have to bear. Material prices between countries only differ in this respect by a maximum of 10%, with the USA also leading the price spectrum
when it comes to implants.
Although the European market is classified as difficult, a considerable surge in
growth is anticipated in the coming years, particularly as markets in Europe are
still severely underpenetrated.
In 2011, only 1520% of adults who allowed themselves to be treated for tooth
loss in the Western world received a dental implant. Even in the USA, where as
few as about 2% of patients suffering tooth loss allow themselves to be treated,
over 80% of these still received conventional treatment in 2011. It is expected
that, by 2020, treatment with implants will increase from todays figure of about
20% to 2530%.39
20 | 21
The fact that many dentists are presently still less than familiar with implantology represents further grounds for growth opportunities. Simultaneously, this
area is still not regarded with an adequate degree of importance on a broad level
during training in professional associations and dental faculties. Although implantology is frequently (still) not regarded as a formal specialisation, an overall
improvement appears to be occurring which will have a positive effect on demand. Increased competence with regard to the use of implants and finishing
of restorations has been identified. Moreover, general dentists are increasingly
willing to recommend implant treatment to their patients. Providers can themselves support their dental customers with training seminars in this respect.
Although a downturn resulting from the recession is apparent in Europe, patients confidence in this technology is also growing. For this reason, significant growth in the high single digit percentage range is anticipated up to 2015
in Europe. However, strategies need to be adapted to suit differing national
Belgium
no data
110
Germany
55
France
Netherlands
no data
110
Austria
115
Switzerland
Denmark
no data
190
Italy
160
Spain
UK
20
Details per 10,000 inhabitants in 2011
Source: Estimates from Straumann, 2012, based on data from the Millennium Group and iData.
Illustration: REBMANN RESEARCH.
Admittedly, uneven developments have been observed between countries in the area of CAD/CAM
(bridges and crowns):41 the European average indicates slight growth. However, the CAD/CAM
market is, on the whole, frequently less profitable at
present than implants.
S4
22 | 23
SCHEDULE FOUR
STRATEGIES FOR THE MICROENVIRONMENT
S4
Identification of high
coverage densities
Secondary
health market
Important stations
Microenvironmental
analysis
under-mobilized
target groups
Identification of
affluent regions
S4
SALES SUCCESS DEPENDS
ON CLEAR REGIONAL
KNOWLEDGE
A successful marketing strategy begins with analysis of market conditions at the location:
There are patients at every location who can be
mobilised. A contemporary study of the utilisation of dental services47 indicates who is involved:
two to six-year-old children, men, segments of
the urban population.
The dental environment is very often extremely
heterogeneous.
Extensive medical and economic reserves are to be
found in multidisciplinary cooperation with other
specialised medical groups.
Supplementary dental insurance from health insurance providers offers opportunities.
Opportunities in the dental sector are to be found in
addressing patients correctly, the targeted offering
of the service spectrum and regular mobilisation
(e.g. through recall marketing measures). According to the Barmer GEK dental report,48 two out of
every three children in Germany between the ages
of two and six years miss individual screening examinations, with commensurate consequences for
milk teeth which, after all, account for 5% of all
dental fillings. Experts recommend the extension of
group prophylaxis in this case to encompass kinder-
24 | 25
1,509
Belgium
1,206
Germany
1,531
France
2,334
Netherlands
2,021
Austria
1,670
Switzerland
1,212
Denmark
1,061
Italy
1,707
Spain
2,077
UK
Belgium
Germany
1,231
3,578
France
4,053
Netherlands
The German study particularly examines factors in this respect which influence
treatment frequency. It determined that an average of 70.3% of the population
had contact at least once with the dentist during 2010. The question arises here
as to why the treatment rate is so different on a regional level, being around
78.9% in Saxony. The lowest value, 63.7%, was recorded in Saarland (see Regional fluctuations). On the other hand, the study provides indications of a
range of further reasons which correlate with frequent dental visits, including a
high proportion of persons with public insurance cover or old age. Sex also plays
a significant role. The male population (66% consulted a doctor) represents an
even higher mobilisation potential for the dental profession than women (74%).
2,943
Austria
3,650
Switzerland
3,265
Denmark
Italy
Spain
UK
2,160
2,935
8,712
Source: cf. ADDE, 2012.
Belgium
1,825
Germany
2,533
France
3,837
Netherlands
2,222
Austria
2,305
Switzerland
Denmark
Italy
1,142
1,495
2,837
Spain
UK
1,662
Source: OECD Health Data, 2009.
S5
26 | 27
SCHEDULE FIVE
STRATEGIES FOR THE MACROENVIRONMENT
Prosperity in
the countries
S5
Important stations
Public
financing
Growth in
the countries
Consideration of cultural
preferences
28 | 29
S5
3.9
1.4
Germany
5.7
2.1
France
Netherlands
0.8
Austria
2.0
1.5
2.8
Switzerland
Denmark
2.4
Italy
Spain
UK
8.8
4.2
no data
4.6
0.8
0.6
It was observed during the economic crisis in 2009 that, in general, the level of treatment for tooth loss fell.
More patients postponed treatment or did without it.57 Dental implants and bone substitute materials were
also affected by the economic crisis, these mainly involving self-pay services. The implant market recovered
slowly following the crisis, only to be negatively affected once againby the debt crisis in 2011, primarily in
the USA and Europe. Other non-essential therapies or materials such as regenerative products were also
particularly affected by the savings behaviour of customers.58
8.9
4.4
What is the relationship between dental services which must be privately funded and demand?56 This question is relevant, both from the point of view of individual countries and with regard to product groups and
services. Different correlations are conceivable here:
1.The market is more stable where dental services are covered, as services can still be obtained if the private economic situation deteriorates.
2.The market is more promising where a higher private funding share exists, as the demand here is
governed directly by the need/price /quality requirement and more resources can be made available
for care.
In principle, it can be said that, the less essential they are considered by a society, the less services tend to be
covered. Emergency care and dental maintenance in particular are covered in most cases as a result. Prevention is only gradually being recognised as a cost-effective strategy for long-term cost avoidance. Care for
children and adolescents in particular is, as a consequence, covered in most countries. On the other hand,
services such as dental prosthetics are available which are classified as being more of a cosmetic nature.
Belgium
connected to the country and the proportion of costs which must be privately funded there. In addition to
the overall economic situation of a country, the distribution of resources within a society also influences
demand. In countries where, for example, numerous older people have lower incomes, the demand for dental care can be relatively lower than is demographically expected.
11.7
6.7
6.5
This all suggests that chiefly uninsured indication areas and those which are not absolutely necessary depend on the economic situation of patients. A further indication of the dependence of demand on payment
is the fall in demand in indication areas affected by savings measures in healthcare. Examples of this are
the successful move away from dental prosthetic therapy following its exclusion from payment cover in
Germany or the restriction of payments for precious metal alloys in recent times.59
X-axis:
100%
Switzerland
Spain
56 N ote: dental services funded privately vary considerably between different countries, but are difficult to quantify uniformly.
The proportion of private expenditure for dental medicine is
therefore drawn upon as an approximate value.
57 cf. Straumann, 2012.
Y-axis: proportion of private expenditure relative to total outlay for dental services 2011
X: -2.20%
Y: 97.20%
0: 118.31
Italy
80%
Y-axis:
proportion of private expenditure
relative to total outlay for dental
services 2011
Circle size: per capita dental expenditure
X: 3.3%
Y: 91.00%
0: 463.30
X: 0.30%
Y: 97.00%
0: 211.10
UK
X: 5.20%
Y: 69.30%
0: 127.98
60%
Austria
Denmark
X: 6.40%
Y: 39.60%
0: 215.66
X: 2.20%
Y: 70.50%
0: 230.64
France
X: 3.30%
Y: 25.30%
0: 184.60
40%
Netherlands
20%
X: 1.30%
Y: 25.00%
0: 191.80
Belgium
X: 6.80%
Y: 28.10%
0: 88.32
Germany
X: 4.80%
Y: 25.90%
0: 287.34
0%
2%
0%
2%
4%
6%
Source: OECD Health Data 2012; illustration and calculation: REBMANN RESEARCH.
S6
30 | 31
SCHEDULE SIX
NATIONAL STRATEGIES, BY AND LARGE
S6
Important stations
Special
care programs
SCHEDULE
FOR THE EUROPEAN DENTAL MARKET | SCHEDULE SIX
32 | 33
S6
tion of German Dental Manufacturers (Verband der Deutschen Dental-Industrie VDDI) employed about
18,100 personnel in 2011 at home and abroad. Customers of these manufacturers are the around 264,000
European dentists and, additionally, dental laboratories.
Europe accounts for about 30% of the global dental market, with Germany for its part representing
the largest market.60 From the point of view of the
VDDI, the German market was worth 1.67 billion
in 2011.61
In Europe, Germany also leads in terms of the number of manufacturers of dental products, occupying
first place ahead of France, Italy and Great Britain.
Alone the 200 member companies of the Associa-
Fig. 19 Development of health expenditure in an international comparison: 19962009; share in GDP in%
USA
UK
Germany
Switzerland
Slight single-digit market growth is forecast for the next few years, but this may differ greatly from sector
to sector and country to country. A complete recovery to the double-digit growth levels which typified the
sector prior to 2008 is at present not anticipated.62
Consolidation is also currently taking place in some segments. Merger and takeover activities in 2011 relating to, for example, implantology and digital dental medicine confirm this.
Clear regional differences are also evident: whereas the market in Europe has become increasingly more
difficult, the US market appeared to be more or less unaffected by economic fluctuations in terms of the implant market.63 The European market is covered 6080% from the EU itself. The other significant supplier
countries are Switzerland, the USA and Japan. Markets within Europe also developed differently. While
sales figures in Germany barely changed (+1.1%), France recorded significant growth (+10.7%). On the
other hand, Great Britain (-1.9%) and,most significantly, Italy (-2.6%) suffered losses.64
France
20%
15%
Overall, however, opinion leaders in the dental market regard the influence of health policy to be considerably lower in the area of dentists/orthodontics than in other health markets (less than 70%) and, in contrast, estimate the significance of general economic development to be considerably greater.65
10%
5%
0%
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Source: WHO Global Health Expenditure Database, National Health Accounts. Retrieved on 23.08.2012
Relative to economic development, health expenditure in a majority of Western countries has risen slightly
in recent years, if only moderately in most countries like Germany, France and Austria. After the USA, the
highest expenditure is registered by Germany, the Netherlands, France and Switzerland. Health expenditure was consciously increased in England in recent years and has since drawn closer to the European
average. However, considerable cost-saving measures are currently being implemented again in the UK.
Fig. 20 Public health expenditure and expenditure for social insurance (2009)
Belgium
10.93%
64.65%
24.42%
6.74%
70.52%
22.73%
Germany
France
3.85%
73.72%
22.43%
Netherlands
8.53%
77.15%
14.32%
Austria
44.79%
32.34%
22.87%
Switzerland
18.95%
46.27%
34.78%
Denmark
15.44%
84.56%
Italy
21%
79%
Spain
no data
UK
8.9%
83.20%
Public expenditure (except social insurance)
Social insurance
7.9%
Private expenditure
Source: OECD Health data, 2012.
60 c f. CBI, 2009.
61 cf. VDDI, 2012.
62 cf. Straumann, 2012.
63 cf. Finanz und Wirtschaft, 18.08.2012.
64 cf. ADDE, 2012.
65 c f. Dental Tribune, 2011.
66 N ote: e.g. Denmark, Finland, Iceland, Ireland, Lithuania,
Malta, Norway, Sweden and the UK.
S7
34 | 35
SCHEDULE SEVEN
SOCIAL INSURANCE SYSTEMS IN DETAIL
Belgium
S7
Austria
France
Important stations
Germany
Netherlands
Switzerland
Belgium
36 | 37
Belgium
without assessment
neutral deviation
positive deviation
negative deviation
Changes in GDP rel. to last year _____________________________________________________________________________________________ 1.5 8% _________________________________ 1.90% _________________________ _____
Total health expenditure of GDP __________________________________________________________________________________________ 10.83% _________________________________ 10.7% _________________________ _____
Total health expenditure _____________________________________________________________________________________________________________________________________ 43,000,000,000 ___________________________________
Volume of the dental market
Percentage of total health expenditure for dental treatment _________________________________________________ 5.12% ________________________________ 2.20% _________________________ _____
Proportion of total health expenditure for dental treatment (calculated) _______________________________________________________________ 900,000,000 ___________________________________
Total sales value of dental market, minus software _________________________________________________________________________________________________ 128,000,000 ___________________________________
Total number of dental dealers ___________________________________________________________________________________________________________________________________________________ 60___________________________________
Dental practices using intra-oral cameras ____________________________________________________________________________ 38.13% ______________________________ 25.00% _________________________ _____
Total sales value of sundries ______________________________________________________________________________________________________________________________________ 78,000,000 ___________________________________
Total sales value of metal implants ____________________________________________________________________________________________________________________________ 12,000,000 ___________________________________
Total sales value of metal implants per 1,000 inhabitants ____________________________________________________ 2,635 ________________________________ 1,121 _________________________ _____
Main sources: OECD Health Data 2012. WHO (National Health Accounts), ADDE 2012 and others (see index in appendix).
Illustration, calculation and supplementary estimates: REBMANN RESEARCH.
The system
Political background
Federal democracy and constitutional monarchy. Capital: Brussels.
Approx. 65% of a population of about 10.7 million live in towns or cities.
Belgium is one of the most densely populated countries in the EU (349
inhabitants/km).
The birth rate has being increasing slightly again since the mid-2000s.
The insurance system
Obligatory social insurance system (Bismarck model) with predominantly
private providers. 99% of the population is insured.
Social health insurance consists of six private health insurance providers
(not-for-profit, but privately managed) and a public insurer. Insurance
contributions are income related, not risk related.
Two insurance schemes exist:
Major risks: hospital care, obstetrics, elective surgery, dialysis,
rehabilitation, implantations and consultant care.
Minor risks encompass medical consultations, dentist, minor surgery,
home care, medication in the outpatient sector. Self-employed persons
previously only insured for major risks are obliged to pay insurance for
both schemes since 2008.
Private insurance providers account for a small market share.
Organisation
A national health insurance institute administers the overall health system
and distributes funds to health insurance providers.
The national health insurance provider negotiates tariffs for two years at a
national level with representatives of doctors (and dentists). This convention must be signed by the health minister. All individual doctors must
then agree.
Physicians are free to practice as convention doctors or to apply their own
tariffs (lower remuneration). Individual contracts between insurance firms
and providers are not possible.
Patients are free to choose their doctor, hospital and insurance.
Funding
National social insurance covers approx. 67% of expenditure (2008).
Patients pay an additional amount of approx. 28% from private funds (additional payments and private insurance policies). 17% is covered by direct
payments, 9% through supplementary insurance and consumer taxes.
Fixed budgets for the health insurers were introduced in 1995 to attenuate
costs. Since then, health insurance firms endeavour to acquire cost-effective
care services.
Medical technology/Dental technology
The market volume for medical technology is approx. 3.6 billion (2009).
The demand for medical technology grows by around 3 to 4% per annum.
Around 300 medical engineering companies are registered in the Unamec
association, 250 of which are involved in sales and only 40 producing themselves.
Imports from Germany grew in 2009 by 21% to 400 million , and growth
rates of 12% were also recorded each year in 2010 and 2011.
About one quarter of all dental instruments and X-ray appliances originates
in Germany (Eurostat).
Recognisable trend towards aesthetic aspects of dental treatment:
above-average growth in, for example, ceramic inlays.
Dental care
Dentists
The majority of dentists work in private sole practices and are remunerated through a fee-for-service system. Numerous dentists restrict treatment
exclusively to private patients
Payroll expenditure for doctors is 27.8% of the budget and 2.8% for dentists.
Remuneration
Practically every service involves a deductible or additional payments with a
salary-based upper limit.
Dental services involving prevention and tooth extraction are remunerated
in full.
Orthodontics, prosthetics and further treatment are remunerated in line
with an agreed service catalogue.
Distinctive features
There is no fluoridation programme in Belgium
(as of 2008).
Sources
cf. EU Manual of Dental Practice, 2008, Belgium
cf. HiT Profile Belgium 2007 and 2010
Further information
Unamec professional association
Union Francophone des Laboratoires Dentaires
de Belgique; www.ufldb.be; (French-language
dental laboratories)
Unie van Dentaaltechnische Bedrijven;
www.udb.be; (Flemish dental laboratories)
Dentex; www.dentex.be; dental technology
fair held every two years in Brussels
Germany
38 | 39
Germany
without assessment
neutral deviation
positive deviation
negative deviation
Changes in GDP rel. to last year ______________________________________________________________________________________________ 1.58% _________________________________3.00% _________________________ _____
Total health expenditure of GDP __________________________________________________________________________________________ 10.83% _______________________________ 11.00% _________________________ _____
Total health expenditure ___________________________________________________________________________________________________________________________________ 307,400,000,000 ___________________________________
Volume of the dental market
Percentage of total health expenditure for dental treatment _________________________________________________ 5.12% _________________________________ 7.60% _________________________ _____
Proportion of total health expenditure for dental treatment (calculated) __________________________________________________________ 23,400,000,000 ___________________________________
Total sales value of dental market, minus software ______________________________________________________________________________________________ 2,308,000,000 ___________________________________
Total number of dental dealers __________________________________________________________________________________________________________________________________________________160___________________________________
Dental practices using intra-oral cameras ____________________________________________________________________________ 38.13% ______________________________ 62.00% _________________________ _____
Total sales value of sundries __________________________________________________________________________________________________________________________________ 1,178,000,000 ___________________________________
Total sales value of metal implants __________________________________________________________________________________________________________________________ 355,000,000 ___________________________________
Total sales value of metal implants per 1,000 inhabitants ____________________________________________________ 2,635 _______________________________ 4,366 _________________________ _____
Number of new dental X-ray units installed ____________________________________________________________________________________________________________________________ 4,100___________________________________
Number of new dental X-ray units installed per 1,000 inhabitants ___________________________________________ 0.07 __________________________________ 0.050 _________________________ _____
Funding
Percentage private expenditure of total expenditure for dental services ____________________________55.46% _______________________________25.90% _________________________ _____
Proportion private expenditure of total expenditure for dental services _____________________________________________________________ 6,050,000,000 ___________________________________
Dental health
Dental health of 12-year-olds (2010, in DMFT) ____________________________________________________________________________0.96 ____________________________________ 0.70 _________________________ _____
Density of market
Number of practicing physicians/doctors _________________________________________________________________________________________________________________________ 300,829___________________________________
Density of physicians (practicing physicians per 1,000 inhabitants) _________________________________________ 3.54 ____________________________________ 3.70 _________________________ _____
Number of practising dentists ______________________________________________________________________________________________________________________________________________ 67,808___________________________________
Density of dentists (practicing dentists per 1,000 inhabitants) _________________________________________________ 0.65 __________________________________ 0.834 _________________________ _____
Number of dental practices __________________________________________________________________________________________________________________________________________________46,670___________________________________
Density of dental practices (dental practices per 1,000 inhabitants) ________________________________________ 0.46 __________________________________ 0.574 _________________________ _____
Number of dental technicians ______________________________________________________________________________________________________________________________________________ 66,400___________________________________
Dental technician density (dentists per 1,000 inhabitants) _____________________________________________________ 0.33 __________________________________ 0.817 _________________________ _____
Total number of dental laboratories (dentists and commercial laboratories) ______________________________________________________________________ 19,595___________________________________
Dental laboratory density (dental laboratories per 1,000 inhabitants) ____________________________________ 0.11 __________________________________ 0.241 _________________________ _____
Dentists per dental laboratory ____________________________________________________________________________________________________7.45 ____________________________________ 3.46 _________________________ _____
Citizens per dental laboratory _______________________________________________________________________________________________ 12,490 ___________________________________4,149 _________________________ _____
Dental graduates per 100,000 inhabitants ________________________________________________________________________________ 1.88 ____________________________________ 2.55 _________________________ _____
Main sources: OECD Health Data 2012. WHO (National Health Accounts), ADDE 2012 and others (see index in appendix).
Illustration, calculation and supplementary estimates: REBMANN RESEARCH.
The system
Political background
Germany is a federal republic consisting of 16 federal states with a parliamentary democracy. The population density of a total of approximately
82 million inhabitants fluctuates strongly on a regional level. Falling birth
figures and growing life expectancy have led to a demographic change with
a strong increase in the share of the elderly population.
The insurance system
Public social insurance with insurance obligation up to an upper salary limit
(Bismarck model). Public health insurance currently consists of approx. 120
individual insurance providers (primary insurers (including local, company,
agricultural and trade association health insurance funds such as the BKK,
LKK or IKK open today to all) or substitute insurers). The state specifies the
framework conditions, while local self-administration (everybody involved
in care) is responsible for care.
Approx. 10% of the population is privately insured.
Organisation
Insured people can freely select doctors.
Contributions (practically split in half between the employee and employer)
are paid into the health fund. Insurers are allocated their funds from this via
a risk structure compensation scheme which is adjusted to take morbidity
into consideration.
The associations for panel doctors (and dentists) are responsible for ensuring
outpatient care.
Funding
Private expenditure arises as a result of supplementary insurance, private
health insurers, individual healthcare services and fees (e.g. prescription
fees). Contributions for private insurance policies cover approx. 8.8% of
overall expenditure for health.
Approx. 7.6% of all health care expenditure is for dental health.
Remuneration
Preventative checkups and dental treatment
for children and adolescents are covered in
Germany. Treatment by dentists is also covered.
Additional payments are necessary in particular
for dental prosthetics (generally 50%).
Dental services accounted for 5% (2.29 billion )
in the first quarter of 2012, with dental prosthetics accounting for 2% (0.79 billion ) of all public
health insurance services.
Distinctive features
69.2% of table salt is fluoridated.
Sources
cf. EU Manual of Dental Practice,
2008, Germany
cf. Rebmann B., 2012
cf. Saekel R., 2010
cf. Klingenberger, 2012
cf. Barmer GEK dental report, 2012
cf. ADDE, 2012
France
40 | 41
France
without assessment
neutral deviation
positive deviation
negative deviation
Changes in GDP rel. to last year ______________________________________________________________________________________________ 1.58% _________________________________ 1.70% _________________________ _____
Total health expenditure of GDP __________________________________________________________________________________________ 10.83% _______________________________ 11.90% _________________________ _____
Total health expenditure ____________________________________________________________________________________________________________________________________ 257,700,000,000 ___________________________________
Volume of the dental market
Percentage of total health expenditure for dental treatment _________________________________________________ 5.12% ________________________________ 4.50% _________________________ _____
Proportion of total health expenditure for dental treatment (calculated) ___________________________________________________________11,600,000,000 ___________________________________
Total sales value of dental market, minus software _______________________________________________________________________________________________ 1,013,000,000 ___________________________________
Total number of dental dealers __________________________________________________________________________________________________________________________________________________ 113___________________________________
Dental practices using intra-oral cameras ____________________________________________________________________________ 38.13%
The system
Political background
Independent republic with a bicameral parliament. A region consists of
commune and department levels with arrondissments. Of 63 million inhabitants, 1.7 million live overseas, with about 80% being urban dwellers.
Demographic ageing is less serious in France than in Germany, and the
birth rate is one of the highest in Europe.
The insurance system
Social health insurance system with centralised statutory health insurance,
increasingly tax-based revenues and a mixture of public and private care.
The national health insurance (Rgime gnral dassurance maladie) is
occupation-related, families are also insured and there is no exemption from
the insurance obligation.
Approx. 92% of the population have additional private insurance, as the
statutory insurance demands high additional payments. The Couverture
maladie universelle, through which those with a low income are now also
additionally insured, has been in existence since 2000.
Organisation
The National Assembly stipulates an annual (virtual) upper limit for health
insurance expenditure. Four expenditure types are divided into sectors: private practices, public clinics, private clinics, social health care.
Numbers of doctors, hospital beds and major equipment items
are centrally planned.
The decision-making autonomy of communes is increasing. The regional
health agencies (agence rgionale de sant) are responsible for the care and
budget of their populations beyond sector limits.
Funding
Health insurance covers approx. 3/4 of health expenditure.
Private funding consists of 12.5% for voluntary supplementary insurance
for additional payments and min. 11% copayment (e.g. contact lenses, aids
and appliances, dental treatment, medication). Private additional payments
exist for practically every service.
NETHERLANDS
42 | 43
Netherlands
without assessment
neutral deviation
positive deviation
negative deviation
Proportion of total health expenditure for dental treatment (calculated) ____________________________________________________________ 3,200,000,000 ___________________________________
Total sales value of dental market, minus software _________________________________________________________________________________________________ 266,000,000 ___________________________________
Total number of dental dealers ____________________________________________________________________________________________________________________________________________________27___________________________________
Dental practices using intra-oral cameras ____________________________________________________________________________ 38.13%
Total sales value of sundries ____________________________________________________________________________________________________________________________________ 155,000,000 ___________________________________
Total sales value of metal implants
Total sales value of metal implants per 1,000 inhabitants ____________________________________________________ 2,635
Number of new dental X-ray units installed ______________________________________________________________________________________________________________________________ 950___________________________________
Number of new dental X-ray units installed per 1,000 inhabitants ___________________________________________ 0.07 __________________________________ 0.057 _________________________ _____
Funding
Percentage private expenditure of total expenditure for dental services ____________________________55.46% ______________________________ 25.00% _________________________ _____
Proportion private expenditure of total expenditure for dental services ________________________________________________________________ 800,000,000 ___________________________________
Dental health
Dental health of 12-year-olds (2010, in DMFT) ____________________________________________________________________________0.96 ____________________________________ 0.90 _________________________ _____
Density of market
Number of practicing physicians/doctors ___________________________________________________________________________________________________________________________ 50,525___________________________________
Density of physicians (practicing physicians per 1,000 inhabitants) _________________________________________ 3.54 ____________________________________ 3.02 _________________________ _____
Number of practising dentists _________________________________________________________________________________________________________________________________________________7,119___________________________________
Density of dentists (practicing dentists per 1,000 inhabitants) _________________________________________________ 0.65 __________________________________ 0.426 _________________________ _____
Number of dental practices ___________________________________________________________________________________________________________________________________________________ 5,800___________________________________
Density of dental practices (dental practices per 1,000 inhabitants) ________________________________________ 0.46 __________________________________ 0.347 _________________________ _____
Number of dental technicians _________________________________________________________________________________________________________________________________________________ 4,100___________________________________
Dental technician density (dentists per 1,000 inhabitants) _____________________________________________________ 0.33 __________________________________ 0.245 _________________________ _____
Total number of dental laboratories (dentists and commercial laboratories) ________________________________________________________________________ 1,025___________________________________
Dental laboratory density (dental laboratories per 1,000 inhabitants) ____________________________________ 0.11 __________________________________ 0.061 _________________________ _____
Dentists per dental laboratory ____________________________________________________________________________________________________7.45 ____________________________________ 6.95 _________________________ _____
Citizens per dental laboratory _______________________________________________________________________________________________ 12,490 ________________________________ 16,322 _________________________ _____
Dental graduates per 100,000 inhabitants ________________________________________________________________________________ 1.88 ____________________________________ 0.73 _________________________ _____
Main sources: OECD Health Data 2012. WHO (National Health Accounts), ADDE 2012 and others (see index in appendix).
Illustration, calculation and supplementary estimates: REBMANN RESEARCH.
The system
Political background
The Netherlands has been a constitutional monarchy since 1815 with a
bicameral parliament. It is traditionally governed by coalition governments.
The Queen does not have any executive power.
The 16.7 million Dutch inhabit a confined country (population density: 450
people/km). About 20% of the population are from a migrant background;
40% are not members of any religion. Life expectancy is one of the highest
in the EU.
The insurance system
Private insurance has been brought into line with public health insurance
since 2006. The reform means that they no longer differ in terms of basic
coverage. All insurances can generate profits.
Since then, every inhabitant is insured for a basic package in a public/private health insurance, and nobody is entitled to refuse this.
A large proportion of the population has voluntary supplementary insurance (e.g. for dental treatment).
Organisation
Traditionally, the healthcare system was heavily regulated by the state. A
health fund exists since 2006. Funds are distributed to insurers through a
risk structure compensation scheme.
The Ministry of Health, Welfare and Sport is responsible for health policy
framework conditions.
Funding
Public health insurance revenues are evenly divided between incomerelated
contributions from insured persons and a fixed basic premium which insured persons pay directly to their insurance.
Private funding covers about 30% of health expenditure
(fees and private supplementary insurance).
Sources
Hit Country profile: 2004,
at a glance summary 2005
cf. Okma K. 2008
cf. Diewitz, M. 2011
cf. SVGB-rapport 2011
Further information
Dutch Journal of Dentistry http://english.ntvt.nl
German-Dutch Chamber of Commerce (AHK
Niederlande); http://Netherlands.ahk.de
Federatie van Technologiebranches (FHI);
www.fhi.nl
Federatie van Medische Technologie;
www.medischetechnologie.fhi.nl
Austria
44 | 45
Austria
without assessment
neutral deviation
positive deviation
negative deviation
Changes in GDP rel. to last year ______________________________________________________________________________________________ 1.58% _________________________________ 3.10% _________________________ _____
Total health expenditure of GDP __________________________________________________________________________________________ 10.83% _______________________________ 11.10% _________________________ _____
Total health expenditure _____________________________________________________________________________________________________________________________________ 36,400,000,000 ___________________________________
Volume of the dental market
Percentage of total health expenditure for dental treatment _________________________________________________ 5.12% _________________________________5.00% _________________________ _____
Proportion of total health expenditure for dental treatment (calculated) ____________________________________________________________ 1,800,000,000 ___________________________________
Total sales value of dental market, minus software _________________________________________________________________________________________________ 186,000,000 ___________________________________
Total number of dental dealers ___________________________________________________________________________________________________________________________________________________ 46___________________________________
Dental practices using intra-oral cameras ____________________________________________________________________________ 38.13% _______________________________15.00% _________________________ _____
Total sales value of sundries ____________________________________________________________________________________________________________________________________ 106,000,000 ___________________________________
Total sales value of metal implants ____________________________________________________________________________________________________________________________ 30,000,000 ___________________________________
Total sales value of metal implants per 1,000 inhabitants ____________________________________________________ 2,635 _______________________________ 3,559 _________________________ _____
Dental health
Number of new dental X-ray units installed per 1,000 inhabitants ___________________________________________ 0.07 __________________________________ 0.042 _________________________ _____
Funding
Percentage private expenditure of total expenditure for dental services ____________________________55.46% _______________________________39.60% _________________________ _____
Proportion private expenditure of total expenditure for dental services ________________________________________________________________ 720,000,000 ___________________________________
Dental health of 12-year-olds (2010, in DMFT) ____________________________________________________________________________0.96 ____________________________________ 1.40 _________________________ _____
Density of market
Number of practicing physicians/doctors ___________________________________________________________________________________________________________________________ 40,464___________________________________
Density of physicians (practicing physicians per 1,000 inhabitants) _________________________________________ 3.54 ____________________________________ 4.80 _________________________ _____
Number of practising dentists ________________________________________________________________________________________________________________________________________________ 4,150___________________________________
Density of dentists (practicing dentists per 1,000 inhabitants) _________________________________________________ 0.65 __________________________________ 0.492 _________________________ _____
Number of dental practices ____________________________________________________________________________________________________________________________________________________3,790___________________________________
Density of dental practices (dental practices per 1,000 inhabitants) ________________________________________ 0.46 ____________________________________ 0.45 _________________________ _____
Number of dental technicians ________________________________________________________________________________________________________________________________________________ 2,850___________________________________
Dental technician density (dentists per 1,000 inhabitants) _____________________________________________________ 0.33 __________________________________ 0.338 _________________________ _____
Total number of dental laboratories (dentists and commercial laboratories) __________________________________________________________________________ 650___________________________________
Dental laboratory density (dental laboratories per 1,000 inhabitants) ____________________________________ 0.11 __________________________________ 0.077 _________________________ _____
Dentists per dental laboratory ____________________________________________________________________________________________________7.45 ____________________________________ 6.38 _________________________ _____
Citizens per dental laboratory _______________________________________________________________________________________________ 12,490 ________________________________ 12,969 _________________________ _____
Dental graduates per 100,000 inhabitants ________________________________________________________________________________ 1.88 ____________________________________ 1.60 _________________________ _____
Main sources: OECD Health Data 2012. WHO (National Health Accounts), ADDE 2012 and others (see index in appendix).
Illustration, calculation and supplementary estimates: REBMANN RESEARCH.
The system
Political background
A democracy, Austria is a federal republic consisting of nine federal states.
Of a population of 8.4 million, approx. 68% lives in towns and cities. Population growth is 5%, and the proportion over 65 years of age is increasing
(2010: 17.7%). Per capita health expenditure is around 1,100 US$ above the
OECD average, with life expectancy 1.3 years below.
The insurance system
Statutory accident and health insurance exists, as is the case in Germany.
Around 98% of the population has occupational health insurance. Consequently, there is no competition between insurance providers. The 21 providers of the public health insurance scheme are organised in the federation
of Austrian social insurers (Hauptverband der sterreichischen Sozialversicherungstrger).
About a third of the population has additional private insurance, mainly for
inpatient care (82%), private outpatient treatment (10%) and dental prosthetics. Approx. 5% of patients have supplementary dental insurance. The
seven private health insurers are organised in the association of insurance
companies (Verband der Versicherungsunternehmen sterreichs).
Health insurance contributions are income-related, with 50 % being covered
by the employer.
Organisation
Organisation and funding of the healthcare system is generally determined
in financial compensation negotiations between the federal government and
the governments of the federal states, with negotiations held once in each
legislative period (a binding agreement).
Detail planning and implementation of the Austrian structural plan for
health (SG) is realised at federal state level through health platforms.
Insured people can freely select doctors.
Funding
Social health insurance and taxes cover approx. 70% of overall health
expenditure, with private households covering approx. 30%.
Almost all services involve additional payments.
Switzerland
46 | 47
Switzerland
without assessment
neutral deviation
positive deviation
negative deviation
Total sales value of dental market, minus software _________________________________________________________________________________________________ 120,000,000 ___________________________________
Total number of dental dealers ___________________________________________________________________________________________________________________________________________________ 22___________________________________
Dental practices using intra-oral cameras ____________________________________________________________________________ 38.13% ______________________________ 53.00% _________________________ _____
Total sales value of sundries _______________________________________________________________________________________________________________________________________71,000,000 ___________________________________
Total sales value of metal implants ______________________________________________________________________________________________________________________________ 9,000,000 ___________________________________
Total sales value of metal implants per 1,000 inhabitants ____________________________________________________ 2,635 ________________________________ 1,176 _____________________________ _____
Number of new dental X-ray units installed
Number of new dental X-ray units installed per 1,000 inhabitants ___________________________________________ 0.07
Funding
Percentage private expenditure of total expenditure for dental services ____________________________55.46% _______________________________91.00% _________________________ _____
Proportion private expenditure of total expenditure for dental services _____________________________________________________________ 3,230,000,000 ___________________________________
Dental health
Dental health of 12-year-olds (2010, in DMFT) ____________________________________________________________________________0.96 ____________________________________ 0.80 _________________________ _____
Density of market
Number of practicing physicians/doctors ____________________________________________________________________________________________________________________________29,089___________________________________
Density of physicians (practicing physicians per 1,000 inhabitants) _________________________________________ 3.54 ____________________________________ 3.80 _________________________ _____
Number of practising dentists _______________________________________________________________________________________________________________________________________________ 4,590___________________________________
Density of dentists (practicing dentists per 1,000 inhabitants) _________________________________________________ 0.65 ____________________________________ 0.60 _________________________ _____
Number of dental practices ____________________________________________________________________________________________________________________________________________________ 3,969___________________________________
Density of dental practices (dental practices per 1,000 inhabitants) ________________________________________ 0.46 __________________________________ 0.518 _________________________ _____
Number of dental technicians _________________________________________________________________________________________________________________________________________________ 2,100___________________________________
Dental technician density (dentists per 1,000 inhabitants) _____________________________________________________ 0.33 __________________________________ 0.274 _________________________ _____
Total number of dental laboratories (dentists and commercial laboratories) ___________________________________________________________________________962___________________________________
Dental laboratory density (dental laboratories per 1,000 inhabitants) ____________________________________ 0.11 ___________________________________0.126 _________________________ _____
Dentists per dental laboratory ____________________________________________________________________________________________________7.45 ____________________________________ 4.77 _________________________ _____
Citizens per dental laboratory _______________________________________________________________________________________________ 12,490 ___________________________________7,957 _________________________ _____
Dental graduates per 100,000 inhabitants ________________________________________________________________________________ 1.88 ____________________________________ 1.36 _________________________ _____
Main sources: OECD Health Data 2012. WHO (National Health Accounts), ADDE 2012 and others (see index in appendix).
Illustration, calculation and supplementary estimates: REBMANN RESEARCH.
The system
Political background
Since 1848, Switzerland has been a democratic federal state with 26 cantons
and semi-direct consociational democracy. About 7.7 million people live
in Switzerland. 188 inhabitants per km make Switzerland one of the more
densely populated countries in Europe. Birth figures fell between the 1970s
and 2001 and the population shrank. The life expectancy of women/men is
84.5/80.1 and, consequently, one of the highest in the world.
The insurance system
The Swiss healthcare system is a social insurance system with market
economic elements. Obligatory basic insurance for every Swiss citizen
(Obligatorische Krankenpflegeversicherung, OKP) covers nationally defined
services for acute care and nursing.
Alternative insurance models (AVM/managed care) can also be selected
since 1996, these being offered jointly by service providers and insurers and
involving a limited selection of doctors. About half of the Swiss opted in
favour of this system.
Organisation
It is one of the worlds most expensive health systems.
Funding
The Swiss health system is funded to approx. 40.8% from social insurance
contributions and around 20% through public subsidies (in part from taxes).
Private cost sharing (franchise and deductible) and cash expenditure for
services account for approx. 30.5%. Contributions from private health
insurance and supplementary insurance are approx. 9.8%.
Medical technology/Dental technology
The dental market is crisis resistant. Straumann and Nobel Biocare Holding
are two of the worlds leading companies in dental prosthetics.
In Switzerland, increased pricing and cost pressure and the growth in
competition on an international level has also led to a change in focus from
product innovations to profitability.
Distinctive features
Swiss purchasers of dental and other medical technology particularly value innovative
technologies and products which are durable
in terms of quality and offer a long service life.
Patients rely greatly on the advice of the doctor
(or dentist) treating them in this respect.
People are acutely aware of the value of
high-quality care.
Similar to in Germany, an annual appointment
for dental hygiene treatment is usual in Switzerland in order to try to retain ones own teeth for
as long as possible.
Where an inlay or crown is necessary, the majority of Swiss opt for ceramic.
Customs clearance is necessary when shipping
dental technology products from Germany to
customers in Switzerland, but this is normally realised without any difficulties. Added to
the net value of goods (the invoice should not
contain any German value added tax) is Swiss
(import) value added tax which is 8% for medical technology products.
Fluoridation is only realised in salt,
not in drinking water or milk
Sources
cf. EU Manual of Dental Practice: Version 4,
2008, Switzerland
cf. Gerlinger T., 2003
cf. Implantat Stiftung Switzerland, 2009
Forum Managed Care, www.FMC.ch
S8
48 | 49
SCHEDULE EIGHT
PUBLIC/STATE HEALTH SYSTEMS IN DETAIL
Denmark
S8
Spain
Important stations
Italy
United Kingdom
Denmark
50 | 51
Denmark
without assessment
neutral deviation
positive deviation
negative deviation
Changes in GDP rel. to last year ______________________________________________________________________________________________ 1.58% _________________________________ 1.10% _________________________ _____
Total health expenditure of GDP __________________________________________________________________________________________ 10.83% _______________________________ 11.40% _________________________ _____
Total health expenditure ______________________________________________________________________________________________________________________________________29,700,000,000 ___________________________________
Volume of the dental market
Percentage of total health expenditure for dental treatment _________________________________________________ 5.12% ________________________________ 4.30% _________________________ _____
Proportion of total health expenditure for dental treatment (calculated) ____________________________________________________________ 1,300,000,000 ___________________________________
Total sales value of dental market, minus software ____________________________________________________________________________________________________51,000,000 ___________________________________
Total number of dental dealers ___________________________________________________________________________________________________________________________________________________ 40___________________________________
Dental practices using intra-oral cameras ____________________________________________________________________________ 38.13% ______________________________ 45.00% _________________________ _____
Total sales value of sundries
Total sales value of metal implants
Total sales value of metal implants per 1,000 inhabitants ____________________________________________________ 2,635
Proportion private expenditure of total expenditure for dental services ________________________________________________________________ 900,000,000 ___________________________________
Dental health
Dental health of 12-year-olds (2010, in DMFT) ____________________________________________________________________________0.96 ____________________________________ 0.60 _________________________ _____
Density of market
Number of practicing physicians/doctors ____________________________________________________________________________________________________________________________ 19,401___________________________________
Density of physicians (practicing physicians per 1,000 inhabitants) _________________________________________ 3.54 ____________________________________ 3.50 _________________________ _____
Number of practising dentists _______________________________________________________________________________________________________________________________________________ 4,580___________________________________
Density of dentists (practicing dentists per 1,000 inhabitants) _________________________________________________ 0.65 __________________________________ 0.826 _________________________ _____
Number of dental practices ___________________________________________________________________________________________________________________________________________________ 3,080___________________________________
Density of dental practices (dental practices per 1,000 inhabitants) ________________________________________ 0.46 __________________________________ 0.556 _________________________ _____
Number of dental technicians _________________________________________________________________________________________________________________________________________________ 1,700___________________________________
Dental technician density (dentists per 1,000 inhabitants) _____________________________________________________ 0.33 __________________________________ 0.307 _________________________ _____
Total number of dental laboratories (dentists and commercial laboratories) __________________________________________________________________________ 450___________________________________
Dental laboratory density (dental laboratories per 1,000 inhabitants) ____________________________________ 0.11 __________________________________ 0.081 _________________________ _____
Dentists per dental laboratory ____________________________________________________________________________________________________7.45 ___________________________________10.18 _________________________ _____
Citizens per dental laboratory _______________________________________________________________________________________________ 12,490 ________________________________ 12,318 _________________________ _____
Dental graduates per 100,000 inhabitants ________________________________________________________________________________ 1.88 ____________________________________ 2.54 _________________________ _____
Main sources: OECD Health Data 2012. WHO (National Health Accounts), ADDE 2012 and others (see index in appendix).
Illustration, calculation and supplementary estimates: REBMANN RESEARCH.
The system
Political background
Denmark is a constitutional monarchy and EU member state since 1973.
Approx. 85% of the 5.5 million inhabitants are urban dwellers, with 30% of
these living in the greater Copenhagen area. The average life expectancy at
the end of the last century was lower than the EU average, but then improved
rapidly to exceed the average.
2.1% (15.5%) is private (additional payments, fees and voluntary supplementary insurance). Cost increases occurprimarily in the inpatient sector.
Approx. 9% of all public health expenditure and 4.3% of all health
expenditure is for dental health.
Organisation
Local authorities and county councils have been responsible for the health
system since 1970. These have to present a plan for coordination of all preventive and curative activities every four years. In addition, budget negotiations
are held every year at different administrative levels.
Local authorities are responsible for inpatient care and fund outpatient
care. They provide nursing homes and local authority dentists who also
visit disabled patients at home. 2% of public expenditure is utilised for local
authority dentists.
Funding
There has been a health tax since 2007 which covers around 80% of the entire
budget. Of the approx. 9.9% of gross domestic product (2008) for health
expenditure,
7.8% (84%) is public expenditure,
Dental services
Dental services are mainly privately remunerated, or about fifty per cent is
paid through supplementary insurance.
Dental treatment for children up to the age of 18 is provided free of
charge through the local community-based dental service (or by private
practices remunerated by it). There is also a school-based prevention
programme. Around 253 million is expended for this purpose.
Basic dental care such as examinations, fillings and periodontology is
Italy
52 | 53
ITALY
without assessment
neutral deviation
positive deviation
negative deviation
Changes in GDP rel. to last year ______________________________________________________________________________________________ 1.58% ________________________________ 0.40% _________________________ _____
Total health expenditure of GDP __________________________________________________________________________________________ 10.83% _________________________________ 9.50% _________________________ _____
Total health expenditure ___________________________________________________________________________________________________________________________________ 163,700,000,000 ___________________________________
Volume of the dental market
Percentage of total health expenditure for dental treatment _________________________________________________ 5.12% ________________________________ 6.56% _________________________ _____
Proportion of total health expenditure for dental treatment (calculated) __________________________________________________________ 10,736,000,000 ___________________________________
Total sales value of dental market, minus software _______________________________________________________________________________________________ 1,127,000,000 ___________________________________
Total number of dental dealers _________________________________________________________________________________________________________________________________________________ 355___________________________________
Dental practices using intra-oral cameras ____________________________________________________________________________ 38.13% ______________________________ 33.00% _________________________ _____
The system
Political background
Italy has been a parliamentary republic since 1948 with a bicameral parliament (House of Representatives and Senate). Since the mid-90s, Italy may
be considered to be a federal state consisting of 20 regions and 94 provinces
with broad financial autonomy.
Italy has the lowest birth rate in the world (1.2) and a steadily increasing life
expectancy. The proportion of the population over 65 years of age is growing.
The insurance system
The National Health System (NHS) has existed since 1978, is accessible to
every citizen and aims to guarantee the same services for all. It has since
been reformed and restructured on several occasions (1992 pro-competition
reform, complete reorganisation in 1998).
The system is predominantly funded through taxes. National health insurance has been replaced at a national level through a taxed-based national
solidarity fund which offsets regional differences.
Providers of care are either employees of the NHS or work in private
practices/clinics.
Organisation
Central government is responsible for the passage of the national health plan
(every three years), allocation of funding and the definition of guidelines
(clinical and for accreditation).
The regions are responsible for implementing the plan and quality control.
Planning and management of local health centres and public
and private clinics.
Funding
Funding of the National Health Service has been almost completely covered
since the beginning of the millennium through regional (value added) taxes.
Public funding covers approx. 3/4 of overall expenditure. Private funding
(about one quarter of total expenditure) consists of additional payments for
medication, diagnostics and consultant visits, direct payments for services
from private providers and private insurance contributions.
Dental service
In general, dental services are not covered by the
NHS and also rarely provided through the public
health service.
A maximum of 8% of services is provided
through the NHS. These principally involve
emergency treatment.
Sources
cf. HiT -Country Profile Italy 2009,
at a glance summary 2001
cf. Breuer, S., 2011
cf. CERGAS, 2008
cf. EU Manual of Dental Practice: version 4,
2008, Italy
Further information
Italian Dental Yearbook,
www.dentaldirectory.it
SPAIN
54 | 55
SPAIN
without assessment
neutral deviation
positive deviation
negative deviation
With average dental health expenditure and density of dentists, the dental health of adolescents is
among the worst in Europe.
Changes in GDP rel. to last year ______________________________________________________________________________________________ 1.58% _________________________________ 0.70% _________________________ _____
Total health expenditure of GDP __________________________________________________________________________________________ 10.83% _________________________________ 9.50% _________________________ _____
Total health expenditure ____________________________________________________________________________________________________________________________________ 111,300,000,000 ___________________________________
Volume of the dental market
Percentage of total health expenditure for dental treatment _________________________________________________ 5.12% _________________________________5.00% _________________________ _____
Proportion of total health expenditure for dental treatment (calculated) ____________________________________________________________ 5,600,000,000 ___________________________________
Total sales value of dental market, minus software _________________________________________________________________________________________________ 486,000,000 ___________________________________
Total number of dental dealers _________________________________________________________________________________________________________________________________________________ 350___________________________________
Dental practices using intra-oral cameras ____________________________________________________________________________ 38.13% ______________________________ 32.00% _________________________ _____
Total sales value of sundries ____________________________________________________________________________________________________________________________________ 209,000,000 ___________________________________
Total sales value of metal implants __________________________________________________________________________________________________________________________ 180,000,000 ___________________________________
Total sales value of metal implants per 1,000 inhabitants ____________________________________________________ 2,635 _______________________________ 3,826 _________________________ _____
Number of new dental X-ray units installed ___________________________________________________________________________________________________________________________ 3,600___________________________________
Number of new dental X-ray units installed per 1,000 inhabitants ___________________________________________ 0.07 __________________________________ 0.077 _________________________ _____
Funding
Percentage private expenditure of total expenditure for dental services ____________________________55.46% _______________________________ 97.20% _________________________ _____
Proportion private expenditure of total expenditure for dental services ______________________________________________________________5,410,000,000 ___________________________________
Dental health
Dental health of 12-year-olds (2010, in DMFT) ____________________________________________________________________________0.96 ____________________________________ 1.30 _________________________ _____
Density of market
Number of practicing physicians/doctors __________________________________________________________________________________________________________________________ 192,872___________________________________
Density of physicians (practicing physicians per 1,000 inhabitants) _________________________________________ 3.54 _____________________________________4.10 _________________________ _____
Number of practising dentists ______________________________________________________________________________________________________________________________________________ 27,000 ___________________________________
Density of dentists (practicing dentists per 1,000 inhabitants) _________________________________________________ 0.65 __________________________________ 0.574 _________________________ _____
Number of dental practices _________________________________________________________________________________________________________________________________________________ 18,500___________________________________
Density of dental practices (dental practices per 1,000 inhabitants) ________________________________________ 0.46 __________________________________ 0.393 _________________________ _____
Number of dental technicians _______________________________________________________________________________________________________________________________________________ 15,700___________________________________
Dental technician density (dentists per 1,000 inhabitants) _____________________________________________________ 0.33 __________________________________ 0.334 _________________________ _____
Total number of dental laboratories (dentists and commercial laboratories) _______________________________________________________________________ 4,800___________________________________
Dental laboratory density (dental laboratories per 1,000 inhabitants) ____________________________________ 0.11 ___________________________________0.102 _________________________ _____
Dentists per dental laboratory ____________________________________________________________________________________________________7.45 ____________________________________ 5.63 _________________________ _____
Citizens per dental laboratory _______________________________________________________________________________________________ 12,490 __________________________________ 9,800 _________________________ _____
Dental graduates per 100,000 inhabitants ________________________________________________________________________________ 1.88 ____________________________________ 3.08 _________________________ _____
Main sources: OECD Health Data 2012. WHO (National Health Accounts), ADDE 2012 and others (see index in appendix).
Illustration, calculation and supplementary estimates: REBMANN RESEARCH.
The system
Political background
Spain is a constitutional hereditary monarchy with a bicameral parliament
(the Cortes). With a population of about 47 million, the country is divided
into 17 autonomous regions which each have their own directly elected governments. Regional tongues in Catalonia, the Basque Country and Galicia
have the status of official languages in addition to the state language of
Spanish, which is also known as Castilian. Linguistic and cultural variety
has been anchored in the Spanish constitution since 1978.
The insurance system
A state health system in which almost the entire population (approx. 95%)
is insured. All employees, the unemployed, pensioners, the disabled and
destitute persons are insured. Families are co-insured.
Approx. 15% have private supplementary insurance (inparticular the
self-employed and public servants and for dental care).
Organisation
17 autonomous regions are responsible for health care and compile a health
plan. The government defines regional budgets and determines prices for
the services provided. The service catalogue is defined by the Ministry of
Employment and Social Security.
There are around 2900 regional health centres and over 10,000 medical
practices for primary care where patients must register themselves.
INSALUD, the national health institute, administers a large proportion of
healthcare services.
Funding
About 75% of health expenditure comes from public funding, meaningtaxes (the majority of which are levied centrally). The universal contribution for
social security (employee 23.6%, employer 4.7%) includes health insurance,
old age pensions and invalidity pensions.
Around 25% of health expenditure involves private spending which
primarilyarises in the form of tax contributions (for the national health
service) and, to a lesser degree, contributions for voluntary supplementary
insurance.
Remuneration
Dental treatment is only covered in the context
of emergency treatment (tooth extraction).
State supplementary insurance exists for public
servants and comparable private insurance policies which cover examinations, extractions and
prophylaxis services. Only 18% of the population chooses comprehensive private supplementary insurance.
Distinctive features
According to the WHO World Health Report
2000, Spain had the 7th best health system in the
world.
Dental care
Dentists
The majority of health centres (ambulatorios or centros de salud) have
dentists who provide emergency care, extractions and prevention. There are
about 0.5 dentists per 1000 inhabitants.
Emergency care is also provided in clinics. Waiting times are
a problem here.
There are numerous private practices where remuneration is on a fee-forservice basis. Prices are considerably lower than in the UK. A checkup costs
around 10 , a filling about 4050 .
Sources
cf. Infodent, 2010
cf. ICEX 2009
cf. International Health Systems,
www.Kaiseredu.org
cf. Hit Country profile Spain, 2008
UNited
Kingdom
56 | 57
UNITED KINGDOM
without assessment
neutral deviation
positive deviation
negative deviation
Proportion of total health expenditure for dental treatment (calculated) ____________________________________________________________ 8,000,000,000 ___________________________________
Total sales value of dental market, minus software _________________________________________________________________________________________________ 424,000,000 ___________________________________
Total number of dental dealers ___________________________________________________________________________________________________________________________________________________ 58___________________________________
Dental practices using intra-oral cameras ____________________________________________________________________________ 38.13% ______________________________ 40.00% _________________________ _____
Total sales value of sundries _____________________________________________________________________________________________________________________________________ 287,000,000 ___________________________________
Total sales value of metal implants ____________________________________________________________________________________________________________________________ 42,000,000 ___________________________________
Total sales value of metal implants per 1,000 inhabitants ____________________________________________________ 2,635 __________________________________ 671 _________________________ _____
Number of new dental X-ray units installed ______________________________________________________________________________________________________________________________ 350___________________________________
Number of new dental X-ray units installed per 1,000 inhabitants ___________________________________________ 0.07 __________________________________ 0.046 _________________________ _____
Funding
Percentage private expenditure of total expenditure for dental services ____________________________55.46% ______________________________ 55.00% _________________________ _____
Proportion private expenditure of total expenditure for dental services ______________________________________________________________4,410,000,000 ___________________________________
Dental health
Dental health of 12-year-olds (2010, in DMFT) ____________________________________________________________________________0.96 ____________________________________ 0.70 _________________________ _____
Density of market
Number of practicing physicians/doctors __________________________________________________________________________________________________________________________ 175,280___________________________________
Density of physicians (practicing physicians per 1,000 inhabitants) _________________________________________ 3.54 ____________________________________ 2.80 _________________________ _____
Number of practising dentists ______________________________________________________________________________________________________________________________________________29,865___________________________________
Density of dentists (practicing dentists per 1,000 inhabitants) _________________________________________________ 0.65 __________________________________ 0.474 _________________________ _____
Number of dental practices __________________________________________________________________________________________________________________________________________________ 11,737___________________________________
Density of dental practices (dental practices per 1,000 inhabitants) ________________________________________ 0.46 ___________________________________0.187 _________________________ _____
Number of dental technicians _________________________________________________________________________________________________________________________________________________ 7,121___________________________________
Dental technician density (dentists per 1,000 inhabitants) _____________________________________________________ 0.33 ___________________________________ 0.114 _________________________ _____
Total number of dental laboratories (dentists and commercial laboratories) _______________________________________________________________________ 2,390___________________________________
Dental laboratory density (dental laboratories per 1,000 inhabitants) ____________________________________ 0.11 __________________________________ 0.038 _________________________ _____
Dentists per dental laboratory ____________________________________________________________________________________________________7.45 __________________________________ 12.50 _________________________ _____
Citizens per dental laboratory _______________________________________________________________________________________________ 12,490 ________________________________ 26,192 _________________________ _____
Dental graduates per 100,000 inhabitants ________________________________________________________________________________ 1.88 _________________________________________________________________________________
Main sources: OECD Health Data 2012. WHO (National Health Accounts), ADDE 2012 and others (see index in appendix).
Illustration, calculation and supplementary estimates: REBMANN RESEARCH.
The system
Political background
The United Kingdom of Great Britain and Northern Ireland (UK) consists of
four countries: England, Scotland, Wales (together known as Great Britain)
and Northern Ireland. Approximately 90% of the around 62 million inhabitants are urban dwellers.
Around 80% of the entire budget of all public hospitals and doctors practices will be administered in future through a few hundred Clinical Commissioning Boards. GP consortiums will be obliged to personally purchase the
services required by their patients through these.
The overall budget is determined for three years in each case (spending
review). It was doubled in recent years (1997: 55.1 billion 2009/10:
approx. 100 billion ), but now massive savings are to be made.
Funding
The NHS is primarily funded through taxes (> 80%).
Private health insurance policies are concluded with increasing frequency.
In 2009, 3.2% (3.1 billion ) of all NHS expenditure was spent on dental
care. The private market is estimated to be around another 3 billion .
Organisation
The Department of Health is responsible for strategic and policy planning
in the NHS. The system has a regional hierarchy: regional organisations
(Health Authorities) are responsible in constantly changing forms for local
health care. Financial restrictions and inefficiencies (waiting lists) have
resulted in the NHS being repeatedly reformed.
The latest reform, the Health and Social Care Bill 2011, aims to achieve the
most comprehensive restructuring of the NHS ever. The main targets are the
strengthening of general practitioners through direct financial responsibility for regional care and increased competition between private and public
providers.
Dental care
Dentists
The majority of dentists are self-employed and treat patients within and
outside the NHS, with increasingly more services being provided in the
private sector (about 60% of dental earnings). This creates regional supply
bottlenecks.
Dentists, like GPs, are primary care professionals whose services are provided through local trusts, although private care is also possible.
Of around 30,000 dentists, approx. 22,000 in basic care worked in private
practices in 2010, with of these being paid through the general dental
services contract.
In addition to this, specialised care is provided in clinics.
Community dentists are employees and responsible for care.
List of references
ADDE (2012): (Association of Dental Dealers
in Europe) and FIDE (The Federation of the
European Dental Industry): 2012 SURVEY on the
European Dental Trade (Market Trends).
(Note: acc. to the authors, data is based in part on
different national data which has been compiled
and, in part, on estimations)
Abele, E. (2011): Dentaltechnik der Zukunft,
Leitmarkt fr Medizinprodukte Made in
Germany; Metav Presseforum am 24.11.2011.
Institut fr Produktionsmanagement Technologie und Werkzeugmaschinen. (see www.
metav.de/cipp/md_metav/lib/all/lob/return_download,ticket,g_u_e_s_t/bid,579/
check_table,it_chap_downl_embed/~/METAV_
Presseforum_Prof_Abele_Dentaltechnik_der_
Zukunft_Praesentation.pdf)
Achermann, G. (Straumann 2012): How will dentistry look in 2020? Presentation: Capital Markets
Day. Amsterdam, May 2012.
AHK: Deutsche Auslandshandelskammer: AHK
Vereinigtes Knigreich; (http://grossbritannien.
ahk.de); AHK Netherlands; (http://Netherlands.
ahk)
Bachner, F., Ladurner, J., et.al. (2012): Das Austriaische Gesundheitswesen im internationalen
Vergleich, Ausgabe 2011. Gesundheit Austria
GmbH. May 2012
Barmer GEK Zahnreport (2012): ISEG Institut
Hannover. Schriftenreihe zur Gesundheitsanalyse, Band 13, Auswertungen des Jahres 2010.
Breuer, S. (2011): Branche kompakt: Medizintechnik Italy, 2011; Germany Trade and Invest;
Milan; 12/2011
58 | 59
Implantat Stiftung Switzerland (2009): Einkaufspreise von Zahnimplantaten fr die Switzerlander Dentists Preisvergleich mit Germany, Austria, France, Italy und den USA. Bern, Dezember
2009 (www.implantatstiftung.ch/kosten.html)
Infodent International 1/2010: Focus on Spain.
FENIN Spanish Federation of Health Care
Technology Companies (Website: www.fenin.es)
Kaufhold, R., Schneider, M. (2000): Preisvergleich
zahnrztlicher Leistungen im europischen Kontext; IDZ-Information 1/2000
Kaiseredu.org: International Health Systems (see
www.kaiseredu.org/Issue-Modules/International-Health-Systems/Spain.aspx, Abgerufen Nov.
11, 2012)
Klein, R. (2006): The troubled transformation of
Britains National Health Service. N Engl J Med.
2006 July 27; 355 (4): 409-15.
Klingenberger, D., Ostwald, D., Daume, P., Petri,
M., Micheelis, W. (2012): Wachstums- und
Beschftigungseffekte der Mundgesundheitswirtschaft, Institut der Deutschen Dentists IDZ, Band
33, 2012
Knig, J., Holtfreter, B., Kocher, T. (2010): Periodontal health in Europe: future trends based on
treatment needs and the provision of periodontal
services position paper 1, European Journal of
Dental Education ISSN 1396-5883, 2010
Kossioni, A. (2012): Is Europe prepared to meet
the oral health needs of older people? 2011 The
Gerodontology Society and John Wiley & Sons
A/S, Gerodontology 2012; 29
Market Research.com (2012): www.marketresearch.com/ (siehe unter (> Life Sciences > Medical
Devices > Dental Equipment)
Matthews, R. (2007): A Healthy Market? The
European dental market: braced for change?
Stockholm Network, 2007
FURTHER Information
www.ids-cologne.de/en/ids/presse/index.php
GFDI Gesellschaft zur Frderung der Dental-Industrie mbH
Aachener Strasse 1053-1055
50858 Kln
Germany
Tel.: +49-(0)221-500687-0
Fax: +49-(0)221-500687-21