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:kansli@tandlakarforbundet.seWebsite:www.tandlakarforbundet.se

The Swedish Association of Private Dental PractitionersPhone:+46855544600Fax:+46855544666E-mail:info@ptl.seWebsite:www.ptl.se

Association of Public Health Dentists In SwedenPhone:+46854515980Fax:+4686603434E-mail:kansliet@stf-tt.orgWebsite:www.stf-tt.orgThe Swedish Association of Dental TeachersPerTidehagE-mail:per.tidehag@odont.umu.se

Other useful information

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The Swedish Association of Dental StudentsPhone:+4686661500E-mail:kansli@tandlakarforbundet.se

Publications:

Journal of the Swedish Dental Association(Tandläkartidningen)andSwedishDentalJournal(thescientificjournaloftheSDA),bothat:POBox1217S-11182Stockholm,SwedenPhone:+4686661500Fax:+4686661595E-mail:redaktionen@tandlakarforbundet.se

Competent authority

The National Board of Health and WelfareRålambsvägen3S10630StockholmPhone:+46752473000Fax:+46752473252Email:socialstyrelsen@socialstyrelsen.seWebsite:www.socialstyrelsen.se

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Dental schools:

HuddingeKarolinskaInstitutetOdontologiskaInstitutionenBox4064S–14104HuddingePhone:+46852480000Fax:+4687118343Email:info@ofa.ki.seWebsite:www.ki.se/odont/Annualintake:approx73Dentistsgraduatingeachyear:approx.48Numberofstudents:approx.329

GöteborgGöteborgUniversityOdontologiskafakultetenMedicinaregatan12Odontologen,GöteborgPhone:+46317411300Fax+46317863207Email:info@odontologi.gu.seWebsite: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:info@odont.umu.seWebsite: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 . kansli@tandlakarforbundet.se . 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