Today with 47 years of age, Orlando Monteiro da Silva was the youngest president ever in the country. Since 2001 is ahead of the Order of Dentists, an area that came later on the train in health, but - says - in an intelligent way. Will propose a meeting of the Orders of health on Wednesday in Lisbon to amend the Constitution: the National Health Service can not tend to be free, as it is written, and self-responsibility of patients is essential. Reduce the numerus clausus School of Dental Medicine is another objective. But there are also safe and conventions such as ADSE to strangle the class.I Journal - You see measures to reduce the expense of the National Health Service (SNS in portuguese language)?
Orlando Monteiro da Silva - I called the SNS sort of a train, where the dentist did not come until very recently, approaching a cliff if nothing is done, particularly in terms of funding. They are symbolic measures, in a political context in which there is great pressure for doing something, but will not change anything substantial.
I Journal - Do you have any proposal?
Orlando Monteiro da Silva - is necessary to revise the Constitution in relation to the SNS. Article 64, which talks about it, should be as brief as possible, without reference to an SNS tends to be free. It is essential that there is a degree of economic participation in the use of health services.
I Journal - But this participation exists ...
Orlando Monteiro da Silva - existed. Were given mixed signals in a way to electioneering. We symbolic user fees were increased and were later abolished. Should be taken into account that about 50% of users were already exempt. The Constitution must have a general principle of the SNS, but its modus operandi can not be restricted. Say for example that the SNS has decentralized and participatory management, when is anything but that. It is centralized and decisions are taken by a small group of people.
I Journal - see other gaps?
Orlando Monteiro da Silva - The health sector can not exist in isolation. We need a better link to refocus the SNS for prevention. Another disagreeable notion, probably, is the self-responsibility.
I Journal - unsympathetic why?
Orlando Monteiro da Silva - is a concept foreign to most people. The first and last is responsible for their own health. It is the principal and the principal person responsible.
I Journal - This has not happened?
Orlando Monteiro da Silva - No. Every day we see a projection for health services in the resolution of problems caused by actions or lack thereof, by decisions that were taken throughout life. We must help people make better decisions for your health.
I Journal - once said that the Ministry was the Portuguese as if they had mouths. Keep this opinion?
Orlando Monteiro da Silva - positive steps have been taken. We do not take the train from the NHS, but our way was to get smarter and less taxing society. With the program's dental check some basic services were contracted for some population groups, which is a very logic of outsourcing in the NHS then English. The State has to provide health care but ensure they are provided, regulated and funded.
I Journal - The treatments are the same for those who arrive with the check-dentist?
Orlando Monteiro da Silva - This is our ethics. Investment in treating a child is a good opportunity to retain patients / customers.
I Journal - But there are complaints that this difference exists with health insurance ...
Orlando Monteiro da Silva - The Order is forbidden to have tables of values in terms of minimum or maximum fees. The intervention in the dentist-check was different because it is a social program that requires the involvement of social care. I remember the conversation with the former Health Minister Correia de Campos on the amount of checks: 80 euros suggested it, 35 euros and the final value was 40 euros. With regard to insurance, contracts / agreements are an individual decision, every doctor or not to accept work under the conditions placed.
I Journal - There was some awareness?
Orlando Monteiro da Silva - I did. There's only one thing that sensitizes insurers - money - which is nonetheless legitimate. This follows a logic of the market: insurance companies take advantage of the number of physicians-dentists to unilaterally impose the tariffs. Give yourself the luxury to download the tables of the values they propose. No more treatments or interventions to be offered at no cost. Here we have an allegation of dumping about a year and we are waiting. But these are situations in the private realm, between the dentist and the convention or the insurer. ADSE situation is quite different, which does not update the values in your tables for 19 years.
I Journal - are very low?
Orlando Monteiro da Silva - the value of a tooth extraction is around 10 euros, which does not even pay the materials involved. It is completely unacceptable and unfair competition. But there's more: an insurer is entitled to make contracts, while the ADSE should work with the contest. A dentist who wants to contract with ADSE can not, because there are more than ten years that the Convention is closed. But if a large economic group appears soon open a clinic with all these conventions. There is no effective regulation in Portugal.
I Journal - What do you think the race of the clinical faculty?
Orlando Monteiro da Silva - The function of schools is not to compete with the healthcare market, but it is important that these services exist for training of students.
I Journal - But there are also medical colleges to give advice.
Orlando Monteiro da Silva - only if embedded in post - graduate.
I Journal - This is what happens in practice? Only in Lisbon and Oporto, the colleges provide more than 70 000 visits per year.
Orlando Monteiro da Silva - I have no data on the subject, but I think there is a growing temptation to do so, through the bottleneck of funding. Want to make faculty hypermarkets dental treatment is a profound mistake. But my main challenge for colleges is being a factory of dentists.
I Journal - Go to intervene?
Orlando Monteiro da Silva - We have a petition approved and in June we will start collecting signatures to bring it to discussion in committee and plenary early next year. The aim is to change some aspects of the law to match the entries in the colleges to the needs of the country. We have about 500 graduates a year, a figure that has increased with the Bologna process. Dentists have an average age of 37 years and we know that there will be people retiring over the next 4 / 5 years. I estimate that this number has gradually decreased to be 10% / year, to reach the half.
I Journal - will propose the termination of a course?
Orlando Monteiro da Silva - No, although seven colleges excessive. The United Kingdom, with more than 50 million people have nine faculties.
I Journal - What are the prospects of these young dentists?
Orlando Monteiro da Silva - Much is forced to leave the country. Portuguese society does not need more dentists, and we are seeing a brain drain after an expensive education. Many of them never come back and this is a huge disservice if we think that this training was around a few years ago, the 100 thousand euros.
I Journal - The number of doctors leaving the country is increasing?
Orlando Monteiro da Silva - In the United Kingdom are close to 440. For other European countries do not have numbers.
I Journal - Thinking in the United Kingdom, which is that they have here and what will get there?
Orlando Monteiro da Silva - Here have an uncertain future, a considerable difficulty in entering the market, a network of more than 5000 clinics and open another one in which it is virtually a suicide. Especially the number of patients who attend is very low. There are our colleagues who are in the office all day waiting for a patient, which may appear or not. The difference is that they come to England to win seven or eight thousand pounds per month.
I Journal - Graduates?
Orlando Monteiro da Silva - Yes And this in Portugal or a senior. But no solution to propose to young people who leave the country.
I Journal - But how do you compete with a salary of 8000 pounds?
Orlando Monteiro da Silva - Leaving the country is a right, but there is something to say about the politics of human resources training. If there is an increased access of the population to dentist if there is a country's economic growth, if there are products / quality assurance, most of these people will not have a future in dentistry.I Journal - There's clandestine exercise?
Orlando Monteiro da Silva - long illegal practice in Portugal, with smuggling of recruitment. With Brazil is very common. There are other colleagues who know, come here three / four months to make some queries, then go back there.
I Journal - How are revenues?Orlando Monteiro da Silva - In the name of the legal colleagues hid. Hence the importance of the new licensing law: until next year all offices will have to ask permission. There will be periodic inspections.
I Journal - How big is the problem?Orlando Monteiro da Silva - We thought the complaints, but no idea what it is only with effective supervision is that it would be possible.
I Journal - Portuguese is the first elected president in the International Dental Federation. Sit to represent Portugal?
Orlando Monteiro da Silva - I feel it's good for the country. My voice is more magnified in the Order by virtue of being elected president of the IDF, but my duties in the day to day but try to focus on the Portuguese case, this is not what is expected. I was not elected to be Portuguese, not for being president.
I Journal - But this is a good example of Portuguese, what would it be?Orlando Monteiro da Silva - The quality of dentists, private practice and dental check program. The experience of the dentist-check, though limited, has been followed with great interest in international terms. Do not think only in Portugal is that oral health is neglected. At this point it would be very disadvantageous if one wanted to end the program.
I Journal - Have you heard that?Orlando Monteiro da Silva - I have heard that the cut could include SNS dental check.
I Journal - Who?Orlando Monteiro da Silva - Above all commentators, outsiders. First, because you spend with the program - 30 million - against the benefit that gives thousands of people is irrelevant. Then because there is nothing, and there is much to cut. The biggest problem with the dentist-check is the expectation that you are creating in the population not covered. This is what I imagine can become difficult to manage ...
I Journal - There's envy in other medical specialties?Orlando Monteiro da Silva - I am convinced that this program will be extended to other areas. Ophthalmology, ... It is important to see that this program is born by the political will but also aware that eventually an area is valued. More than half the population has no teeth in the mouth. I remember a few years you are missing two teeth to a miss of Portugal, which is unthinkable.
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