Response to interpellation 2024/25:126 on the public dental care system
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD argues that Swedish dental health is good but that lack of accessibility is serious 1. KD advocates for lowering the age limit for free dental care from 23 to 20 years to reduce the differences between public dental care and private companies, increase resources for those with the greatest needs, and facilitate staff recruitment 1 2. KD emphasizes that the change is requested by regions and public dental care organizations 1. KD argues that S argues for maintaining the higher age limit despite it increasing the burden on public dental care 2. KD claims that the proposed measures are a way for the state to take responsibility 3. KD argues that one strengthens Tandpriskollen and proposes increased control over the dental care sector to stop unserious actors 3. KD wants to strengthen the patient's position and maintain a system of freedom of choice 3. KD advocates for differentiated compensation systems depending on municipality type to increase access to dental care in rural areas 3. KD wants to link a risk assessment instrument to the state dental care support to provide care based on need 3 4. KD considers the age limit issue to be part of the answer to facilitate for Folktandvård's staff and ensure that capacity is used where the needs are greatest 4.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Socialministern Jakob Forssmed (KD)
Mr. Speaker! Peter Hedberg has asked me if I intend to take measures so that the acute situation within the public dental care in northern Sweden shall cease and if I intend to in some way act to ensure an equal responsibility for patients between the public dental care and the private dental care companies.
Oral and dental health in Sweden is generally good. In line with the development of the welfare society and the expansion of dental care, Swedish dental health has developed positively for a long time. I do, however, view the lack of accessibility in dental care and how it affects people all over the country seriously.
The National Healthcare Competence Council has an important role in this context. Through its advisory function, the council shall contribute to good planning of the healthcare's competence supply. The council's mandate is to make assessments of competence needs and to support and achieve cooperation on competence supply issues at national and regional levels. Through this, the council contributes to cooperation and dialogue between relevant actors, but it shall also contribute with knowledge that can serve as a basis for the government's decision-making.
In order for dental care resources to be utilized effectively, the government has submitted the bill Amended age limit for free dental care (prop. 2023/24:158) to the Riksdag. The amendment is a proposal from the special investigator Veronica Palm's investigation When need should guide - a dental care system for more equal dental health (SOU 2021:8) and has been requested by regions and public dental care organizations.
The proposal means that the upper age limit for free dental care is changed from 23 years to 20 years, and it will mean that the number of people included in the public dental care's basic mandate decreases. The change is expected to in this way reduce the differences between the public dental care organizations and the private dental care companies. With the planned change, increased opportunities are also created for the public dental care's providers to recruit and retain staff because the patient group changes and leads to a need for a broader spectrum of dental care measures. In addition to the increased patient revenue that the proposal is expected to lead to, it can mean more and more varied work tasks for the public dental care's staff, which creates conditions for competence development.
In addition, the government has, among other things, tasked Socialstyrelsen with developing a national model for risk assessment within dental care. Such a national model can, in the long term, contribute to a uniform assessment of dental care patients. Through this, dental care resources can be prioritized to those patients who have the greatest need for dental care, while at the same time the accessibility of dental care increases.
The Government announced a dental care reform in the budget bill for 2025. The dental care reform aims to strengthen the high-cost protection for dental care so that it more closely resembles the high-cost protection that exists in other healthcare. A strengthened high-cost protection means lower dental care costs for patients who are 67 years and older. The objective with a strengthened high-cost protection is that patients should be able to visit dental care to a greater extent based on need and thereby achieve better oral health.
The Government intends to allocate approximately 3.4 billion kronor annually from 2026 to strengthen the high-cost protection for dental care. The report *Tiotand vård - ett förstärkt högkostnadsskydd för tandvård* (SOU 2024:70) has recently been submitted to the Government. One of the investigation's proposals involves a municipality-type supplement that provides healthcare providers with higher compensation when they treat patients residing outside of major cities. The investigation's report is now being prepared within the Government Offices, and I look forward to returning to these issues.
Peter Hedberg (S)
Mr. Speaker! I must begin by thanking the Minister for Social Affairs for the answer, even though I believe that there are still a great deal of question marks remaining.
The situation for the public dental care in northern Sweden is acute, and I note that the Minister for Social Affairs in the response meant that the lowered age limit for free dental care can facilitate things by having fewer people included in the basic mandate. I mean that the problems are more extensive than that. In the dialogues and conversations I have had with representatives for the public dental care here in my county, Västernorrland, it has become obvious that the question one should ask is not how the public dental care can become better, but whether we should keep the public dental care at all. The basic mandate itself is, after all, under threat.
In Västernorrland, the public dental care system has for many years actively worked to develop the healthy tooth care agreements to ensure the goal of good dental health for the entire population. But the development in recent years, where staff have instead moved over to private actors, in many respects concentrated in larger cities, has forced the agreements to be phased out, not only in Västernorrland but also in other parts of northern Sweden.
Today, the public dental care in Västernorrland and many other places in northern Sweden can barely manage to handle the children's dental care. Adults are no longer called in for any examinations, and only the most acute cases can be relevant for certain groups. Despite having worked systematically with precisely preventive measures and well-planned revision intervals, one is forced to phase out the healthy tooth care agreements due to staff shortages. I mean that it is completely unreasonable in a country like Sweden in 2024.
What I also want to discuss in the debate is that the system is not quite logical. The situation in northern Sweden entails great pressures on the public dental care. This is because we do not have equal conditions between the actors. The regions and the public dental care have a population responsibility and a last-resort responsibility for care, especially acute dental care. But this does not apply to the private actors, who can more freely choose their patients. I mean that this, in combination with free pricing, creates a system where inequality is cemented and where the goal of good dental health for all is threatened.
It was a well-known example a couple of weeks ago in my county. A person was denied dental care due to their weight, considering that the individual would not be able to sit in the dental practitioner's chair. If one had sought emergency dental care at the public dental clinic, one would have been admitted. But this was about planned dental care. That example alone says something about how sick it has become in our part of the country, where one is denied dental care because of weight.
Based on the question I have posed in my interpellation, I would like to ask the Minister for Social Affairs the following: Can he give his view on the situation in the public dental care? Does he share the view that it is actually a crisis? Can he further clarify his view on the different conditions and rules that apply to the public dental care and the private actors? Does he intend to take any measures to drive through a change?
Socialministern Jakob Forssmed (KD)
Mr. Speaker! I appreciate that Peter Hedberg raises this important issue.
It is quite clear that there are very large challenges for dental care in Sweden. This applies in particular to public dental care and especially in more sparsely populated counties outside the metropolitan regions. It is also for this reason that we present a number of measures. The Health Competence Council has a clear task to also focus on the dental care sector and what we can do for the supply of competence. The mandate to review a national risk assessment model linked to dental care support aims for dental care to also be provided more according to need.
It then matters how far the free dental care for children should extend. Should it extend up to the year one turns 19, or should it continue up to 23? Here, the argumentation is surprising because dental care organizations themselves have called for a lowering of the age limit, for exactly the reasons the member states here, that is, that one has a mandate that displaces other dental care for persons with greater needs.
This has also been investigated by the Social Democrat Veronica Palm, who has proposed that the limit should be set to the year the patient turns 19. This is because we need to have a needs-based dental care. Folktandvården takes too great a responsibility today, and that needs to be changed in this way. It is also about dental care being better able to be provided based on need.
Therefore, it is strange that the Social Democrats are proposing that we should stick to this. We hear from Folktandvården and from the investigator, the Social Democrat Veronica Palm, as well as in the argumentation presented by the member himself, that it increases the burden on Folktandvården that the basic mandate – the free dental care for children – extends all the way up to 23. It makes it harder for Folktandvården to retain staff and competence. That is one of the reasons why we are doing this.
We also do it so that we can develop dental care and, not least, direct greater resources to those who have poorer oral health. This applies in particular to elderly people who have not had the opportunity for the same preventive dental care, who have meager pensions and who need to be given the opportunity to both get appointments and go to the dentist. One simply cannot choose everything at the same time; one must manage to make these priorities.
When there is such a solid basis for actually moving the limit down from 23 to 19 years, it surprises me that the Social Democrats choose to oppose the proposal. It would make things more difficult for Folktandvården if your proposal were to pass, Peter Hedberg. It would make the situation worse, based on the arguments the member presents.
Peter Hedberg (S)
Mr. Speaker! I note that we previously had an interpellation debate concerning the tax cuts that the government is proposing.
If one looks at different types of economic incentives and economic concerns, one can observe that one of the government's main lines in policy has been to try to address inflation. The Social Democrats' line regarding dental care for children - or dental care for youth - extending up to the age of 23 is naturally very linked to the fact that those patients do not always have such large economic margins.
I think the Minister for Social Affairs is being a bit misleading when he says that Folktandvården and the actors have demanded this. It is certainly true, but what they are primarily saying is that some type of regulation was needed to regulate the responsibility between the public actors - such as Folktandvården - and the private actors. As it stands now, there are no incentives at all for the private actors to take a larger share of the responsibility for children' and youth dental care.
I participated yesterday in a seminar about the situation in northern Sweden, which Region Västerbotten co-organized. The word that kept recurring there was "regulation". There was also a very strong desire to see the whole of the system, that is, that all actors are needed, but if all actors are to be able to operate on the same type of terms, it requires that the state actually steps in and takes the responsibility to regulate this. That is, because the regions cannot do it.
I also intended to bring up this issue regarding free pricing again. We have a reference price list that TLV establishes, and which is precisely a reference list and a kind of consumer information. It doesn't actually govern a particularly large part of dental care. In the current situation, adult dental care patients are referred to actors who can charge practically any price, and therefore I wonder a bit what use the reference price list provides. It is also what Folktandvården and the regions are highlighting.
People are willing to pay quite a lot to have good dental health, but that assumes they can do so. In my home municipality, Kramfors, there are examples of actors exceeding the reference price by 180 percent, and I cannot think that is reasonable in any way—in any part of the country. I do not think the Minister for Social Affairs thinks so either, but he is welcome to clarify that.
I also come to the question of freedom of choice, which bourgeois politicians very often emphasize. I am in no way saying that we should get rid of private dental providers, rather the opposite. We need both the private dental providers and the public ones. But one can ask what freedom of choice the patient has who has to choose between no dental care at all or 180 percent more expensive dental care.
Instead of resources being used to meet the needs of the entire country, we see, as I mentioned in my first post, an overcapacity in the metropolitan areas. There, they are actually chasing patients to a large extent, and due to the overcapacity, they have quite a lot of free space that could be utilized for other things.
I completely agree – and so do the Social Democrats – that this issue with risk assessment systems is important, just as it is that one can achieve different types of forms of cooperation between the regions and the private actors. But without a clearer regulation of the question of responsibility, I fear that this risks becoming toothless. I see that the Minister for Social Affairs noted that I said "toothless" – it was not intentional, but one has to have a bit of Gothenburg humor sometimes!
I think like this: This does not need to be an ideological battle issue. If one wants a part of the state and regional dental care support - there are various forms - it would also be reasonable to make one's resources available even for children's and emergency dental care. Thus, the regions and the private actors could share it, and then we might also be able to maintain the free dental care at higher ages - even for those groups in their youth who do not have such large economic margins.
I therefore want to ask the Minister for Social Affairs if he is prepared to look at such a system precisely in order to resolve the problems.
Socialministern Jakob Forssmed (KD)
Mr. Speaker! I still think that this does not quite add up.
The opposition calls for the state to step in and take responsibility, and now we are doing so. We are listening to the regions, the Folktandvården organizations, and to the investigator Veronica Palm and making changes to the age limit. It is not just a price issue for the individual, but it is also a capacity issue for the one who is to perform this. That is why we are making these changes.
Then the Social Democrats say: Do not make the changes that are requested so that we can manage the dental care situation in Sweden! Do completely different things!
I am not closing any doors when it comes to looking at other things, but this is something we can do here and now. We are also doing things regarding the reference prices: We are strengthening Tandpriskollen and putting forward proposals to further strengthen the control over the dental care sector. We know that we need to ensure that there are no unserious actors in this sector and increase the control surrounding this, so that funds do not flow out of the dental care sector in a way that they should not. We are doing that now; we are putting forward a long series of proposals regarding this.
The reference prices are important and play a role, and Tandpriskollen plays a role. But it is clear that we need to strengthen the patient's position in various ways in this context. I also think that is important so that we can maintain a system of freedom of choice. One should feel secure when going to the dentist, and one should be able to keep track of both one's rights and what is reasonable to pay in these contexts.
I also want to point out that we now have a new investigation that this government has commissioned, which contains proposals for differentiated compensation systems depending on where one establishes themselves. I look forward to further processing that. There is simply a difference in municipality type based on where the patient is residing. It is about the fact that we are seeing a difference in establishment between large cities and, not least, northern Sweden and more sparsely populated parts of Sweden, where it is simply much harder to get appointments. This is a tool that we have asked the investigator to look at and which we are now also processing in the Government Offices.
It would of course be interesting to hear how the member views this. Now, we are doing several things. It is the same thing with the risk assessment instrument; ensuring that it is linked to the state dental care support is about being able to provide dental care better according to need. Today, it does not function sufficiently well in terms of needs being what should guide it. But I still want to say that there is a consistency in how we work with this.
As said: It surprises me that the member, who clearly sees the same problem as I do, goes against those who actually see it as not the whole solution but a partial solution to change parts of this.
Peter Hedberg (S)
Mr. Speaker! The Minister for Social Affairs said in his response that we generally have good dental health in Sweden, and I share that perception. This debate, however, is about the fact that dental health is threatened in the long run, and I do not think the Minister for Social Affairs and the government are quite following all the way. It is very true that the dental care providers have requested that the threshold for fee exemption be lowered, but it is also because they face a situation where the playing field is not equal regarding the question of responsibility. I think the Minister for Social Affairs is dodging this.
Folktandvården has a greater social mission when it comes to both the execution of the dental care itself and the supply of competence. They also point out that Folktandvården takes a very large responsibility for educating and training new dentists, dental hygienists, and dental nurses at the beginning of their careers. Then, however, they move on. Folktandvården is treated very stiffly with today's various regulations, I think.
I definitely believe that what the Tiotandvård investigation has shown regarding municipal type supplements, which is also being prepared in the Government Offices, can be a step in the right direction. But if one operates in the market that dental care is in, the basis must still be that equal conditions shall apply.
I think, again, that this does not need to be a major point of contention. I think it would be very natural that one can access the state dental care support if one makes their resources available for children's and emergency dental care. That part is what Folktandvården and the regions are calling for almost the loudest, I would say – that part and the free pricing. That was, at least, the message I heard yesterday and that I have heard from many dental care directors.
Therefore, I ask again - based on what the Minister for Social Affairs said in his previous statement about that he does not exclude anything - whether it can be a feasible path to actually regulate and legislate on equal conditions regarding the social mission and the population responsibility.
Socialministern Jakob Forssmed (KD)
Mr. Speaker! Fundamentally, we have good dental health in Sweden, but it is not provided sufficiently according to need today. Then one must be prepared to consider various measures to achieve that. I fundamentally think that the right of free establishment is good, but it does not function well enough. Therefore, I look forward to broad proposals on municipality-type supplements and other measures to ensure that more people around Sweden will have the opportunity for dental care.
I think we are doing several things. We have given a mandate to the National Healthcare Competence Council to review competence supply issues. This is important so that we can get input and a basis for what the government and the state can do further in this context. I have also pointed out several other things to ensure this, for example a risk assessment instrument that can be linked to dental care support to ensure that dental care is provided more according to need.
I also think that the age limit issue is important in this context. As the member himself notes, this is not the entire answer to how we should facilitate the situation for Folktandvården's staff, but it is part of the answer. It concerns issues such as recruitment, being able to retain staff, and obtaining a more level playing field in relation to others. Not least, it is about that we should use the capacity we have – for it is not unlimited – for those people who have the greatest needs. It is their needs that should be met.
We shall simultaneously maintain the possibility for children, up to the year they turn 19, to receive the good preventive dental care that lays a good foundation for good oral health throughout life.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.