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Dentistry in Sweden 2009
Dentistry in Sweden2009
Government and healthcare in Sweden 4
Oral healthcare 7
Education, training and registration 12
Workforce 18
Practice in Sweden 24
Professional matters 30
Financial matters 37
Licensing medical professionals 39
Other useful information 49
Contents: Page
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Government andhealthcare in Sweden
SwedenisaNordiccountryandhasapopulationwithabout85%ofinhabitantslivinginthesouthernhalfofthecountry.ThecapitalisStockholm.
Ithasaconstitutionalmonarchywithaparliamentarysystemofgovernmentbut,asHeadofState,theKingonlyhasaceremonialfunction.TheSwedishParliament,theRiksdag,consistsof349members.Thesemembersarechosenin29differentconstituenciesandthereforerepresenttheentirecountry.Atpresent(2008)sevenpoliticalpartiesarerepresentedintheRiksdag.Together,membersbelongingtothesamepartyformapartygroup.
Manyaspectsofgovernment,includinghealthcare,aredelegatedtothecountyormunicipalitylevel(290municipalitiesin2008).Boththecountiesandmunicipalitieshaveelectedcouncilswhichmaylevytaxes.LiberalimmigrationpolicieshavegivenSwedenamulticulturalpopulation,withimmigrationaccountingfor48%ofthegrosspopulationgrowth.
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Socialexpenditureaccountsforsome30%ofSweden’sGrossDomesticProduct(2005).
Year Source
%GDPspentonoralhealth 9,1% 2006 OECD%ofthisspentbygovenrmt 84,6% 2006 OECD
Mosthealthcareisprovidedthroughanationalsocialinsurancesystem,whichalsoprovidessickpay,childbenefits,disabilityallowancesandpensions.Thenationalinsurancesystemoperatesasagovernmentagency(theNationalSocialInsuranceBoardorRiksförsäkrings-verket),throughlocalSocialInsuranceOffices(Försäkringskassan).EveryonewhoisresidentinSwedenisregisteredwithasocialinsuranceofficewhentheyreachtheageof16.Theexpansionofhealthcareinthe1950sand1960scon-centratedespeciallyonsecondarycare,sothatSwedennowhasahighpropor-tionofspecialistandhospital-basedservices.Publicexpectationsofhealthservicesarehigh.Intotal,around85%
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(2005)ofhealthcarecostsincludingdentistry,arefundedbygovernment.
ForthemajorityoftheSwedishpopulationgeneralhealthcareispaidforthroughgeneraltaxation,plusasmallfee(€15in2008)foreachvisittoadoctor.
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Oralhealthcareistheresponsibilityofcountygovernment,althoughcountiesarenotrequiredtoprovidetheservicesthemselves.
Year Source
%GDPspentonoralhealth 0,68% 2006 SCB**%ofthisspentbygovenrmt 78% 2005 NBHW*
**SourseSCBNationalräkenskaperna*TheNationalBoardofHealthandWelfare
Public healthcare
Almostalloralhealthcareisprovidedinoneoftwoways.Firstly,thereisaPublicDentalService(NDS)whichprovidesfreedentalcaretochildrenuptotheageof19.Thesedentalservicesaremainlydeliveredinlocalclinicswhicharemanagedbythecounties.ChildrenandtheirparentscanchoosetoattendeithertheNDSorprivatepractitioners.Secondly,adultsandelderlypeoplewhoarenotentitledtofreecarefromthePublicDentalServicecangetsubsidiseddentalcarefromtheNDSordentistsinprivatepractice.
Oral helthcare
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Theframeworkchangedin2008withanewnationalinsuranceschemeintroducedonJuly1st2008.
A dental care voucher wasintroduced–thevalueofthedentalcarevoucheris€32everyotheryearforeveryoneaged30to74,€64everysecondyearforthoseaged20to29and75andover.Thevouchercanbeusedasapart-paymentforadentalcarecheck-upatanydentist’sordentalhygienist’spractice,orasapart-paymentforsubscriptiondentalcare.
A high-cost protection scheme thatwillprovidecompensationequalto50%ofapatient’sdentalcarecostsbetween€321-€1590and85%ofcostsexceeding€1590.Thefirst€320isalwayspaidbythepatient.
“Reference prices” areintroduced-compensationlevelswillbebasedon“referenceprices”.Theseshouldhaveaprice-steeringeffectonpricesandenablespatientstocomparedentalpricesmoreeasily.Thereisfreepricingwithasubsidy.
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Dentistsinprivatepracticesettletheirpricesthemselves.Thecountiessettlethepricesforalltheclinicswithinthecounty.
Reimbursement –Notallkindsofdentalcarearereimbursable.Preventivemeasuresanddiseasetreatmentareprioritised.Reimbursabledentalcareisbothcost-effectiveandsocioeconomicallyefficient.Forthosewithlong-termillness,certaindiseasesorspecialneed,getasubsidyfordentalcare.
In2004(latestfiguresavailable)thetotalcostfordentalcarewasapproximately€2.1billion.Patients’co-paymentswere€1.3billionofthissum,sothetaxpayers’sharewas€0.8billion.Ofthis,€0.33billionwasprovidedthroughthenationalinsurancescheme.
ItiseasiertoaccessNDS-careinthebigcitiesthaninthecountry.Duringaone-yearperiod(2004)68%ofthepopulationaged from 16 to 84, accesseddentistry.Inany2-yearperiod,approximately85%oftheadultpopulationaccessdentistry.
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Private insurance
Privateinsuranceisavailablefororalhealthcarebutisveryrare.
Quality of care
ThereisaDentalActwhichstatesthatallSwedishcitizensareentitledtogoodqualitydentalcare.ThestandardsaremonitoredbytheRegionalDepartmentsoftheNationalBoardofHealthandWelfare(Socialstyrelsen).Theauthorityhasissuedaregulationimposingthedentalservicestoworkwithqualityquestions.ThedentalservicealsoworksusingasystemcalledLexMaria,whereallincidentsthathavecausedorcouldhavecausedseriousinjury,aretobereported.
Health data
Year Source
DMFTatage12 1.00 2005 WHODMFTzeroatage12 58% 2005 OECDEdentulousatage65 Nodata
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“DMFTzeroatage12”referstothenumberof12yearsoldchildrenwithazeroDMFT.“Edentulousatage65”referstothenumbersofover64swithnonaturalteeth.
Fluoridation
InSwedenthereisnofluoridationschemealthoughdentistsworkcontinuouslywithpreventiveinformationtoallchildren.Childrenoftengetatoothbrushorapackageoftoothpasteontheirfirstvisittothedentist.
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Undergraduate training
Primary dental qualificationAllthedentalschoolsarestateownedandfinanced.TheyareallpartoftheFacultiesofMedicineoftherespectiveuniversities.Toenterdentalschool,studentsmusthavecompletedsecondaryeducation.Thereisnoentranceexamination.Thedentalundergraduatecourselasts5years.
Year of data 2003
Numberofschools 4Studentintake 247
Numberofgraduates 166Percentagefemale 67%
QualityassuranceforthedentalschoolsisprovidedbytheNationalAgencyforHigherEducation.
Qualification and vocational trainingPrimary dental qualificationOncompletionofstudiesstudentsareawardedadegree,knownas“Tandläkarexamen”.
Education, training and registration
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Vocational training (VT)Thereisnopost-qualificationvocationaltraininginSweden.
Registration
InordertopractiseasadentistinSweden,aqualifieddentistmusthavealicenceawardedbytheNationalBoardofHealthandWelfareunitforQualificationandEducation.Thisbodykeepsaregisterofdentists.Themaindegreeswhichmaybeincludedintheregisterare:the licence, andadiploma ofspecialisation.
Costofregistration(2008) £64.00
Dentistsdonotneedtore-registerannu-ally.
TheSocialInsuranceOffice(Försäkringskassan)alsokeepsaregisterofpractitionerswhoareaffiliatedtothenationalsocialinsurancescheme,anddentistsmustbeonthisregisterbeforetheycanclaimsocialinsurance
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subsidies.Registeringforaffiliationwiththenationalsocialinsuranceschemeonlyrequirestheproductionofarecogniseddegreecertificateordiploma.
Language requirementsTherearenoformallinguistictestsinordertoregister,althoughdentistsareexpectedtospeakandunderstandSwedish.However,anemployerhastherighttodemandknowledgeinSwedish–asthe“casebook”mustbewritteninSwedishandapatienthastherighttounderstandwhatiswritteninit.
Further postgraduate and specialist training
Continuing educationContinuingeducationisoptional.TheSwedishDentalAssociationhasacontinuingeducationprogramme(printedandsenttoallmemberstwiceayear),butalmostallcountycouncils(publicdentalhealth)doaswell;thedentalindustrygivescoursesandalsothereareprivateinitiatives.
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Specialist trainingTrainingforthespecialitieslaststhreeyears,aftertwoyearsingeneralpractice.IttakesplaceinuniversityclinicsorrecognisedpostgraduateinstitutionsapprovedbytheSwedishBoardofNationalHealthandWelfare.Thecapacityofspecialisttrainingin2007wasabout283places–50%werebeingused.ThemajorpartofthistrainingispaidforbytheCounties,directlythrougheducationonrequestorindirectlythroughtheco-ordinatedCountygrant.In200850%ofthespecialistsweremorethan54yearsoldanditisanticipatedthattherewillbeashortageinsomedisciplines.
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Thereistrainingin8specialties:•Orthodontics•Endodontics•Paedodontics•Periodontology•Prosthodontics•Dentomaxillofacialradiology•Oralandmaxillofacialsurgery•Stomatognathicphysiology
Thenumberofspecialisttrainingpostsislimited.Thesystemsforremunerationvary.
ThosewhocompletespecialisttrainingintheEUrecognisedspecialismsofOrthodonticsandOralSurgeryreceivethefollowing:
•’bevisomspecialistkompetensiortodonti’(certificateawardintherighttousethetitleofdental practitionerspecialisinginortho dontics)issuedbytheNational BoardofHealthandWelfare.
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• ’bevisomspecialistkompetensioralkirurgi’(certificateawardingtherighttousethetitleofdentalpractitionerspecialisinginoral surgery)issuedbytheNationalBoardofHealthandWelfare.
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Dentists
Year of data 2005
Orthodontics 255Endodontics 42
Paedodontics 85
Periodontics 105
Prosthodontics 117
Dentomaxillofacialradiology 41
OralSurgery 0
OMFS 143
DentalPublicHealthStomatognathicpathology 30
*figuresrefertoactivespecialists
Thedentalassociationreportsthatthenumberofactivedentistsisdecreasing.Retirementisincreasingduetothedispersionofage.Inthemid1990stheGovernmentreducedundergraduatenumbersby40%.Additionally,emigrationishigherthantheimmigrationofdentists.
However,thelossofretireddentistsisbalancedbythenewly-qualified,sothereductionoftheactiveworkforceisonlyfromthisemigration.Thereisno
Workforce
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informationaboutanyunemploymentamongstSwedishdentists.
Movement of dentists across bordersDuringanumberofyearstherehasbeenanet lossofdentists.MostoftheemigratedSwedishdentistshavemovedtotheUnitedKingdomandNorway.However,by2008,thetrendofagreatmovementoutofSwedenappearedtobeending.During2004and2005thenetimmigrationofdentistswaspositive.
Specialists
Year of data 2007
Orthodontics 260Endodontics
PaedodonticsPeriodontics 102
Prosthodontics 61
OralRadiologistsOralSurgery 154
OMFSDentalPublicHealthOthers
In2008about11%ofdentistswerespecialists.
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Patientsarereferredbyadentisttothespecialist.MostspecialistsworkinthePublicDentalServiceortheuniversities.Asmallnumberworkinprivatepractice,butmanyoftheseareapproachingretirementage.Therearemanyassociationsandsocietiesforspecialists-alistoftheseisavailablefromtheSwedishDentalAssociation.
Auxiliaries
ThesystemofuseofdentalauxiliariesiswelldevelopedinSwedenandmuchoralhealthcareiscarriedoutbythem.Apartfrom(chairside)dentalnurses,therearethreetypesofdentalauxiliary:
Year of data 2008
Hygienists 1,500Technicians* 2,200
Denturists 60Assistants 5,500Therapists 250
Thesefiguresarefor“active”dentalauxiliaries
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Dental hygienistsTotrainasahygienistrequiresanacademicentryoftwo“A”levels,andthen2-3yearsofundergraduateacademiceducation,inoralhealthscience,atoneofseveralUniversityCollegesinSweden.Oralhealthscienceismultidisciplinaryandcomposedofmedical/odontologicalandbehaviouralsciences.
AfterqualificationallhygienistsarelicensedbytheNationalBoardofHealthandWelfare.Theyhavetohavearegisterablequalificationandmayworkindependently.Theirdutiesmayincludediagnosisofcariesandperiodontaldisease,andtheymayprovidetemporaryfillingsandlocalanaesthesia(mandibularandinfiltration).
Mostdentalhygienistsworkinlocationswheredentistswork,withabout40%employedinprivatepracticeand60%inthepublicdentalhealthsector.Theyarerequiredtoobtainprofessionalindemnityinsurance.
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About225wereselfemployedin2008.Theytakelegalresponsibilityfortheirworkandchargefeestopatients,whichmayvaryfromwhatdentistscharge.About30ofthe225selfemployedhygienistsowntheirownprivatepractice.
Dental techniciansTotrainasadentaltechnicianrequiresanacademicentryoftwo“A”levels,andthenthreeyearsoflecturesandpracticaltrainingatadentalschool.AfterqualificationtechniciansarelicensedbytheNationalBoardofHealthandWelfare,buttheydonothavetohavearegisterablequalificationtowork.Theirdutiesincludetheproductionoffixedandremovableprostheticandorthodonticappliances.Theymaynotdealdirectlywiththepublic.
Justlessthan20%areemployedbytheCountiesand80%workinprivatepractice.In2006/200765dentaltechnicianswerequalified.
DenturistsdonotexistinSweden.
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Orthodontic auxiliariesOrthodonticoperatingauxiliaries’traininglastsoneyearandtakesplacewhereorthodontistsaretrained.Thisenablesthemtocarryoutspecifiedprocedures,buttheymustworkunderthedirectionofanorthodontist.
Therearenoofficialfiguresofthenumberoforthodonticauxiliaries,buttheabovefiguresareanestimatebytheDentalAssociation.
Dental nursesAbout65%ofdentalnursesareemployedbytheCounties.Ahighnumberofthemismiddleaged(in2008).SinceJanuary2008therehasbeenacommonnationaleducationfordentalnurses.
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Year of data 2007
Private(general)practice 3,290Publicdentalservice 4,124
University 236Hospital 150ArmedForces 2
GeneralPracticeasaproportionis 44%
Working in private/general practiceInSweden,dentistswhopracticeontheirownorassmallgroups,outsidethePublicDentalService,hospitalsordentalschoolsaresaidtobeinprivatepractice.Theterm‘generalpractice’referstodentalpractitionerswhoarenotspecialists.
Dentistsinprivatepracticeareself-employedandareremuneratedmainlybychargingfeesfortreatments,supplementedbysocialsecuritysubsidies.Themostcommonwayofremuneratingadentististopayafeeforeachtreatment(itemofservice).IfthetreatmentisoneincludedintheNDSthedentistgetsreimbursedbythedentalinsurance.
Practice in Sweden
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In2008,veryfewdentists(lessthan1%)acceptedonlyprivatefee-payingpatients.
Fee scalesAnewsystemwasintroducedin2008(referredtoearlierintheOralHealthcaresection).
Joining or establishing a practiceTherearenoruleswhichlimitthenumberofdentistsorotherstaffwhomayworkinasinglepractice.Mostnewlyqualifyingdentistswhoenterpracticedosoasassociatesinagrouppractice.Thereisnostateassistanceforestablishinganewpracticeandgenerallypractitionerstakeoutcommercialloansfromabank.
Thedentalpracticecanbehousedinanypremisesandtherearenoconstraintsontheopeningofnewpractices.Theresponsiblepractitionerhastomakecertainenvironmentalandtechnicaladjustmentstothepremises,suchasinstallinganamalgam-separator.
Nostandardcontractualarrangementsareprescribedfordentalpractitionersworkinginthesamepractice,though
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thatishighlyrecommendedbytheprofessionalorganisations.Theymaybeemployeesofaprincipaldentist,inpartnershiporemployedunderaleasearrangement.Thisleasearrangementistherentingofaroom,equipmentandsometimesstafffromthedentist-owner.Suchdentistshavetheirownpatientsandpayeitheramonthlyrentorapercentageoftheirincome.
Dentistswouldnormallyhaveabout1,500patientsontheirlist.
Thecontrolsformonitoringofthestandardofcarearethesameasalreadydescribedabove.
Working in the public dental service
Thereisapublicdentalservicewithresponsibilityforfreeservicestochildrenupto19yearsofage.Apartfromchildren,theservicealsoprovidesdentalcareforadultsasstatedearlier.ThePublicDentalServiceisfundedbytheCounties.Itbroadlyprovidesthesametypesoftreatmentforwhichnational
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insurancesubsidiesareavailable.Foradultsthesamesystemofnationalinsurancereimbursementsandfee-scalesapplyasinprivatepractice.
Theserviceemploysabout55%ofallpractisingdentists,approximately700asspecialists.Specialistsreceivepatientsfromdentistsinprivatepractice,aswellasfromdentistsinthePublicDentalService.Allthesedentistsaresalaried.
Besidesthedentaldegree,theonlyformalqualificationrequiredtoworkinthepublicdentalserviceisforspecialists,whoshouldhavereceivedrecognisedadditionaltraining.
ThemonitoringofdentistsinthePublicDentalServiceisthesameasthatfordentistsinprivatepractice,exceptwhereservicesareprovidedfreeofcharge.
Theprovisionofdomiciliary(home)careisnotverycommoninSweden,andisusuallyprovidedbypublichealthdentists.
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Working in hospitals
InSwedendentistsworkinhospitalsassalariedemployeesofthecounties.Thereareusuallynorestrictionsonseeingpatientsoutsidethehospital.Theyprovideconventionaldentaltreatmenttodisabledormedicallycompromisedpatients.Dentaltreatmentundergeneralsedationand/ornitrousoxygenisalsoavailablebutthesedation/anaesthesiacannotbeperformedbyadentist.Forthis,formalpostgraduatetrainingisrequired.
Working in universities and dental faculties
Dentistsworkinuniversitiesanddentalfaculties,asemployeesoftheuniversity.Theyareallowedtocombinetheirworkinthedentalfacultywithpart-timeemploymentelsewhereand,withthepermissionoftheuniversity,mayworkinprivatepracticeoutsidethefaculty.AcademictitleswithinaSwedishdentalfacultyare: professor (responsibleforeducationandresearch), associate
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professor (teachingandresearch),and assistant professor (teaching).Therearenoformalageortrainingrequirements,butmostpromotionsaremadeonthebasisofscientificresearchexperience.
Thetimeofatypicalfull-timefacultymemberofstaffisspent1/3onteaching,1/3ontheirownpatients,1/3onadministrationandresearch.Thecomplaintsproceduresareasdescribedabove.
Working in the armed forces
Twodentistsworkfull-timeasstaffofficersintheSwedishArmedForces.
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Professional associations
TheSwedishDentalAssociation(SDA)hasfourmemberassociations:
•theSwedishAssociationofPrivateDentalPractitioners,•theSwedishAssociationof PublicDentalOfficers,•theSwedishAssociationof DentalTeachersand•theSwedishAssociationof DentalStudents.
Throughthemembershipinoneoftheseassociations,thedentistautomaticallygetsamembershipintheSDAaswell.Almost95%ofallactivedentistsinSwedenaremembersoftheSDA.
Number Year Source
SwedishDentalAssociation 7,005 2008 FDI
TheSDAhas,throughamembershipintheSwedishConfederationofProfessionalAssociations(SACO),closelinkstootherprofessionalorganisationsinSweden.
Professional matters
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Ethics and regulationTheSDAhasformulatedanumberofethicalguidelinesforthemembers.TheguidelinesareimbeddedintherulesoftheSDAandareformulatedbytheAssociation’shighestdecision-makingbody.TheSwedishAssociationofPrivateDentalPractitionershasformulatedanethicalcodefortheirmembers.
Asfarastherelationshipofthedentistwiththeiremployeesandwithotherdentistsisconcerned,therearenospecificcontractualrequirementsbetweenpractitionersworkinginthesamepractice;howeveradentist’semployeesareprotectedbythenationalandEuropeanlawsonequalemploymentopportunities,maternitybenefits,occupationalhealth,minimumvacationsandhealthandsafety.
Fitness to practise/disciplinary mattersIfapatientcomplains,andthedentistcannotresolvethematterdirectly,therearetwoprocessesthroughwhichtheissuesmaybeconsidered.LocalBoardsforPrivatePractice(composedofdentists)andLocalBoardsforPublic
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DentalServices(mayconsistofpeoplefromanotherprofessionthandentistry)isoneway,andtheMedicalResponsibilityBoard(HSAN),onbehalfoftheNationalBoardofHealthandWelfareistheother.
MembersoftheMedicalResponsibilityBoardareappointedbythegovernmentandmusthavespecialknowledgeandinsightintoquestionsconcerninghealthcare.Thepersonwhosubmitsthereportconcerningdentalmattersisalwaysadentist.TheMedicalResponsibilityBoard(HSAN)istheonlyauthoritythatcanapplysanctions.Therearefouralternativesanctions:anadmonition,acaution,tokeepthelicenceforatrialperiodorthelicenceissuspended.Themostcommonreasonforadentisttolosehislicenceisillness-lesscommoniscrimeandlackofskill.
AnappealagainstadecisionmadebytheMedicalResponsibilityBoard(HSAN)canbemadetotheCountyCourtinStockholm.
Data protectionAnewPatientDataActwasimplementedfromJuly1st2008.ThenewAct,whichappliestoall
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careprovidersregardlessofwhoisthemanager,regulates,amongotherthings,suchissuesastheobligationtokeeppatientrecords,internalsecrecyandelectronicaccesswithinacareprovider’soperation,thedisclosureofdataanddocumentsthroughdirectaccessorbyotherelectronicmeans,andnationalandregionalqualityregisters.Moreover,thereareamendmentsto,amongotherthings,thesecrecylegislationwithintheareaofthehealthandmedicalcareservices.
AdvertisingAdvertisingisregulatedbylaw.Adentistcannotcomparehimselfwithotherdentistsnorsayheisbetterthansomebodyelse.Onlybasicinformationmaybegiveninanadvertisement.Advertisingshouldbe“reliable,impartialandaccurate”.
DentistsareallowedtopromotetheirpracticesthroughwebsitesbuttheyarerequiredtorespectthelegislationonDataProtection,ElectronicCommerceandtheActofMarketing.
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Insurance and professional indemnityLiabilityinsuranceiscompulsoryfordentists.FordentistsworkinginthePublicDentalServicethereisanationalscheme.InsuranceforprivatepractitionersisprovidedbytheSwedishAssociationofPrivateDentalPractitionersandbytheproducers’cooperativePraktikertjänst,forthedentistsjoinedtoPraktikertjänst.(ThePraktikertjänstgroupisaprivateproviderofhealthcare,schoolsandwelfare,withtheownersthemselveshealthcarepractitioners).
Theliabilityinsurancefortheprivatepractitionersprovidesfinancialsupportforthecostoffurthermedicalanddentaltreatment,compensationforlossofincome,damagesforpainandsuffering,physicaldisabilityandinjuryandotherinconveniences.Aprivatedentalpractitionercurrentlypaysannuallybetween€180to€582(2008),accordingtohisincome,forthiscover.TheinsuranceisvalidfordentistworkingonlyinSweden.
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Corporate dentistryDentistsareabletoformlimitedliabilitycompanies.Non-dentistsmayfullyorpartlyownthesecompanies.
Tooth whiteningToothwhiteningproductsarenotregulatedasMedicalproductsinSweden.Fortoothwhiteningproducts,classifiedascosmetics,soldinretailtradethehighestallowedlimitforhydrogenperoxideis0.1%.Althoughtheregulationofproductsprescribesamaximumof0.1%,productswithhigherlimitofhydrogenperoxideareoftensoldintheretailtradebecausethecompaniesexpectnew,lessstrictrulestocomefromtheEU.
Health and safety at workInoculationsarenotcompulsoryfortheworkforce,butthereisageneralrecommendationtoundertakeinoculations,suchasHepB.
Ionising radiationUsingthemostcommonX-raymachines(upto75kilovoltintraoralreceiver)demandsnoregulatorypermission.However,tooperatetheequipment,
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thedentistmustfulfilobligationsintheSwedishRadiationProtectionOrdinance.Continuingeducationandtrainingisnotmandatory.Tobeabletobuyanduseapanoramicx-raythedentistneedstoundergofurthereducation.Panoramicx-raysandmoreadvancedx-rays(morethan75kilovoltintraoralreceiver)mustberegistered.Theequipmentmustbeoperatedbyadentistorbesupervisedbyadentist.
Hazardous wasteAmalgamseparatorsare required by anationallaw,sinceJanuary1999. Therequirementappliestoallunitsorpremises.Ifwasteisnotdisposedofaccordingtonationalregulationsthedentistisliable.
Regulations for Health and Safety
For Administered byIonisingradiation SwedishRadiationProtection
Authority,SE-17116StockholmElectricalinstallations ThecountryauthoritiesMedicaldevices MedicalProductAgency,
P.O.Box26,SE-75103UppsalaWastedisposal SwedishEnvironmentalPro-
tectionAgency,SE-10648Stockholm
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Retirement pensions and healthcare
Peoplebornbefore1937receiveasupplementarypaymentaccordingtotheoldrules,andthosebornbetween1938and1953receivepartofthepensionaccordingtothenewsystemandpartaccordingtotheoldsystem.Anyonebornafter1954willreceivepensionsaccordingtothenewsystemonly.Thenewpensionsystemwillbasepaymentsonlifetimeincomeandindividualscontribute18.5%oftheirpay.
Thenormalretirementageisbetween65and67.Adentistisallowedtopracticedentistryuntiltheageof70.Thereisalsoadisabilitypension(againfromtheFörsäkringskassan)forthoseunabletoworkduetochronicillnessordisability.
TaxesNational income taxThehighestrateofincometaxisabout58%onearningsoverabout€52,436(2008)peryear.
Financial matters
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VAT/sales taxVATis25%ofthevalueofsometypesofgoods,includingdentalequipment,instrumentsandmaterials.Therearealsoreducedratesof12%(onpublictransportation,hotelsandprovisionsetc.)and6%(onnewspapersandcinematickets).
Various financial comparators
Zurich = 100Stockholm
2003 2008
Prices(excludingrent) 91,1 97,8
Prices(includingrent) 88,1 92,9
Wagelevels(net) 56,5 65,7
DomesticPurchasingPower 59,9 70,6
Source:UBSAugust2003&January2008
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ThetaskoftheNationalBoardofHealthandWelfareistoexaminewhethertheconditionslaiddowninlawhavebeensatisfiedand–ifthisisthecase–issuingacertificateofcompetencyintheformofaspecialistqualificationcertificate.
TheBoardhasspecificresponsibilityforexaminingwhetherpersonswithmedicaltraininginanothercountrysatisfytheconditionsforpursuingtheirprofessioninSwedenandbeinggrantedSwedishauthorisation.Thisincludestherunningofcertaincoursesandexaminationsaccordingtothecurrentsystem.Thissystemisthesubjectofreview.
ThetaskoftheBoardincludespreparingspecificationofthequalificationsforthedifferentprofessionalgroups.TheBoardisalsoresponsibleformaintainingaregisterofallauthorisedhealthcarepersonnel(HOSP).
Licensing medical professionals
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Information on how to apply for a licence to practise for medical and paramedical professio-nals within the EU/EEA or Switzerland
IntheSwedishhealthcaresector21professionsareregulatedbylegislationbymeansofauthorisationand/orprotectionoftitle.Ifaprofessionisnotsubjecttolegalregulations,themigrantisfreetoapproachtheemployerwithoutanyassessmentorpermissionfromtheNationalBoardofHealthandWelfare.ThosewhohavebasictraininginanotherMemberStatethanSweden,inprofessionslistedintheapplicationformdonothavetopayanyregistrationfee.
Professions regulated on the basis of coordination of minimum training conditions EvidenceofformalqualificationsarelistedinAnnexVintheDirective2005/36/ECforprofessionsrecognisedonthebasisofcoordinationofminimumtrainingconditions.Thoseprofessions
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aredentalpractitioner,specialiseddentalpractitioner,doctorofmedicinewithbasictrainingandspecialiseddoctor,midwife,nurseresponsibleforgeneralcareandpharmacist.
Professions regulated by the general system for the recognition of evidence of training Professionsbelongingtothegene-ralsystemareaudiologist,biomedicalscientist,chiropractor,dentalhygienist,dietician,medicalphysicist,occupationaltherapist,optician,ortopaedicengeneer/technologist,psychotherapist,prescrip-tionist,psychologist,physiotherapist,radiographerandspeechtherapist.Evidenceofformalqualificationinpro-fessionsregulatedbythegeneralsystemshouldwhennecessarybetranslatedintoSwedishorEnglish.
Application for a licence to practise AnapplicationmustalwaysbeaccompaniedbyaEuropeancertificateofcurrentprofessionalstatus.Thatcertificateisastatementfromthecompetentauthorityconfirmingthattheapplicantisentitledtopractisehis/herprofessionwithoutlimitation
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inthememberstateofestablishment.Thecertificatemustnotbeolderthanthreemonthsandhastobepresentedinitsoriginalform.Thecertificateofcurrentprofessionalstatusisreferringtoprofessionalactivitiesinthememberstateofestablishment.
InaccordancewiththeEuropeanDirective2005/36/EConeofthefollowingcertificatesisrequiredfromtheapplicantsfromthenewmemberstates.Thecertificatemustbeissuedbythecompetentauthorityinthecountryofeducation.
CertificateofcomplianceCertificateofequivalenceCertificateofacquiredrights(confirmingthreeyearsprofessionalexperienceduringthelastfive-years’period,insomecasesfiveyearsprofessionalexperienceduringthelastseven-years’period).Insomecasesfurtherdocumentationconcerningeducationandtrainingwillberequired.
ThedocumentshavetobetranslatedintoSwedishorEnglishbyanauthorizedtranslator.
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Thecorrespondingsetofrulesappliestodentists,doctorsofmedicine,nursesresponsibleforgeneralcare,midwifesandpharmacistswithfewexceptions.
Thoseprofessionswhichareapplicabletothegeneralsystemincontrasttothosementionedabovewillhavetobeassessedmorethoroughly.
Specialist qualificationDoctorsofmedicineanddentistswithaspecialistqualificationhavetoapplyforrecognition.
AspecialistnursingtitleisonlyapplicableforanurseresponsibleforgeneralcarewhoalreadyhasobtainedalicencetopractiseinSweden.
True copiesCopiesofdiploma,certificateandotherevidenceofformalqualifications,passportmustbecertifiedtobetruecopiesbyanauthority,professionalorganisationoraninstitution.
Passport (orSwedishpersonbevis)IftheapplicantisresidinginSwedenaSwedish”personbevis”shouldbe
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enclosed(mustnotbeolderthanthreemonths).IftheapplicantisnotresidinginSwedenacertifiedcopyofavalidpassportshouldbeenclosed.
Medical and Paramedical professionals qualified in the candidate countries (CC)
On1May2004theaccessiontreatieswiththetennewcountrieswillenterintoforce.Themedicalqualificationswillbelistedinthedoctorsdirective93/16/EEC.Furtherenlargementisexpectedduring2007(BulgariaandRomania).Doctorsinpossessionofalistedqualificationawardedincompliancewiththeminimumtrainingstandardsareanticipatedtobenefitfromautomaticrecognitionunderthedirectiveinthesamewayasdoctorsfromthecurrentmemberstates.Theremaybecaseswherethequalificationdoesnotcomplywiththeminimumtrainingstandards.Thiscouldbecompensatedbyevidenceofatleastthreeconsecutiveyearsofprofessionalexperienceduringthelastfive-yearperiod.
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Thecorrespondingsetofruleswillapplytodentists,nurses,midwifesandpharmacistswithfewexceptions.
Thoseprofessionswhoarefallingunderthegeneralsystemincontrasttothosementionedabovewillhavetobeassessedmorecarefullyandinformationabouteducationandtraininginthecandidatecountriesremainstobecollected.
FurtherinformationmaybeobtainedfromtheNationalAuthoritiesinthecandidatecountries.
Medical doctors qualified outside the EU/EEA/Swit-zerland
TheNationalBoardofHealthandWelfare,beingtheSwedishAuthorityresponsibleforregistrationofmedicalpractitioners,annuallyreceivesalargenumberofenquiriesfromforeignmedicalgraduateswishingtopractisemedicineinSweden.Asarule,theBoardisunabletocomplywiththeserequestsasaresultoftheconditionsdescribedbelow.
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Medical practiceForeignmedicalgraduatesareunabletowork–temporarilyorpermanently–inthemedicalprofessionwithoutpassingacomplementarytrainingprograminSweden.ThisprograminvolvescoursesandtestsintheSwedishlanguage,amedicalexamaswellaspracticeandintroductorycoursesinthemedicallegislationofthiscountry.However,duetothelackofresourcestoprovidethiscomplementarytraining,theBoardisunabletoofferthiscompulsoryprogramtootherforeignmedicalgraduatesthanthosewhohavegainedstatusasresidentsinSweden.ThisisgrantedbytheSwedishBoardofMigrationforpolitical,humanitarianorfamilyreasons.Apermitbasedonofferofemploymentisnotsignificantinthiscontext.
Eventhoughmanyapplicantsmustberegardedasfullyqualifiedspecialistswithinacertainfieldofmedicine,theaboverestrictionshavetobeenforced.
Postgraduate trainingSpecialtytraining(residency)inSwedeniscomposedofhospitalservicesinasubordinatepositionunderfullprofessionalresponsibility.Thetrainingperiodwithin
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thespecialtyitselfandwithinotherrelevantfieldsisinprogressduringatleastfiveyears.SpecialtytrainingcannotbecommenceduntilfullregistrationasaSwedishmedicalpractitionerhasbeenachieved.
Thus,aforeignmedicalgraduatemustbefullyregisteredinSwedenandconsequentlytheaboverestrictionsconcerningthecomplementarytrainingrequiredwillbeapplicable.TherearenocoursesattheSwedishmedicalschoolsorteachinghospitalsleadingtothequalificationasaspecialist.
Postgraduatetrainingintermsofinternshipissubjecttotheaboverestrictionsaswell.
ItshouldbeemphasizedthatgraduatetrainingprogramsinSwedencannotbeofferedtoforeignmedicalgraduatesattheirownexpense.NeitherisitpossibletobegrantedSwedishscholarshipsinthisconnection.
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Medical doctors qualified outside the EU/EEA/Swit-zerland and recognised in a Member state
InSwedishlegislationthereisaprovisionthatentitlesdoctorswithathirdcountryqualificationtobenefitundertheDoctors´DirectiveiftheyhavebeenrecognisedinanotherMemberstate(orEEA-country/Switzerland).InthatsituationtheNationalBoardofHealthandWelfarewillbeabletograntautomaticrecognition.Furthermore,theBoardisnotmaintainingthenationalityrequirement.
Thedoctormustbeabletoconvincetheemployerthathe/shehasacquiredsufficientknowledgeoftheSwedishlanguage.
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Main national associations and information centres:
Swedish Dental AssociationPOBox1217S-11182StockholmPhone:+4686661500Fax:+4686625842E-mail:[email protected]:www.tandlakarforbundet.se
The Swedish Association of Private Dental PractitionersPhone:+46855544600Fax:+46855544666E-mail:[email protected]:www.ptl.se
Association of Public Health Dentists In SwedenPhone:+46854515980Fax:+4686603434E-mail:[email protected]:www.stf-tt.orgThe Swedish Association of Dental TeachersPerTidehagE-mail:[email protected]
Other useful information
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The Swedish Association of Dental StudentsPhone:+4686661500E-mail:[email protected]
Publications:
Journal of the Swedish Dental Association(Tandläkartidningen)andSwedishDentalJournal(thescientificjournaloftheSDA),bothat:POBox1217S-11182Stockholm,SwedenPhone:+4686661500Fax:+4686661595E-mail:[email protected]
Competent authority
The National Board of Health and WelfareRålambsvägen3S10630StockholmPhone:+46752473000Fax:+46752473252Email:[email protected]:www.socialstyrelsen.se
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Dental schools:
HuddingeKarolinskaInstitutetOdontologiskaInstitutionenBox4064S–14104HuddingePhone:+46852480000Fax:+4687118343Email:[email protected]:www.ki.se/odont/Annualintake:approx73Dentistsgraduatingeachyear:approx.48Numberofstudents:approx.329
GöteborgGöteborgUniversityOdontologiskafakultetenMedicinaregatan12Odontologen,GöteborgPhone:+46317411300Fax+46317863207Email:[email protected]:www.odontology.gu.seAnnualintake:approx64Dentistsgraduatingeachyear:approx.48Numberofstudents:approx.298
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MalmöMalmöHögskolaOdontologiskaFakultetenS-20506MalmöPhone:+46406658428Fax:+4640925359Email:doesnotexistWebsite:www..mah.se/odAnnualintake:approx54Dentistsgraduatingeachyear:approx.38Numberofstudents:approx.207
UmeåInstitutionenförodontologiUmeåUniversitetS-90185UmeåPhone:+46907850000Fax:+4690770580Email:[email protected]:www.umu.se/odontAnnualintake:approx56Dentistsgraduatingeachyear:approx.32Numberofstudents:approx.239
www.tandlakarforbundet.se/in-english.aspx
PO Box 1217 . SE-111 82 Stockholm . Phone: +46 8-666 15 00 . Fax 08-662 58 42 . [email protected] . www.tandlakarforbundet.se
The organisation for the Swedish dental profession
TheSwedishDentalAssociation(SDA)istheorgansationforthedetalprofessioninSweden.Wedealswithissuesaffectingtheroleofdentistsinthecommunity,professionalethics,educationandscience.Professionalskills,ahighqualityoftreatmentandpatientcarearekeyconcepts.TheoverallgoaloftheSwedishDentalAssociationistoworktopromoteeducation,knowledge,qualityandexpertiseamongSwedishdentistsandSwedishdentalhealthcare.
TheSwedishDentalAssociationisamemberoftheWorldDentalFederation,FDI,(FédérationDentaireInternationale)andtheCouncilofEuropeanDentists(CED).
TheSwedishDentalAssociationoffersitsmembers:
•monitoringandactiveinfluencingofdentists´pro-fessionalareasofinterest•continuingeducation,coursesandtheAnnualDentalCongress•Tandläkartidningen(theSwedish-languagejournaloftheSDA)andtheSwedishDentalJournal.•membershipserviceandcollegialsuppor
