746. Scam in dental clinics passes through Tomar (Second part)

745. Scam in dental clinics passes through Tomar (First part)

Amélia Martins, from Tomar, is one of those injured by the sudden closure of Lusosmile dental clinics. Like other clients, she paid in full for dental treatments that she never had.

Journalist Sandra Felgueiras published an article in the magazine Sábado about this scandal that is also happening in Tomar, because one of the clinics had facilities in Corredoura.

 The magazine, citing the victims, says that the clinics required users to take out loans. “The contracts, made in record time, were drawn up at the clinic itself, which decided with which banks these same loans were made”, reads the report. “They told us that they only worked with credit, they prepared everything and we just had to sign. They received the money and I paid 120 euros to the bank for 60 months”, says Manuel Martins, Amélia's husband.

The injured person was approached on a street in the city of Tomar for a free evaluation consultation. This was followed by a budget of more than 6,000 euros to treat the teeth and the imposition of a credit as a condition for starting treatments, reports the reporter.

“We made him take credit to Cetelem right there at the clinic. I even asked if I could pay for the consultations, I could do it with difficulty, thus avoiding taking out a loan, but I was told right away that it was not possible. After all, neither money nor treatment”, laments Manuel Martins in the report that was also broadcast yesterday on CMTV.

This is just one of many cases of desperate and indebted families with the unexpected closure of LusoSmile dental clinics in Caldas da Rainha, Felgueiras, Tomar, Vila Real and Almada. The injured are joining and there is already a lawyer hired to represent them in court.

Tomar na Rede

744. Health is confusion. From the oral, you don't even talk.

In recent days, serious problems with the SNS began to lead the national news agenda; in particular, after the sad case in which a pregnant woman lost her baby.

These problems are old and no government has been able, to date, to solve them adequately; not for lack of good ideas from some ministers of health. But because little was put into practice.

Is the problem structural? Conjunctural? In my opinion, the problem is structural and the portrait has been around for a long time. There is no shortage of doctors, there are doctors, but they run away from the SNS. The finance minister even says that the problem is not financial; therefore, it will have its roots in the mismanagement and strategy adopted over the years by the various governments.

In 2017, “Integrated Responsibility Centers (CRI)” were created with the mission of ensuring the development of best clinical practices focused on the needs of users, adapting the internal organization of SNS entities to efficient management; to foster clinical governance processes that contribute to the continuous improvement of the quality of care provided in the SNS; increase the accessibility and response times of the SNS to citizens; to maximize the installed capacity on the public SNS network; promote the autonomy, involvement and accountability of professionals in the management of resources, encouraging them to exclusively develop their activity in the SNS; increase the levels of productivity and satisfaction of SNS professionals,

The question that arises is, why do the CRIs work well, for example at Hospital de São João, in Porto (by the way, a hospital that has had a strong dynamic and administration), and in other hospital centers it has an image “ ghost"? A case to say “It has to be investigated”, as our President says.

In the next few lines, I will give some focus to oral health, despite knowing that in other areas of health, chaos reigns and care for life is compromised. But I will speak, because oral health is itself at risk and if it is not restructured, it will be on the verge of extinction. And at this point I have to talk about sustainability, based on three essential pillars: social, economic and environmental (with an emphasis on waste).

In the social chapter, accessible oral treatments are essential to improve health conditions and reduce the disparities that exist between populations; as well as to limit the health burden on the population and reduce socio-economic inequalities. Social disparities in health and health care are particularly evident in the oral cavity. There is a clear association between poor oral health and chronic diseases such as diabetes, cardiovascular and respiratory diseases. Many people are chronic carriers of infections in the oral cavity, limiting themselves to overloading the emergency department in case of an exacerbation, where they are often prescribed palliative antibiotic medication. In addition to not solving the pathology, it entails significant costs.

It should be noted that in 51 hospital centres, there are 27 Stomatology Services where 145 stomatologists work.

On the other hand, most dentists are self-employed in the private sector, as there is no career that allows these professionals to be integrated into the NHS staff. However, the lack of proximity responses in oral health has led some health centers to enter into “service contracts” with dentists; there are, today, around 135 to 150 dentists in health centers, providing primary care.

Interestingly, the number of dentists in Portugal, per capita, is 1 dentist for 884 inhabitants, more than double the number recommended by the World Health Organization, which is 1 professional for 1500 to 2000 inhabitants. Of course, as the market does not absorb them, more than 20% either emigrated (12.72%) or gave up the profession (7.96%), according to data from the Portuguese Dental Association.

Arrived here, there is still a huge need on the part of the population to receive oral health treatments in the SNS, which does not respond to these needs. Stomatologists work in tertiary hospitals and are scarce; on the other hand, and while there are almost no dentists working in the SNS primary care, the unemployment or underemployment of dentists reaches numbers never imagined.

The real encounter between patients and dentists or stomatologists is reserved for those who “can”. This is the true expression of waste and the inverted pyramid.

There is a great need for the training of integrated teams of dentists and stomatologists in the SNS, as well as the creation of more oral medicine offices, in health centers and in public hospitals.

Addressing the environmental aspect , we found that private offices, with the implementation of Decree Law 108/2018, which sets safety standards regarding protection against the hazards resulting from exposure to ionizing radiation (relative to our rx devices) combined with a evident lack of knowledge by its national editors of the reality of the Health sector, namely Oral Health and Veterinary Medicine, is proving to be impossible to implement, leading to the ruin and extinction, in a few months, of two sectors of human health and animal. I am also referring here to Veterinary Medicine, which has provided valuable services to the country and which in recent decades has had a development, recognized by all.

However, the aforementioned legal diploma hands over to the Portuguese Environment Agency (APA), the inspection body, which is neither more nor less than IGAMAOT - general inspection of agriculture, the sea, the environment and spatial planning, which inspects and imposes fines. , which can range from 24,000 to 5,000,000 euros. I ask: what do our little rx's do to the environment? Radiation is minimal, incidentally described in scientific articles. Does not make sense. If, on the one hand, Rx are essential diagnostic tools, the professionals who deal with these devices meticulously comply with the entire safety protocol. Concern for the environment has always been important for health professionals.

In blatant panic, dentists in the private sector cannot help but wonder: are public health establishments and private hospital groups subject to the same rigorous scrutiny as the imaging activity, or is this yet another attempt to crush small health providers? health?

Will the practice of Oral Medicine be the new nuclear disaster of the 21st century? Given the surprising possibility of fines in the order of tens of thousands of euros, which could reach hundreds of thousands, would it not be financially more reasonable to close dental practices?

From an economic perspective, it is imperative to try to assess the future financial impact of full coverage of the entire national territory, taking as a goal the existence of 1 dentist for every 1500 inhabitants on the poverty line, thus assuming a more universal and equitable access to oral health care.

Considering the need to hire 1379 professionals and an annual cost of €41580 per dentist + assistant (estimating €1600 + €800 of gross salaries + social charges), the financial impact for the total coverage of the population on the poverty line is €57,338,820 per year.

According to the State Budget report for 2021, it was expected that the Budget (consolidated revenue) of the Ministry of Health would amount to 12,565.4 million euros. It would thus be an increase of only 0.46%, and we would have served the fringe of the most needy population. I'm only talking about the most needy, because let's forget about a universal SNS that can serve the population as a whole.

Private oral health clinics are closing due to the bureaucratic impositions required and difficult to comply with, the millions of Portuguese who seek the SNS find a “band-aid” in all areas of medicine, and the chaos seems to last.

And because we must think of solutions, together with dariacordar/zerodesdicio, chaired by Paula Policarpo and where I am the oral health coordinator, we have a 360 sustainable project thinking about the three aspects of sustainability for oral health.

Also at SEDES, together with dentists and stomatologists, we wrote a document containing possible solutions for oral health, which will be published together with all the recommendations of the different groups included in the SEDES observatory.

Ana Sofia Lopes

 OBSERVADOR

743. Ministry of Health hires 9 out of 10 dentists on green receipts

The absolute lack of interest shown by the Ministry of Health in the oral health of the Portuguese population is revealed, for example, by the scandalous way in which it treats dentists who work for the SNS (9 out of 10 with green receipts).

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More than half of young dentists are dissatisfied with their profession, and if they could go back they would choose another career, and close to 25% intend to complete their studies in another area in order to practice another profession. The survey received more than 2,400 responses from a universe of 4,745 dentists registered with the Order under 35 years of age.
Most young dentists practice their profession in one (38%) or two clinics (26%). On average, 43% see between 6 and 10 patients per day and approximately 40% see more than 11 patients daily.
Only 17% of dentists under 35 years old claim to have a work contract. Close to 70% of respondents are self-employed without employees, that is, they work on green receipts. A situation that worsens for those who work for the State, almost 90% of young dentists placed in health centers or public hospitals are hired on green receipts, and almost half (48.9%) are hired through companies. 92.5% work in private clinics and offices, 4.1% in private hospitals and 2.4% in health centers.
In the private sector, the vast majority (78%) receive on a percentage basis, and of these, almost 55% earn between 31 and 40% of the value of the medical act. It should be noted that 92% of respondents reveal that they receive a percentage lower than 50%. Almost half (45%) of those who responded to the questionnaire took a year or more to earn an amount similar to the national minimum wage. Data show that more than 50% of young dentists have a gross monthly income of less than 1,500 euros (53%) and more than 70% have a net monthly income, that is, after discounts, below that same amount (74 %). More than half (51%) of young dentists receive less than 1,000 euros net per month.
The results of this survey are in line with the concerns that the chairman of the Portuguese Dental Association, Miguel Pavão, has publicly expressed about the excess of dentists and the underemployment conditions of younger professionals.
O Jornal Dentistry

742. OMD: Proposals for oral health presented to the Minister of Health

The Portuguese Dental Association (OMD) presented to the Minister of Health a proposal for the creation of a strategy and planning committee for oral health, with the objective of defining, in the short, medium and long term, proposals with effective responses to medical needs. -dental care of the Portuguese population.

The OMD intends to reformulate the National Program for the Promotion of Oral Health (PNPSO) and focus it on a logic of prevention and promotion of oral health, with a specific financing model, which makes use of different models of access to oral health care, whether public, private or the social sector.

For Miguel Pavão, chairman of the OMD, “oral diseases continue to be the health area most neglected by health systems, resulting in an oral health deficit for the Portuguese. Reversing this reality is complex and lacks a multidimensional approach that allows for a transversal and integrated articulation of public health policies, with a view to reducing the burden of oral diseases. It is essential in this equation to relate social inequalities, poverty and addictive behaviors and addictions in oral diseases”.

During the meeting, the Minister of Health recognized that it is a complex and difficult task to reverse the delays of several years of investment in oral health.

Among the proposals presented by the chairman is the creation of oral health units in all health centers, with the entry of dentists in the Regional Health Administration to lead the implementation and development strategy, in conjunction with the General Directorate of Health. The OMD wants dentists to manage the local and regional teams and even the national team of the PNPSO, which classically has been given to professionals without specific training in oral health.

The chairman of the OMD reveals that “we asked the minister to move quickly with the creation of the commission in order to resolve this patchwork of oral health in the SNS. It is important for everyone to understand that there is no general health without oral health. A maxim that has been forgotten. The SNS is over 40 years old, but the dental check was only created in 2008, and as a solution limited to some audiences. In other words, there is a huge delay in relation to other areas of health”.

The OMD defends the extension of the dental check to new segments, namely an emergency check for trauma and a review of technical aids for, for example, dental prostheses. The OMD also calls for a review of the value of the dental check, reduced since 2014, within the scope of the troika's financial rescue program.

Knowing that Marta Temido takes over the health financing dossier, Miguel Pavão questioned the minister about the allocation of funds for oral health in the State Budget for this year, which the Government will deliver this Wednesday to Parliament.

The chairman of the OMD recalls that “the government program approved in the Assembly of the Republic is very vague in relation to oral health. He has intentions, but nothing comes true. What we want from the Minister of Health is that she takes action, that she commits herself to a fixed budget for oral health in the State Budget, which can also additionally be financed with revenue from the tax on soft drinks. We want a fixed budget for oral health, we want to know where and how it is invested. It is the only way to guarantee that all Portuguese people have access to medical and dental care. Both the SNS and the private sector are part of the solution, the Government understands the need to address oral health in a more strategic, integrated and inclusive way”.

Ordem dos Médicos Dentistas

 

741. MIGUEL PAVÃO: "Oral health is being permanently postponed"

 

In an interview, Miguel Pavão, chairman of the Portuguese Dental Association, points out some necessary reforms in terms of oral health. This is the case of the reformulation of the dental check and the need for an effective integration of professionals in the National Health Service (SNS).

What portrait do you make of oral health in Portugal?

Oral health is something that is being permanently postponed due to what were the historical vicissitudes of not having been integrated into the creation of the SNS. It was a mistake at birth, which was hardly corrected and reversed. And it was forever postponed, because it was only in 2008 that there was an attempt to implement a project, which is the dentist's check, in which some steps were taken. But there was an ambition for the project to evolve and that ended up not happening. Simultaneously, there were disorganized and strategyless attempts to integrate dentists into the SNS. The ridiculous thing happened that there were ARS [regional health administrations] that set up dental clinics and never had a dental appointment. Then, there was a small leap in 2017, with the creation of the Oral Health for All project, by Minister Adalberto Campos Fernandes and Secretary of State Fernando Araújo, who, I would say, was the one who really took this cause and founded it, but who ended up not being able to complete the process because there was a government reform. With the entry of Minister Marta Temido, the process stagnated, and then a pandemic entered, which always served as an excuse. If there has been an evolution in the oral health of the Portuguese, it is due to professionals in the private sector.

Does the lack of investment in oral health in the SNS create inequalities in access to care?

As of today, and according to our barometer data, a large part of the population still does not visit the dentist and does not access dental offices. About 41% of the Portuguese did not visit the dentist in 2021. It means that there is a level of the population, which is very much in line with socioeconomic indicators of poverty, which still does not have access to dental clinics. What happens is a bipolarity in the access to care. Whoever has the economic capacity invests. On the other hand, we have a segment of the population that, due to lack of economic capacity, cultural level and literacy, does not have this possibility.

Almost 2.4 million dental checks were wasted. Should the project be rethought?

Completely. There was an important leap [with the creation of the check], but the truth is that the project did not evolve. In fact, it just went backwards. We cannot forget that, after the introduction of the troika, there was a reduction in the value, which has never been updated. Dental checks have been lost across the board. There have been no audits, there has been no ambition in the project and the Portuguese Dental Association, at the moment, feels quite incapable because it does not have interlocutors, either in the Ministry of Health or in the Directorate-General for Health, who say "let's work on this dossier". This is one of the weaknesses that we have been pointing out. I presented a proposal to the Minister of Health, before the fall of the government, for the creation of a working group for a strategic reflection on various dimensions of oral health.

A new agenda for post-pandemic oral health

The next legislature will be marked by political stability and PRR funds. What should be the priorities in oral health?
One of the priorities is the integration of dentists in the SNS and the reform of primary health care for oral health, where the creation of oral health units must also be formatted. We also have the dental check and the oral health program. And we have a third dimension, which cannot be neglected, which has to do with the preparation and planning of professionals who are linked to oral health. We train too many dentists, we have too few hygienists.

In 10 years, there was a 70% increase in the number of dentists. Do you defend the reduction of vacancies in universities?

Of course yes. It is not because we are increasing the number of dentists that the population is having more access to oral health care. What is lacking are truly programmed policies to achieve equity in access to medical and dental care. The World Health Organization launched, in 2021, a resolution that will influence until 2030 an attempt that Member States can really adapt health professionals to a more preventive intervention. From our point of view, there must be planning and a strategic vision of measures, in which we have to reduce the number of vacancies for dentists in medical and dental schools and prepare, so that there is training and qualification of other aspects, such as more community and preventive intervention.

Jornal de Notícias

 

740. SMD calls for unionization

In a short video published on its Facebook page, the Dentists Union (SMD) calls for the registration of professionals in the sector. 

With the slogan “Together we are stronger”, the SMD intends to capture the attention of dentists for an active participation in the sector. For those interested, the SMD provides a Registration Form with the union. 

The SMD has been very active in its actions with the holding of a webinar on “labor relations in dentistry” and a meeting with the ADSE on the “Agreed Regime of the ADSE provider network and within the scope of the Regime”. 

More recently, the union's actions included the holding of the Odonto Summit where “The State of the Class” was debated and the presentation of a complaint to the Ombudsman about the “contractual illegalities of Dentists in the National Health Service”. 

dentalpro 

739. PORTUGAL IS NOT JUST LISBON: Free oral health for children and young people

Since it opened two years ago on Avenida Almirante Reis, SOL – Saúde Oral in Lisbon, a service of Santa Casa da Misericórdia, has already attended to more than 9,000 people of 38 nationalities and carried out 40,000 free consultations.

Are you between 0 and 18 years old and need to go to the dentist? If you live in the capital, you have access to the free services of SOL – Saúde Oral em Lisboa, an equipment of Misericórdia de Lisboa whose main objective is to prevent the oral health of children and young people.

To register for the various types of consultations, simply present your identification document and confirm your place of residence and age.

According to André Brandão de Almeida, coordinator and clinical director of SOL, the work developed over these two years has been more in the context of treatment than prevention. The objective is to change this reality, that is, to make the response increasingly involve prevention, early treatment and changes in habits.

One of the most recent studies and projects developed by SOL, on eating habits during the period of confinement, reveals that children ate more sugary products and more fresh fruit than usual. Another conclusion: during the time they stayed at home, the children changed the frequency with which they brushed their teeth.

SIC Notícias

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Santa Casa da Misericórdia has gambling recipes nationwide. Isn't it ALSO YOUR OBLIGATION to provide the same oral health support service to all children nationwide, without discriminating where they live?

 

738. President of dentists warns of calamitous oral health cases in the country: there are young people aged between 25 and 30 who no longer have any teeth in their mouths

 

Three out of ten people in Portugal do not have access to oral health, warned the president of dentists today, reporting "calamitous" cases such as 25-year-olds without any teeth and elderly people who have never entered an office. Over the course of four days, Miguel Pavão evaluated the conditions of dentists who work in various health units of the five Regional Health Administrations (ARS) in the country, in an itinerary that ended today with a visit to the Damaia Health Center, municipality of Amadora, district of Lisbon.

At the health centre, where the president of the Lisbon and Tagus Valley ARS, Luís Pisco, was present, the chairman of the Portuguese Dental Association (OMD) took stock of the "Dental Medicine in the SNS" roadmap, starting by alerting that the goal of the "Oral Health for All Project" for 2020 has not been met. The goal was for all health centers to have the possibility of having a dentist, but in 2021 the OMD "went to the field, traveled around the country, and realized that this design is to be fulfilled", Miguel Pavão told the Lusa agency. Only 40% of the territory is covered in terms of dental medical assistance, he pointed out, justifying that, of the 278 planned health centers, only 132 are operating with a dental office.

During the tour, Miguel Pavão observed situations of "very calamitous oral health": "There are young people between 25 and 30 years old who no longer have any teeth in their mouths. It is worrying these days to witness this reality". On the other hand, in the countryside, there are "very old people" who have never had the opportunity to go to the dentist, he said, arguing that this "is an opportunity" to finally have access to dentistry. However, he defended, this response needs to be complemented with the part of oral rehabilitation, which involves people being able to put on dental prostheses, a possibility that the OMD will present to the Government, through public-private partnerships.

Miguel Pavão explained that dentists, who have a network of private providers throughout the country, can provide this service in "a shared way, either by the user or by the budget of the Ministry of Health". He also said that during the script he found "a major discrepancy" between the ARS, and that "there is no truly grounded and oriented strategy for dentistry".

The chairman said that the Center was the region where he saw "a lot of deficit and a lot of difficulty regarding the issue of oral health", but he noted that "it is not good" to compare who "goes more advanced". But he said there are "good examples" that could be replicated: "In Lisbon and Castelo Branco I saw oral health units created that have to be a precursor example of what will be scaled, disseminated and disseminated so that dentistry is a vigorous reality and a capable response that the Portuguese can trust". "Dentists have a very important private service network, there are co-payments and models that are in place and there are others that can be created, but this answer in the SNS does not duplicate the answer, because 30% of the Portuguese population do not have care and still do not has access to the dentist", creased. This is "a socially disadvantaged population", which covers 2.3 million Portuguese who need oral health support, which "is fundamental for social inclusion and employability", he said, considering that this "is a cause national. Present at the visit, Inês Monteiro Filipe, a dentist in a public health unit, and who is part of the regional group of Oral Health of ARSLVT, defended that it is necessary to guarantee equity of access to the population. "We have municipalities with a high population density and with a dentist and we have municipalities with a smaller population density with a dentist as well and, therefore, it does not guarantee equity of access", he stressed. According to the dentist, the medium and long-term project is to increase the capacity of Dentistry in these municipalities to reach a time when there is no family dentist, but "a dentist for most of the population that has this need". Currently, he said, "we have 37 offices already set up in 26 municipalities, there are 52 in ARSLVT, and until the end of this month,we expect the opening of 12 more and by the end of the year the opening, if not all, of most".

HN // HB

SAPO