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Dental Treatment Stomatology calls for changes
Maciej Nowak
Polish stomatology financed by tax payers from public funds is bound to collapse. Chronic long-lasting underfunding and underestimation of dental services costs have even drastically grown in recent months especially due to a decline in the exchange rate of Polish zloty against euro and a rise in prices of energy sources.
Unfortunately, dental basic benefit package does not fulfil current epidemiological and demographic needs and requirements of Polish society. The procedures and services it covers enable only relieving pain and treating some symptoms of stomatognathic system diseases. When it comes to diagnostics, refunding actually includes just two intraoral radiograms of teeth per year.
Epidemiological data on oral cavity health condition of Polish people are alarming. Soon we may become a toothless society, not to mention the negative influence of many oral cavity and tooth diseases on general health state (focal infections, lower birth weight of babies, preterm deliveries).
Although the Ministry of Health together with the Health Technology Assessment Agency (Agencji Oceny Technologii Medycznych - AOTM) are intensively working on basic benefit packages for all medical disciplines, stomatology as a whole has been excluded from these works. A new project of dental basic benefit package submitted for social consultancy includes the same services and the same rules for providing them as the one in force at present. Moreover, oral cavity diseases treatment and prophylaxis have not been included in a ministerial project of health priorities even for adolescent patients (!).
The National Health Fund (Narodowy Funusz Zdrowia - NFZ) in its project of the financial plan for 2010 assumes a decrease in funds for dental care by about 132 mln zlotys compared to the present year. What is interesting is that the financing level is different in different regional departments of the National Health Fund. Percentage share of funds for dental care in the departments' budgets ranges from 4,39 % in Warmińsko-Mazurski Regional Department (Warmińsko-Mazurski OW NFZ) to 2,73% in Mazowiecki one (Mazowiecki OW NFZ).
It may result from differences in costs of rendering dental services depending on the region. Unfortunately, the National Health Fund has never provided the public opinion with the financial analyses they own and concerning the way in which valuation of dental services in particular regions is made and all the elements which make up their final costs and which include for example material costs, dentist's work time, energy costs, dental surgery maintenance, equipment depreciation and so on.
Having economic crisis, forecast increase in unemployment and GDP decrease in 2010 in mind we rather cannot expect an increase in private expenditures on dental care.
From the signals that reach us we know that the National Health Fund has intensified controls of contracts performance in order to gain additional financial resources. The controls are aimed at imposing extremely high pecuniary penalties on medical services providers in a situation when such a control reveals even relatively petty irregularities like askew hung required notices with information for patients, small accounting mistakes or, according to inspectors, lacks in medical documentation.
It seems that a dentist will have to bear costs of financial shortages in Polish health care system and inadequate construction of dental basic benefit package. We cannot agree to it. The whole environment ought to demand radical changes which might be multidirectional and not necessarily have to be connected with reaching for the funds designed for other branches of medicine.
A few years ago health care physicians set up Zielonogórskie Agreement (Porozumienie Zielonogórskie). It turned out to be strong and powerful enough to carry out big system changes. It proves it is unity that gives power and which Polish dentists lack so much now.
The author is a doctor of medical science