Sunday, August 19, 2012

Emergency dentist visit

A few weeks ago, I had my first interaction with the Dutch healthcare system. I woke up one day to a mild toothache, in a tooth that I've previously had problems and a previous root canal. Like all things, I decided to wait it out a bit longer, except it got painfully worse the second day. By that time, I thought, better call a dentist. But how? I had no idea how the Dutch dental system worked

Luckily, after talking with a few other Americans here, and Dutch colleagues, I found that the system supports both insured and non-insured (self-pay) patients, in my case, that would be me.

But - one might ask, how does it work for non-insured patients? Interestingly, the dentist I go to (and apparently other dentists here) publish all their prices! What an amazing concept - people in the US talk about wanting a more competitive healthcare market, but when have you ever seen prices listed, even for a dentist? (see pricelist from my NL dentist here)

I chose Tenden Tandaartsen based on a recommendation from an INSEAD classmate, and a nice location near the Leidseplein. A surprisingly pleasant experience. Very clean/modern looking waiting room, new digital x-ray and EMR equipment, English speaking assistants and dentists, and interestingly, a separate room for every patient. Totally unlike the US dentists, where everything is in the open, the only thing blocking your chair from the next is usually a bookcase, and you can hear the equipment or discussions with the patient next to you, etc. When I told my Dutch colleagues about this, they were completely shocked, apparently, European privacy rules would never allow a setup like that.

So - the total cost for an emergency visit, x-ray, and diagnosis? EUR90. That's probably cheaper than a self-pay cleaning visit in the US! Cleaning vists here: typically EUR30-50! The reason prices are lower are twofold: first, there's clear price competition, since prices are listed for patients, and the only government intervention is that there is a clear maximum price, but no subsidy. One might think that with a price cap, that would drive away dentists, but apparently, the maximum price is still high enough that there's enough dentists around town that can make a decent living. It's a "managed competition" environment. Furthermore, the choice between self-pay or insured gives people a choice based on their own needs. For regular cleaning and small things, it doesn't make sense to buy any dental insurance.

And the diagnosis - apparently, when my root canal was previously done, the dentist didn't do a correct job of removing all of the root, so there was some residual nerve that was being inflammed by a sinus infection. Very clear on the x-ray that there was 3mm root remaining. Grr - I hate it when people just don't do their job right. Luckily, watching/waiting worked more, and it just went away, with some help of ibuprofen.

In either case, a pleasant experience with the Dutch system, and a good model of where basic dental care could go if the market were truly competitive.

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