15(40)
4
Institutional setting and data
Dental care in Sweden is provided through both private clinics and the
Swedish Public Dental Service, which is the county councils’
15
dental care
organization. The majority (60–80%) of dental care for individuals aged
20 and above
16
is supplied by private clinics. Patients can freely choose
either public or private clinics as providers and price setting is free.
The Swedish dental care system was reformed in 2008. The system now
contains a general dental care subsidy, which applies to all citizens aged
20 years and above, and a high-cost protection plan. The size of the
subsidy covers preventive dental care and dental care that reduce pain
and enables the patient to eat, chew and speak without impediment. The
subsidy is 300 SEK/year for individuals aged 20–29 years or above 74
years and 150 SEK/year for individuals aged 30–74 years. Patients are
reimbursed at 50% through the high-cost protection plan for dental care
costs between SEK 3 001 and SEK 15 000 during a twelve-month period.
For costs above SEK 15 000 the reimbursement rate is 85%.
The Dental and Pharmaceutical Benefits Agency (TLV) decides which
procedures are subsidized and determines a reference price list, which
serves as a basis for calculating the size of the subsidy and reimbursements
within the high-cost protection plan. The reference price list is revised
every year based on general cost trends in dentistry with regard to
technological developments such as new treatments and changes in the
use of materials. The reference prices are supposed to reflect a “normal
price” for each treatment, that reflects actual costs (SOU 2007:19).
The dental care system is administered by the Swedish Social Insurance
Agency (SSIA), who also hold the Dental Care Register. Since the dental
care subsidy and the high-cost protection plan applies to all dental care,
both publicly and privately provided dental care is in the register.
17
The reimbursements in the high-cost protection plan are calculated over
the consumption during a twelve-month period. Therefore, all dental care
is registered, even if an individual does not reach the first threshold in the
high-cost protection. Hence, the register also covers dental care that is fully
paid for by the patient.
18
15
Sweden is divided into 21 counties at the regional level. The county councils’ main
responsibility is health and medical service (about 80% of total expenditures). The
Swedish Public Dental Service has a legal responsibility for ensuring the supply of
dental care to the citizens in the county (National Dental Service Act,
tandvårdslagen (1985:125)).
16
Dental care is free for children and young people aged 19 or under.
17
All public clinics and about 96% of the private clinics are connected to the dental
care system. Little is known about the 4% of the private clinics that operate
entirely outside the national dental care system.
18
Apart from purely aesthetic dental care, which is never reimbursable.
