Public Dental Service (PDS) Facing Impending Health Care Reform in Finland

Abstract

Aims: An impending health care reform will change the organization, provision and financing of services in Finland alongside a County Government renewal. The Public Dental Service (PDS) faces a new era of commercialization and competition with the private sector. Public financing of oral healthcare will be reduced radically. The aim of this study was to find out what the personnel in the PDS think about their future work opportunities.

Methods: An electronic questionnaire was sent to a random sample of 12 health centres in Northern and Southern Finland after ethical approval from the National Institute for Health and Welfare. Altogether 311 PDS employees (121 dentists, 60 dental hygienists and 121 dental assistants) responded; a response rate of 71%. The Chi2 test was used in the statistical analyses.

Results: Only 24 (22%) of those working in Southern and 59 (29%) of those in Northern Finland believed that there would not be changes in their work environment after the reform. In contrast, 56 (51%) and 62 persons (31%) respectively (p<0.05) anticipated that their PDS-unit might become a “commercial company” following the municipal enterprise or some other model. In the South, 39 (36%) and in the North 43 (21%) persons (p<0.05) expected changes in the work force, most often “more dental hygienists, fewer dentists”. Of the dentists 25 (19%), of the dental hygienists 9 (15%) and of the assistants four (3%) could think of moving to the private sector. Most respondents (241, around 80%) suggested that more immediate treatment of dental emergencies, considerably more periodontal treatment and home care instructions for adults and more dental hygienists would increase efficiency. About half of the respondents 58 (53%) in the South and 85 (42%) in the North (p<0.05) thought that greater patient flow would increase income in the PDS.

Conclusions: The dental personnel who responded to the questionnaire expect radical changes in their working conditions especially in Southern Finland where the private sector has a greater market share than in the Northern parts of the country. Dentists and dental hygienists seemed to be more aware of changes than dental assistants.