Developments in oral health care in the Netherlands between 1995 and 2018

Abstract

Background: Over the past several decades, changes in legislation and regulations have been implemented in oral health care in the Netherlands. In 1995, for example, a major transformation in the funding of oral health care was implemented, after which most oral health care for adults was no longer covered by national insurance. In 1997, the Individual Healthcare Professions Act, in which the authorizations of care providers were described, was established. The Healthcare Quality, Complaints and Disputes Act, established in 2016, concerns the accountability of professional behavior. Regulations concerning employment have changed several times since 1995. These changes have affected the work and practice situation of oral health care providers. Methods: Data from many publicly available sources were gathered and combined with internal reports mainly derived from the Data Stations project of the Royal Dutch Dental Association. This project was established in 1995 and, since its initiation, 6716 dentists have participated an average of 6.7 times. Results: Between 1995 and 2018, nearly all professional groups in oral health care increased, particularly those of dental hygienists and prevention assistants. The number of dental practices decreased, but practices got larger in terms of dental units, number of patients, and personnel. The percentage of inhabitants visiting oral health care professionals remained unchanged, but the type of care provided moved towards more prevention. Oral health care providers exploited new opportunities to enhance and express their professional behavior. Conclusions: Oral health care in the Netherlands has evolved in recent years toward more collaboration in teams, and professions have established institutions to promote the quality and safety of care. Greater emphasis has been placed on prevention of dental diseases. These processes were influenced by new legislation and regulations, demographic changes within professional groups, and other social developments.

Work situation and prospects of recently graduated dentists in the Netherlands

“…In recent years, the oral health care landscape in this country has seen four considerable changes. 1 First, more different caregivers, such as dental hygienists and prevention assistants, have become involved in the delivery of oral health care. 2 Within the oral health care team, dentists are perceived as the manager.…”

“…In 1999, 77% of the dentists worked in a private solo practice; in 2018 44% did. 1 , 6 Consequently, the number of practices in which dentists collaborate increased. This collaboration can imply shared ownership, but not necessarily.…”

“…For example, in 2018, 23% of the dentist worked in a practice that was owned by one dentists, but also employed one or more dentists and 33% worked in a practice that was co‐owned by two or more dentists. 1 Van Dam et al observed that between 2008 and 2014 the proportion of young dentists with the ambition of owning a practice significantly decreased. 7 This applied mainly to female dentists.…”

“…The opportunities to avoid practice ownership have been increasing, as dental chains emerged in the Netherlands in recent years. 1 The rise of dental chains occurs in many countries, including Spain and the United Kingdom, and some chains operate internationally. 8 , 9 , 10 The fourth development in the dental landscape in the Netherlands is the presumed appearance of a undersupply of dentists.…”

Inanspruchnahme und Ausgaben in der zahnmedizinischen Versorgung

“…Selbst innerhalb Europas sind die Unterschiede erheblich. Für die Niederlande wurde eine etwas höhere jährliche Inanspruchnahmerate von 80 % für 2018 beschrieben, basierend auf einem positiven Trend beginnend mit 74 % im Jahr 1996 [ 10 ]. Im Gegensatz dazu lassen ältere Ergebnisse aus Finnland auf eine jährliche Inanspruchnahme von nur etwa 38 % schließen [ 11 ].…”