The author of this article: to crisp
Dental implants are finally bidding farewell to the era of 10,000 yuan a piece?
Recently, the Zhejiang Provincial Medical Insurance Bureau issued the Notice on Regulating the Price Items of Medical Services such as Oral Implants and other Medical Services and policy interpretations. According to the document, the total price of a single routine planting process in public medical institutions does not exceed 4,320 yuan, and it will be implemented from April 1.
Source: Zhejiang Provincial Medical Security Bureau
The price of the whole process service, that is, the total of all the fees including consultation fees, biochemical tests, imaging examination fees, implant implant fees, crown placement fees, scan design modeling fees, anesthesia fees, and drug fees.
"The original total price of imported dental implants was about 17,000 yuan, but it may only cost 7,000 yuan under this set." Zhou Qi, a master of stomatology from a southern province, explains.
One tooth, from 30,000 yuan to more than 7,000
"A tooth, a suite." In the past, expensive was the most direct impression people had of dental implants. In recent years, many places have also explored the price control of high-value dental medical consumables.
As early as around 2015~2016, many places in Zhejiang Province have supported the use of medical insurance personal balance account funds to pay for dental implant costs. In 2021, the Ningbo Medical Insurance Bureau further reduced the price of dental implants in the medical insurance catalogue to 3,000 yuan per domestically produced and 3,500 yuan per imported one.
According to the results of the fourth national oral health epidemiological survey [1], 37% of adults and 86.1% of the elderly in mainland China have tooth loss, but the overall proportion of tooth missing restoration treatment in mainland China is only 63.2%.
A survey of 3,260 elderly people in Shanghai [2] showed that 29.7% of the elderly had a need for dental implants, and the high price was the number one reason for not receiving dental implants. Another study that analyzes the cost of dental implants in Shanghai dental institutions shows that the price of a full set of consumables for dental implants is about 19,000~26,000 yuan, and if you add related examination fees, diagnosis and treatment fees, the average medical cost of dental implants is about 30,000 yuan.
Origin, market positioning and price of major implant brands
Source: Reference 3
In September 2022, the National Medical Security Administration issued the Notice on Carrying out Special Governance of Oral Implant Medical Service Charges and Consumables Prices to further standardize dental medical services and consumables charges.
The cost of oral implants is roughly divided into three parts: implants, crowns and medical services. The Notice stipulates that the target for the whole process regulation and control of the medical service price of a single conventional implant in tertiary public hospitals is 4,500 yuan (referring to the sum of the prices of medical services such as outpatient consultation, biochemical tests and imaging examinations, implant implants, and crown placement). The price of the implant and crown parts needs to be generated through centralized procurement and auction listing.
Source: Xiamen Municipal Medical Insurance Bureau
In January this year, the centralized procurement of oral implant systems led by the National Medical Insurance Administration and led by the Sichuan Provincial Medical Insurance Bureau opened bids in Sichuan. The average winning price of the products to be selected dropped to more than 900 yuan, an average reduction of 55%. In March, the Sichuan Medical Provincial Insurance Bureau took the lead in launching the oral crown bidding network, and the maximum effective declaration price of participating enterprises ranged from 234 yuan to 820 yuan, which is expected to land in the first half of the year.
For the cost of medical services, each region will set a certain margin ratio according to the region and hospital level. For example, Shanxi Province has a regulatory target of 4200 yuan; Zhejiang Province leaves a margin of 4%, that is, the total price of the whole process does not exceed 4320 yuan. (Note: All of this refers to the cost of single conventional planting)
Source: Sichuan Provincial Medical Insurance Bureau
"The total service fee is 4,500, the cost of implant and abutment materials is less than 2,000, and the cost of crown materials is about 700, which adds up to about 7,000 yuan." Zhou Qi said, "This is still the price of Swiss implants with imported zirconia crowns, and the total price originally required about 17,000 yuan. Before the document was issued, we estimated that we could reduce the price to 10,000, but now it seems that we are conservative."
After collection, more patients choose to "pull the seed"?
As soon as the news about the centralized procurement of dental implants came out, everyone expressed their expectations for it. There are even many people who only wait for the price reduction before planting teeth.
Source: Lilac Garden comment area message
The price of a single dental implant fell to less than 10,000 yuan, some people are happy, and some people are worried. Yan Xiao, an oral implantologist at a third-class hospital in a first-tier city, said he was worried that such a sharp price reduction would bring about "excessive dental implantation" in the clinic.
Traditionally, the patient's natural teeth should be preserved as much as possible, because no matter how good the implant tooth is, it cannot be restored to the exact same condition as the natural tooth. However, in the actual clinical situation of oral cavity, the prognosis of many affected teeth is difficult to completely determine, and there are many cases where teeth can be preserved or not, such as completely healthy premolars can be extracted due to orthodontic needs. Therefore, the formulation of a good treatment plan should fully consider the patient's subjective wishes and objective situation.
In Yan Xiao's view, after the collection of dental implants, for the functional teeth that can be retained after treatment, some patients may be more inclined to "extract the seed", which may also affect the doctor's decision.
"The overall success rate of root canal treatment is about 70~90%, and it takes a long time and is expensive, and the cost of a full set of root canal treatment plus repair in a third-class public hospital in a first-tier city is about 5,000 to 6,000. The success rate of dental implants under the operation of professional doctors can be more than 98%, and the comfort and life expectancy of use are close to those of natural teeth."
Yan Xiao said that if the price of dental implants is close to or even lower than root canal treatment, then some patients may be more inclined to extract teeth for dental implants, thus subjectively losing the willingness and degree of cooperation for treatment.
Jia Le, a dental doctor at a third-class hospital in Sichuan, does not think that there is a need to worry about the situation of "pulling out seeds". "Dental implants can only be replaced when root canal treatment for a patient is difficult, requires apical surgery, takes a long time, and the prognosis is uncertain. For problems that can be solved by root canal treatment, it is not appropriate to replace it with dental implants. The choice of treatment is determined by the disease itself, not by the cost of the treatment plan."
Similarly, according to Yue Ming, a dentist in a private hospital in North China, with the expansion of everyone's demand for oral medical services in recent years, the awareness of oral care health care is also increasing. "At least from my own patients, they all choose to preserve their teeth as much as possible."
Will private and public competition change after service prices are reduced?
Of the three components of dental implant costs, the dentist's main income depends on the cost of services in them. The fee standard of 4500 is to combine the doctor's operation fee and examination fee.
"More than 200 preoperative blood tests; Panorama + CT preoperative and postoperative at least 2 times, 360 yuan; anesthesia costs more than 100; Digital mouth sweep mold 500 yuan. In this way, the actual operating costs of doctors are not much." Zhou Qi explained that the cost limitation may also be detrimental to the promotion of new digital technologies: "If you want to design and use digitally-assisted implant surgical guides, it may be equivalent to doing it at a loss."
On the one hand, doctors in public hospitals are worried that the restriction of service fees will reduce the enthusiasm for clinical operations to a certain extent; On the other hand, doctors in private hospitals are worried that after losing their price advantage, patients will gradually lose to public hospitals.
According to the 2020 China Health Statistics Yearbook, by the end of 2019, there were about 885 dental hospitals in the country, of which 723 were private specialized hospitals, accounting for 81.69%.
Changes in the number of dental hospitals nationwide
Source: Reference 4
For a long time, private hospitals have occupied a dominant position in the field of oral implantology. In terms of the procurement of consumables, the purchase price of private hospitals is generally lower than that of public hospitals. For example, in a Swedish planting system, which is currently the most expensive planting product, the average procurement cost price of private institutions is about 58% of similar products in public hospitals; For a low-to-medium implant system like a Korean brand, the purchase price is only 55% of that of public hospitals [3].
After the adjustment of centralized procurement and service fees, the original price difference advantage of private hospitals is no longer available, and patients may tend to choose public hospitals. And in order to save patients, will private hospitals also reduce prices?
"It is true that many patients do come to consult whether the price will be reduced, and there will be patients who are waiting and seeing. At present, our hospital has not adjusted its prices, and it will take some time for the documents to be implemented in many places." Yue Ming, who works in a private dental hospital, is optimistic about the collective procurement of dental implants, "and not only dental implants, but also orthodontics and restoration may slowly enter the centralized procurement, which is also a trend."
In Yue Ming's view, there may be a flow of patients with this price trend in a short period of time, but the final flow of patients is unknown. "The operational thinking of private and public hospitals is still different. And no matter which hospital you are in, in fact, everyone is not comparing the price in the end, it must be the quality of medical services."
In the article, Zhou Qi, Yan Xiao, Jia Le, and Yue Ming are pseudonyms.
Curator: AME | Executive Producer: Gyouza
Source: Visual China
Bibliography:
[1] Wang Xing. The fourth national epidemiological survey report of oral health[M].People's Medical Publishing House,2018.
[2] ZHANG Shuyu, DONG Hua. Investigation on dentition defects and repair status of elderly population aged 65~74 in Jiading District, Shanghai[J].Shanghai Journal of Stomatology,2018,27(5):522-525.)
[3] YUAN Suwei, ZHANG Lili. A comparative study on the cost of dental implants in public and private dental institutions:Based on a typical case study in Shanghai[J].China Health Economics,2022,41(3):60-62.)
[4] TF Securities. In-depth company research. Tongce Medical. Leader of private dental medical groups