The biggest drawbacks of the National Health Fund system in dentistry
Firstly, settlements with the National Health Fund are based on so-called contracts. Unfortunately, for at least 10 years, the valuation for dental services has not changed. This means that while the cost of living, purchasing materials, or running a business has drastically increased (the social security contribution has increased by over 100%), the dentist receives exactly the same amount from the National Health Fund as 10 years ago.
For example, for a regular filling, i.e., a so-called filling on the chewing surface of a tooth, the dentist receives 38 points from the National Health Fund. 1 contract point = 0.98 PLN – 1.10 PLN.
Of course, we must consider that firstly: the dentist usually works with a dental assistant (who has to be paid for the work done) and that besides the time the patient spends in the office, we must also account for the preparation and cleaning of the office.
We can, of course, shorten the working time and do the filling in 10 minutes. However, this is associated with a reduction in the quality of the treatment performed or simply opting out of such work.
Another very important topic
Cooperation with the National Health Fund means that a bureaucrat decides which method and treatment approach is better for the patient. For example, even though doctors, for medical reasons, would like to apply a different treatment method, they cannot because a bureaucrat at the National Health Fund decided that only amalgam fillings are reimbursed.
The doctor has a limited range of services that can be provided under the National Health Fund but would like to propose something else that they believe would be a better solution for the patient. This is the case, for example, with tooth extraction, with the thought that in the future the patient would like to opt for implant treatment. To take advantage of this, the dentist can prepare the socket for the implant during the visit when the tooth is removed, securing it with appropriate materials.
Unfortunately, the National Health Fund does not reimburse this, and the patient, even if they wanted to pay extra for this procedure during a free visit, the doctor cannot perform this procedure.
There have been situations where a dentist, acting in good faith, performed the tooth extraction procedure under the National Health Fund contract and additional procedures privately. Unfortunately, the National Health Fund, after some time, imposed a large financial penalty on such a doctor. Therefore, some dentists withdraw from cooperation with the National Health Fund because it is not only unprofitable but also simply dangerous.
The National Health Fund reimburses a removable dental prosthesis in the case of a lack of at least 6 teeth.
And what if a patient, for example, lost 4 upper incisors in a traffic accident? Unfortunately, such a patient must pay for the replacement of these missing teeth themselves.
When such a patient comes to me privately, I can present them with various options for replacing these missing teeth. So there is no situation here where the insurer dictates to the patient what treatment to choose.
It comes to the point where a dentist with a contract with the National Health Fund must provide medical services contrary to the current standard of medical knowledge, and for this reason, more and more doctors decide they do not want to do this.
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