Health care organizations and purchases, public and private, and also clinical professionals play important role in approving the products, services and delivery models of healthcare
interventions. Nevertheless, according to Bower (1996), the general public and particular
groups interested in healthcare are able to make an indirect influence over prioritization and
funding and adopting of specific innovations. However, according to Bower, in all developed
countries there are free major (sometimes conflicting) forces, which currently drive powerful
demands for innovation in every aspect of healthcare.
I. Technology opportunity – the vast capability to develop novel methods of diagnosing,
treating and monitoring patients.
II. Growth in demand – past success in producing "medical miracles" has boosted demand.
III. Growth in costs – has put pressure on public purses and also private insurers.
In order to understand how these forces are influencing the European dentistry, this research
demanded to interview two professionals in this field. The first is Roman Šmucler MD, CSc, a
president of the Czech Dental Chamber, and Doctor Samuel Elhadad, who works for an Israel-
American company Dentsim, which develops innovative products for dental markets in the Europe and the US.
According to Šmucler, all the mentioned forces are present in dentistry. Nevertheless, there is one more important force which forces the demand for innovation – the need of dentists to excel. He says that dentistry is very competitive, because only in the Czech Republic is approximately 500 dental clinics. He claims that it is not only about money, but about the feeling from a job well done.
The health care system in Czech Republic is based on a compulsory insurance model, with a number of insurers financing health care providers on the basis of contracts. These providers are government hospitals and private providers of dental services such as small and medium enterprises and entrepreneurs. According to the Czech Dental Chamber, in 2003 about 90% of dental care was delivered by private dentist. In 2007 about 87% of all practices were private.
Elhadad pointed out (Appendix 6.2), that the medical field is different from dental field because of two factors. First of all, it is very surprising, that basically the dental healthcare in the Europe is socialised. That means, to take care in the EU is easier that in the United States. Even though, because it is accessible, it seems that dental health of the average European is lower than in the US. Elhadad believes, that it is all about education and prevention and the education of oral health in the European sector is not well done yet.
The second factor, according to Elhadad, is the fact that dentistry (in average) is not the legal
issue so that the technology meets the dental market much later than the medical market. But
he agrees, that there are some specific health markets with basically match these three
mentioned forces above.
Nevertheless, Šmucler do not agree with this clam. He believes that the willingness for
innovation in dentistry is huge. He claims, that dentist attend many expensive trainings and the competition between them creates pressure and the willingness is much higher that the
doctors from hospitals have. He says that dentists are probably farthest in adopting new
technologies – for example 3D printers and CAD-CAM are becoming standard. CAD-CAM is a
technology suitable for creation of dental restrains such as dental prostheses, including crowns, crown lays, veneers, inlays etc. (Rekow, 1987). Furthermore, the dentistry is getting ready for full robotization. He says that orthopaedics is not so far.
But, Elhadad argues, that dentists are more conservative than medical doctors. His argument is built upon two points. The first is that the European dentists are basically entrepreneurs. They have to manage the cost effectiveness of their offices. They have to focus on return of
investment of each product. They rather avoid techniques or products which increase the cost.
As an example, Elhadad mentioned CAD-CAM as well. He says that CAD-CAM is becoming a
standard in the US, but it is not becoming the standard of care in the Europe. Elhadad argues that it is because the European dentists are completely under control of government. By the
nature of dentists would maybe possible wants to adopt new technologies but not without
return on investment and it is based on what the public and government will aloud to
reimburse. The patient will always choose the product or service which is paid by government. This is the bad cycle of the current dentistry.
The second point is that the dentists are very isolated and alone. The dynamic is different
compare to the medical markets. Usually, hospitals have the ability to pay for the technology
because it is the standard of the care. Furthermore, this ecosystem allows to talk to each other and to share information. But, in the case of dentist, the only way they can do that is to be proactive and learn by them-self about new technologies. These two factors cause that the
dentist are not able to exchange the information what technologies are as easy as being part of a hospital team.
According to Elhadad, the innovation already exists in the European market, but the way how
dentists adopt new technologies is limited. The reason is, according to Elhadad, the health
system policy. Elhadad explain the system on the following example: in the Czech Republic,
most of the treatment is covered by government. I a patient with a missing tooth is asked to
choose between a bridge that will cost 200$ or an implant with the same cost. In the second
case the insurer will pay back 75% of the cost. The patient will take the bridge for sure. This
system, Elhadad says, does not allow covering the cost to set up new technology in the dentist's office.
The participants were asked on how innovation technologies affect the cost of dental services. Šmucler pointed out, that the nature of cost of innovative technologies is the same as everywhere. At the outset, the cost of the technologies is higher, but later on, the competition tends to decrease the cost. Ones the technology is applied, Elhadad claims, the quality of dental services increase. On the other hand, it also makes the patient spend more money. Elhadad thinks that it will be more out of patients' pockets that from insurers.
To finish this part, Elhadad argues, that in the forces mentioned by Bower at the beginning of
this chapter is missing public health sector (in the context of dentistry). The public health sector in the Europe is very complex and does not allow private sector of dentistry to be bold to adopt more technologies.