The International Angle
The International Angle
The International Angle
NADL representative attended the European Federation of Dental Laboratory Owners (FEPPD) annual meeting June 2-4 in Budapest, Hungary. You can use the insight about the European dental marketplace to plot your laboratory’s business plan because the European market often foreshadows developments in the U.S. market. Through your NADL membership, you are able to influence European regulations, which is important because the U.S. Food and Drug Administration frequently bases its regulations on European laws. Below are reports from several European dental laboratory associations about the dental marketplace in their countries. Read about the NADL's involvement with FEPPD in the August/September issue of the Journal of Dental Technology. Order it here.
Czech Republic
The main task of this year is to organize and ensure the smooth course of the international congress of dental technicians, which is to be held in May 2006 in the town of Cel·kovice. It is the first important event of this kind in the history of our association. The congress will last two days and the participants will have an opportunity to listen to the lectures of foremost experts representing well-known producers of dental equipment and materials, such as the company VITA, BREDENT, BEGO, INTERDENT etc.
A separate mention should be made of the lecture of the Ministry of Health’s representative who will focus on the topic "Medical devices for special purposes." Illumination of this topic is very important for our dental technicians, especially from the administrative point of view.
On the occasion of the congress, a sales exhibition of dental materials and equipment will be held. At the same time, the congress is intended to be a social event as well.
On 1 April 2006, the transitional period finished in which all private dental technicians were obliged to send a registration form to the Ministry of Health. On the basis of this, they received "The Certificate of Performing a Medical Profession without Specialist Supervision". During the next six years, dental technicians will have to obtain 40 credit points for further professional education, otherwise the validity of the certificate will not be extended. Obtaining credit points will cost dental technicians both money and time, because for one whole-day’s training only one credit point will be given.
Owing to the fact that our products come under the regime of regulated prices, we have to make individual calculations of our products. These calculations are checked by inspectors sent to laboratories by the Ministry of Finance. In our opinion, the inspectors should be sent to dentists first, as dentists are those who charge total sums to patients. Products of dental laboratories account for only a part of the total price. We, therefore, think that these price inspections should begin in the place where the total price is created. We intend to use the legal course to solve this dispute between us and the Ministry of Finance.
The Association of Private Dental Technicians of the Czech Republic has 730 members at present and is still a member of the Economic Chamber of the Czech Republic and the Association of Entrepreneurs and Traders of the Czech Republic, which are the two most important business associations in our country.
Denmark
As we have had an increase in cases with our insurance company during the last years we have been looking into the reasons for damages. The result shows that damage occurs when the dental technician has worked with combination works - more or less.
Why it that? Is the reason:
* That the description of how to work with the products is not sufficient - directions in Danish? - seminars of instruction of the new technology?
* Is the dental technician good at what he is doing - has he made himself acquainted with the new technology?
* Is the dental technician strong enough to back out - make certain reservations - confronted with demands from the dentist of how to perform the work? Has the dentist made enough space for the wanted construction? Are the imprints good enough to fulfill the wanted work?
* Shall we emphasize to the dentist that if he grinds or adjusts our work - it is at his accountí- we are not responsible for his actions?
We consider always a complaint from the dentist as legitimate and we redo our work - at our own expense, which is according to Danish legislation (a right to make a complaint within 2 years). We accept - by all means - that the dentist is right.
If an injury occurs and the insurance is activated, the insurance does not cover defects in the delivered work - this is at the dental technicians account - materials and own labor. The insurance covers if the delivered product causes damage at the surrounding in the oral cavity.
Dkr. 3.000 (equal to 403 Ä) is at ones owns risk.
A possible warranty does not come into force until after the 2 years of claim.
* * * *
Once again we want to emphasize the importance in having only one language spoken - English - during the meetings in FEPPD.
It is our attitude that the expenses covering interpreting should help to keep a low budget and help to avoid rises in the subscription.
The constant rise in fee is difficult to understand for our members, who have to pay at the end!
Further all countries - except the English speaking countries - would participate on more equal terms.
If a country is not able to participate in the meetings without interpreter we suggest that all costs are paid by the country in question.
Finland
This year was the first time when The Association of Finnish Dental Laboratories held its annual meeting only once. The meeting was held in February in Tampere, which is one of the biggest cities in Finland situated in the middle of Finland.
In the same weekend we arranged also courses to our members. The course topics were: Team work in laboratory, Problematic lower jaw and How to take good digital photos. Also we had a chairman’s corner where the chairman told the latest news and the members had chance to ask questions and meet other board members than chairman too.
We have had a close relationship to The Union of Denturist of Finland.
They held also their annual meeting in the Tampere at the same time than us.
The meaning is to arrange the “dental weekend” again in February 2007.
We have co-operated closely with Social and healthcare ministry and tried to effect to the documentation. Now we have stopped that and are waiting the voting result of MDD from European Counsil and Parliament.
The member services
We have developed our member services actively.
Our association’s board founded a working group, which concentrated to the quality system in laboratories. The working group has created documentation forms, which are based to National Agency for Medicines’ demands and also MDD. Our members can order these forms from our office and using forms laboratory fulfils the required standards of documentation and quality system. The working group continues its work and will develop forms even better.
We have made an agreement with one insurance company. According to the agreement the company offers insurances just modified to the laboratories but only to our member laboratories.
Competition
Competition is mainly domestic. In certain parts of the country, mainly in big cities the competition is very hard. Foreign competition has not strengthened remarkable. Even it is too early to say how the Estonia’s membership of European Union is changing the situation in the future, at the moment the effect to the Finnish markets seems to be lower than expected.
At the same time than the competition is tight many laboratory owners will be retired and execute their laboratories. This situation makes new possibilities to the younger dental technicians to start with own laboratory.
The average price level of dental technical products has been steady for a long time and we have no signs that the price level will be higher. Finland’s companies new tax law’s effectiveness to the business was lower than expected. In value added tax (VAT) system here has not been changes.
Italy
From the last AGM in Torino Antlo has been occupied in different fronts, to improve the conditions of the category. After the politic assembly in June 2005, we undertook an important enterprise against the formative credits of the Italian Health Ministry. In fact, here in Italy we have to accumulate these credits every year, and so Antlo has decided to dissent from this absurd obligation, organizing events without formative credits. The aim of this enterprise is to obtain a law from the Health Ministry, to be finally considered as a “health care profession,” and to have a professional association, which could give us guarantees and more controls.
We presented, thanks to some exponents of The Italian Parliament, different amendments about the new law for the “health care profession,” and we obtained the assurance, from the Italian Government, to restructure the profile of the dental technicians. After the approval of the law in January 2006, we organized a big demonstration in Rome: on the 9th of February, about 2 thousands dental technicians coming from different parts of Italy met in front of the Government Palace, to demonstrate the distress of the whole category.
The same day in Rome we organized also a meeting “the day of the Italian dental technicians” with the involvement of many exponents of the Italian Parliament, and we clarified our needs:
* Become a “Health care profession.”
* Have a professional order to control and to watch over the category.
* Obtain the exclusivity as “Custom made Medical Devices Manufacturers.”
If we achieve these objectives, we’ll finally obtain important advantages for the category and also for the patients, because we think that a custom made medical devices must be produced by a professional and qualified manufacturer and should be part of a protected market. We believe that these aims could be very important for all the European dental technicians, and consequently for the members of the Federation. Therefore, this topic could be object of discussion also during the AGM, and Feppd could work in the future for the amendment of a European directive.
Unfortunately we have to admit that our proposal to create a single Italian Federation has failed because the other two Italian dental technicians associations have come undone and their members have become part of the so called “Benessere” and “Benessere e Sanit” including dental technicians, opticians, orthopaedics, hairdressers, beauticians, podiatrists, and so on.
Because of the lacking power of the category associations, it is almost impossible to create a single big Federation.
Malta
For over a decade the MDTA has worked very hard, at times addressing and focusing all its energies to improve the training and Education of the basic qualified dental technologist. Since its recognition and establishment as a Health Care Profession (or Paramedic Profession) in 1985, the MDTA, through repetitive recommendations and lobbying, persuaded the Ministry of Education to initiate a 4 year Diploma course at the Institute of Health Care University of Malta.
It is therefore no surprise that in Malta, before, but most of all, after accession to the EU, is very much concerned with the difficulty our Council (regulatory body) is experiencing in evaluating qualifications from other EU applicants to register in Malta. This issue in turn is related to the establishment of Health Care providers and free movement of workers (service providers) who are listed in the EU Directives.
One particular Directive, on the recognition of qualifications of these service providers, pertaining to the general system, stimulates complicated discussions as, the directive specifically states that any certificate, qualification or diploma of 1 or 2 year duration, is to be recognized, with a option of an Aptitude test or Adaptation period at the applicant’s discretion.
We have embarked on the Leonardo Project and the MDTA is giving its contribution to this vast program, however it will take some years for its completion and final implementation. A harmonised/standardised training scheme recognized in all EU states will certainly settle matters in the evaluation of qualifications. However, we in Malta, will still experience this delicate issue for another number of years.
I will not go into the few proposals our organization submitted in 2004, to the Ministry of Competitiveness, regarding the EU Directive on Internal Market Services. These, together with submissions by other organizations, eased further complications, as Health Care professions, which are regulated, are to be excluded from this Directive. In brief, this directive aims at eliminating barriers to ensure the development of service economic activities and promote employment, equality, economic growth, social protection and greater movement of workers from one state to another. It is believed that the EU can be the most competitive and dynamic knowledge-base economy in the world by 2010.
Another matter of concern is policies or criteria for initial regulation of the profession in EU states. Understandably “grand father” clauses will be introduced, however the MDTA believes that those states, that had long standing organized dental technician courses, should make a proviso, as “grand father” clauses are usually introduced, for new legislations, when no opportunities of attending recognized courses are available in that state. One must be careful not to compromise the level achieved in any State and keep in mind that Registration in any EU State facilitates registration to another State.
The proposed MDD has acknowledged, most if not all the proposals generically offered by the PEPPD and its members. Minor progress, to say the least, has been done on the implementation of the MDD, for custom-made dental appliances, in Malta. The reasons may be various, however I suspect that the main delay for
its observance is:
Dental professionals feel they are exposing their services to a heavier taxation, more regulatory control and further expenses to abide with the Directive.
We must understand that the most positive outcome of the MDD is for the Health and safety of the end user (patients), improved standards and healthier professional ambiance of our working environment. Another expression of the directive that should make no improvisation on emphasizing the professional attitudes of having qualified and registered employees, in all areas of dental services, clinical or laboratory based.
The mentality of employing an unregistered workforce (specifically in the commercial labs), for cheap labor has to be a thing of the past-forgotten and overcome. I believe the MDD will pave the way to create this status, particularly in Malta where we have struggled over the years to sustain our ethical and professional principals.
Norway
The total membership in The Norwegian Association of Dental Laboratory Owners - NTFF_-are 220 owners of dental laboratories. Recently we have established a technical organization, named “Faglig Forum” with the intension to develop specially the dental technicians skilled and other professional interests.
In addition to the owners, the organization named Faglig Forum have 70 laboratory employed members, and the students and pensioners. The total members of dental laboratories in Norway are 300.
Knowledge of the trade
NTTF has worked out a comprehensive analysis covering all parts of the dental skilled trade with help from the consultant company Capgemini. The analysis, which is covering the dental trade situation to day and in the future, with recommendation for the dental laboratories, is well received among the members.
The most important conclusions are:
* In the short time the demand after dental products will probably increase, but decrease in long time.
* The demand for full ceramic and implants will increase in the future
* Price is not necessarily the most important criterion for the dentists choice of dental laboratory competence, quality and build up confidence is of greatest consequence
* The competition between laboratories has increased, both because of the increased import trade as well as from other Norwegian laboratories.
* It is not signals for changing in the working income for importers of dental products to Norway. The total part of imports for importing dental companies were 12 % of the total Norwegian marked in 2003. The import share is really greater. Number of imported tooth compensations were about 20 % of the total Norwegian market.
* Price for imported products from “Far east” are near 50 % cheaper than the Norwegian price level.
* The business economy in dental laboratories is relative good, but only half of the economy outcome compared with most of the dentists.
* The economic margin for dental laboratories has been on the same level since 2001, but the manufacturing capacity has increased.
The Authorities set dental treatments on the agenda
A report from The Public Health Department, covering dental treatment in Norway, was published in autumn 2005.
The discussions is specially concentrate about this: Should The Authorities pay for dental treatment to the patient and Should The Authorities set the price-level for the dentists? NTTF has given a statement and discussed the questions in meeting with the Department.
Changes in the education structure
The education structure for dental technicians on the University College in Oslo is under restructuring.
A reform from the Authority called Quality-reform, and to small grants to the teaching at the school, lead to more training out in the laboratories. The advantage with more education in a laboratory is better knowledge in the practice part of the work, and better relations to the industry. The practice dental laboratories have to make an appointment with the University College, and carry through a guiding course. More students assumed to choose a working place outside the greatest towns after education.
Up-grading course for NTTFs members
NTTF has worked out a set of systematic up-grading course for the members. It is necessary for health-personnel with authorization to be up-dated and have documentation for it. It is a follow-up initiative in accordance with earlier mention analysis conclusions about demand for competence for dental technicians.
NTTF worked systematically with demand to that laws and rules shall be followed up in all occupational groups, including importers. We are very conscious of the rights and duties according to what the authorization gives and follow up that people must have authorization for practicing as a dental technicians.
United Kingdom
2006 sees Alan Petrie as Chairman of the association, Alan has been a DLA council member since 2001, and prior to his appointment to the executive of the association he was chairman of our Scottish Committee.
Membership Update
The membership levels for the DLA in 2006 have remained strong during a period of great change and uncertainty for UK laboratory owners, our current membership figures are:
* 936 laboratories
* 26 multi-location laboratories
* 61 affiliate members
* 1023 Total Membership (2005 total 1002)
DAMAS has also seen significant progress in the UK with 120 laboratories registered and a further 10 laboratories looking to become audited in the next few weeks.
Overview of the UK Industry
In terms of Statutory Registration, the regulatory body, the General Dental Council (GDC) agreed on the 2nd May to register Dental Technicians, however, the GDC felt that not all employees in the dental laboratory should be subject to the rules previously agreed, therefore they will also be registering dental laboratory assistants i.e. employees that carry out only one process in the laboratory. The register will open from 31st July 2006 and remain in transition until 31st July 2008 from the 1st August 2008 only registered dental technicians will be able to place a custom made dental appliance on the market in the UK.
On April 1st 2006, the new dental contract became fully operational throughout England and Wales. Scotland and Northern Ireland have yet to decide upon their contractual arrangements for National Health Service Dentistry. The impact of the pilot contracts in 2004 and 2005 were devastating so it was therefore largely expected that when the contract was implemented throughout England the effects would be very detrimental to laboratory businesses. As at the end of the first month, there has been a mixed result to the contract, some labs are claiming the busiest periods to date and other are expecting to make redundancies. The DLA are carrying out a number of surveys to assess the impact, as well as residing on the Department of Health’s Implementation Group to represent laboratory trends.
Education & Training
Everyone involved in education and training for dental technology has been waiting for the GDC to finish their deliberations over statutory registration, however, The DLA’s training brand IDEA has been extremely proactive in setting up courses and providing members with support for staff development. In 2006 IDEA has organized 3 technical courses and is just about to host a series of business management courses for laboratory owners, these course coincide with the publication of the DLA’s first book “Understand Strategic Change,” this book has been written especially for lab owners and managers and has been issued to all DLA members. In terms of education providers, the UK now only has 10 colleges/Universities providing dental technology courses, to assist dental lab owners who wish to fully qualify their staff, yet have no provider the DLA are working with a commercial company on a distance-learning project.
DLA Activity
The DLA held it bi-annual event “DTS,” this year we held it at the Ricoh Arena in Coventry. Without doubt the event was our greatest success to date, with 68 exhibitors occupying 120 stands, 2 keynote speakers and over 1400 delegates. As the market is very unpredictable at the moment there were concerns about the attendance and the atmosphere for the event, it was therefore very encouraging to note that the mood was very positive and that most delegates had decided to invest in their businesses and aim at moving their businesses in the direction of private / cosmetic dentistry.
The DLA journal “Dental Lab” continues to grow from strength to strength, since last year the journal has increased in member input and the number of technical articles published, this has resulted in the journal increasing from 52 pages to 82 pages, published 10 times per year. This has been particularly pleasing for the DLA as the market now has several new journals, which did threaten dent Dental Lab, however, current feedback suggests contrary.
