When will the "cliff-style" price reduction of dental implants come?
Reporter investigates issues such as expensive dental implants, false propaganda
Editor's note
A dental implant can cost as little as a few thousand yuan, and as many as tens of thousands of yuan—the price of dental implants is expensive, and it has always been a pain point for people's livelihood.
In the dental implant market with huge demand, there is a large degree of pricing freedom, information asymmetry, decomposition charges, false propaganda, etc., making dental implants the hardest hit area of today's "expensive medical treatment".
On August 18, the National Medical Security Administration announced the "Notice on Carrying out Special Treatment of Oral Implant Medical Service Fees and Consumables Prices (Draft for Comment)".
It can be said that this is a signal that the country has begun to rectify the chaos in the dental implant market, and it is also an inevitable requirement for the localization of medical services.
To this end, this newspaper investigates and sorts out industry problems in the field of dental implants in recent years and many topics of public concern, interviews industry practitioners and relevant experts, and presents various status quo of the dental implant market, in order to effectively control the market chaos.
Our reporter Han Dandong
Our trainee reporter Zhang Shoukun
Our intern Gao Ruiying
"I knew that dental implants were expensive, but I didn't expect it to be so expensive. Two teeth cost nearly 50,000 yuan." Ms. Yuan from Shanghai told the "Rule of Law Daily" reporter that because of a problem with her two upper left teeth, she came here in February this year. Going to a dental clinic, the examination confirmed that the root of the tooth could not be repaired, and the doctor suggested that she choose dental implant surgery.
In terms of hospital charges, Ms. Yuan saw that the cheapest implant for a tooth was 10,000 yuan.
After thinking over and over again, Ms. Yuan chose Swiss ITI implants, which cost 12,000 yuan per tooth.
"The doctor said that this implant is better in terms of hardness and corrosion resistance. If you choose a cheap dental implant, the implant may break or fall off after a period of time, and you will have to spend money and suffer." In the end, Including the cost of bone implants, Ms. Yuan spent 48,000 yuan on two implants.
Dental disease is a problem that many people will encounter, and the high cost of dental implants is a common problem that plagues the general public.
This people's livelihood issue has attracted the attention of the relevant state departments. On August 18, the National Medical Security Administration announced the "Notice on Carrying out Special Treatment of Oral Implantation Medical Service Fees and Consumables Prices (Draft for Comment)" (hereinafter referred to as "Draft for Comment"). ), open to the public for comments.
This is a signal that the country has begun to rectify the "expensive medical treatment" and related chaos in the dental implant market.
After the "Draft for Comments" was released, it caused a heated discussion among the public, and some netizens commented that "expecting a substantial reduction in the price of dental implants".
Why are dental implants so expensive?
Why do some dental clinics offer only a few hundred yuan for a dental implant, and why does the price difference come from behind?
Will there be a "cliff-style" price cut in the future?
Around these issues, the reporter conducted an in-depth investigation.
Severely missing teeth are in high demand for dental implants
The price difference is reflected in many aspects
The high cost and high time cost of dental implants have become the heart disease of many patients.
"I didn't expect the dental implant market to be so popular. It took me more than a year to get a dental implant in Beijing." Wang Rui, who works in Beijing, told reporters.
In March last year, Wang Rui discovered that he had a lump on his gums. After going to the dental hospital for an examination, the doctor suggested that he do an implant surgery within six months after the bad tooth was pulled out to solve the problem once and for all.
In order to ensure the success of the operation, after the tooth extraction, Wang Rui chose a relatively well-known public hospital for implant surgery. As a result, it took him almost 4 months to make an appointment.
Although the appointment was made, Wang Rui learned that the implantation operation on the expert number he had signed would take more than 8 months, so he transferred the number to another doctor.
After blood draws, radiographs and routine examinations, Wang Rui waited for 6 months before he was listed for surgery.
Because the bone under the extracted tooth was empty, it took another 5 months for debridement and bone meal implantation.
In July this year, Wang Rui finally had an implant surgery.
"It took more than a year before and after, and the various expenses added up to 20,000 yuan per tooth. I took more than ten times of leave and made four or five hospital appointments. The energy spent on it cannot be measured. Protect your teeth." Wang Rui said.
What happened to Wang Rui can be said to be a common phenomenon.
Recently, the reporter consulted a number of dental hospitals and medical institutions in Beijing, Tianjin, Shanghai and other places. Some of the hospitals said that they had no materials and could not do implant surgery in the near future.
Dental implant surgery is popular because of the serious problem of missing teeth.
The results of the Fourth National Oral Epidemiological Survey showed that among adolescents, the rate of missing teeth was about 25%; among middle-aged people, the rate of missing teeth was about 36%; among the elderly, 86% had missing teeth.
Wang Lin (pseudonym), a doctor from a private dental hospital in Beijing, who has more than ten years of experience in dental implants, introduced to reporters that dental implants are based on the lower structure implanted in bone tissue to support and retain upper dental restorations. Dental implants consist of a lower implant and an upper restoration.
Dental implants generally require two-stage operations. The first-stage operation is to cut the soft tissue of the missing tooth after local anesthesia and disinfection, locate and drill holes on the alveolar bone, and place the implant to make the implant and the alveolar bone. A bony union is formed and then the soft tissue heals, a process that takes about 3 to 5 months.
The second-stage operation is to replace the screw cap with a healing abutment on the implant, so that the healing abutment is exposed in the oral cavity, and then the restoration, that is, the crown, is installed on the healing abutment.
Judging from the quotations of different medical institutions, the price range of a tooth implant is very large. At present, the price of dental implant surgery on the market is between 8,000 yuan and 22,000 yuan per tooth. This price includes material and service fees.
"Dental implants are a strict medical technology, and patients need to undergo oral surgery. There are standardized inspection and treatment procedures before, during and after surgery, and each patient's treatment plan is highly individualized and refined. Before surgery, you should have in-depth communication with the doctor, fully understand your own situation, treatment plan, postoperative risks and treatment costs, and then decide whether to accept dental implant treatment. Generally speaking, implants can be used under the condition of regular inspection and careful care. 10 to 20 years." said Zhang Jian, vice president of Tianjin Stomatological Hospital and a standing member of the Oral Implantation Committee of the Chinese Stomatological Association.
On August 26, the reporter saw on the medical fee list of the implantation center of Tianjin Stomatological Hospital (Nankai University Stomatological Hospital) that the cheapest artificial tooth root implantation is 8,000 yuan per piece, and the most expensive artificial tooth root implantation. It is 18,000 yuan a piece.
A doctor who is examining patients told reporters that the price of a dental implant on the market usually consists of two parts: material cost and service cost, including preoperative inspection, tooth extraction cost, surgery, crown cost, etc. If If the bone condition is not good or encounter other conditions, other costs may be added.
"Therefore, the difference in the price of dental implants is reflected in the material of the implant, the level of the hospital, the technical level of the doctor, etc." Zhang Jian said.
False propaganda in the dental implant market is rampant
Doubtful about low-cost dental implant qualification materials
At the end of 2020, Ms. Lin from Shenzhen, Guangdong underwent dental implant surgery in a dental clinic.
Ms. Lin told reporters that she chose this clinic because she liked the advertisement of the clinic's lifetime warranty.
Unexpectedly, in the past year, Ms. Lin's implant crown has a quality problem. When she went to the clinic to solve the problem, she was told that her implanted teeth were not guaranteed for life, and the lifetime warranty was only for implants.
The difference between the words "implant" and "dental implant" made Ms. Lin feel like she was being fooled.
In addition, the two doctors before and after gave different explanations for why Ms. Lin’s crown cracked: one doctor said that her teeth were too long, which caused the implants to crack easily, but Ms. Lin never treated this problem in the clinic. was mentioned; another doctor said that the implant had not been properly adjusted and that it had cracked.
"If it weren't for the fact that I listened to the clinic, I would not have chosen a dental implant with a 'lifetime warranty' that is more expensive than ordinary dental implants. This is obviously a misleading consumer by the clinic." Ms. Lin said.
During the investigation, the reporter found that there are many similar false advertisements.
In March last year, when Ms. Xia from Nanjing, Jiangsu inquired online about the price of dental implants in a dental clinic, she received a reply that she could plant two teeth for less than 3,000 yuan.
With suspicion, Ms. Xia came to the agency, but the staff told her that she needed a total of more than 6,000 yuan.
Ms. Xia believed that if two teeth were planted at this price, it would be cheap in the market, so she chose to pay for treatment and performed a first-stage operation on the same day.
When she went to the hospital to remove the sutures in April last year, the hospital told Ms. Xia that she must pay more than 500 yuan again, and promised that no additional fees would be required in the future.
When waiting for the second-stage operation a few months later, Ms. Xia was told that she would need to pay another 4,000 yuan for the operation.
"According to the hospital's propaganda, it cost more than 10,000 yuan to do things that could have been done at 6,000 or 7,000 yuan. I don't know if the cost will be increased in the future. Now I don't believe the hospital's words, and I'm currently asking the other party to compensate the difference. "Ms. Xia said.
In addition, on social platforms, there are many advertisements for low-cost dental implants or even free dental implants.
But when a reporter leaves personal information or calls for consultation, the other party's quotation immediately becomes the market price.
In addition to decomposing the cost and charging other fees in the later treatment, the reporter found in the survey that there are indeed two or three thousand yuan in the market for dental implants, and the cheapest price is only more than 900 yuan.
Can such dental implants be used?
What problems or risks might exist?
"The price of dental implants is composed of consumables and service fees, and reducing the price can only be done from these two aspects. If the price of dental implants is too low and there is no additional cost in the future, there may be doctors who do not have relevant qualifications, and the implants may be based on Shoddy 'parallel imports', or illegal implants processed by underground factories." A doctor in the industry revealed to reporters that although cheap dental implants dare not say that there are 100% problems, the quality of implants and the level of medical security are definitely not guaranteed.
In order to strengthen the management of oral implantation technology in my country, standardize the clinical application of oral implantation technology, strengthen the medical quality management and control of oral implantation technology, and ensure medical quality and medical safety, the former National Health and Family Planning Commission formulated the "Oral Implantation Technology Management Specification". Make basic requirements for dental implant medical institutions and physicians.
As far as medical institutions are concerned, there should be stomatology diagnosis and treatment subjects approved and registered by the health administrative department, and the clinics used for oral implant surgery should be independent clinics, etc. The scope is stomatology, and the stomatology practitioners with a bachelor's degree or above in stomatology should also undertake relevant study and training before engaging in dental implant diagnosis and treatment activities; work in a professional dental implant department established by a medical institution for more than 3 years, and Physicians who specialize in the clinical diagnosis and treatment of dental implants are exempt from training.
It is understood that the proportion of dental implant doctors in general dental hospitals is about 30%. During the interview with reporters, some hospitals said that all dental doctors can perform dental implant surgery, but when the reporter asked what qualifications dental implant doctors should have, The other party could not give a clear answer, but only emphasized that "I have experience and have done it for many years."
Wang Lin said that the implantation operating room has high requirements in practice. It should be spacious and bright, with standardized design, strict disinfection, sterile and dust-free to avoid pollution, air filtration in the purification layer, and digital control of temperature and humidity. Before the doctor enters the operation, it needs to use Wash the entire hands, arms, and elbows with disinfectant water, follow the seven-step hand-washing method, and then wear sterile surgical gowns.
In addition, the implant doctor must have a general thinking mode, a comprehensive treatment concept and overall plan design control awareness.
"In reality, there are indeed situations in which the operating environment and site are not up to standard, the sterilization of medical devices is substandard, and the techniques of planting doctors are substandard," said Wang Lin.
Commercialization makes dental implants tricky
Whether the price of dental implants can be reduced remains to be seen
Why is there so much chaos in the dental implant market?
In the opinion of Deng Liqiang, executive director of the Chinese Society of Health Law, dental implants are classified as dental restorations and belong to the scope of beauty, while the beauty industry is a relatively developed field of medical commercialization, with a large degree of freedom in pricing, while information asymmetry, decomposition charges, etc. make charges In the process, the tricky things increase, and it is difficult to verify the implants after they are shoddy.
"The combination of the above phenomena will make consumers lose their judgment in the choice and price of dental implants, and thus fall into the chaos of dental implants." Deng Liqiang said.
In order to standardize the charges for dental medical services and consumables, recently, the National Medical Insurance Bureau has successively issued documents to rectify related problems: on the one hand, it has decided to carry out special treatment of dental implant medical service charges and consumable prices; on the other hand, it has launched a nationwide price survey. Register for work.
Before the price survey was released, Ningbo, Cixi, Zhejiang, Bengbu, Anhui and other places had already conducted a small-scale dental implant negotiation pilot.
For example, in Bengbu, Anhui, the price of the complete set of dental implant materials dropped by up to 89.5%, and the lowest price limit for dental implant projects was not higher than 1,800 yuan per piece, setting a new record for the lowest official price of dental implants in the country; Zhejiang Ningbo limited the price of dental implant consumables to domestically produced 1,000 yuan, 1,500 yuan for imports, and 2,000 yuan for medical services in medical institutions (level 2 and below), with a price reduction of 60%.
If the consumables fee and service fee are billed separately, can the price of dental implants be reduced?
Recently, experts from the National Medical Insurance Bureau said in an interview that the biggest obstacle in the collection of dental implants is that the price of implants only accounts for a small part of the entire operation cost.
If the price of implants is only cut off, various hospitals can completely increase the cost of surgery.
To carry out statistics on the cost of the whole process of dental implants in many places, it should be to comprehensively manage related costs such as dental implants and dental implant surgery fees.
In fact, the pilots in Ningbo, Zhejiang, and Bengbu, Anhui did not put forward specific requirements for doctors, but only generally stated that price reductions would not reduce technical services.
The "Draft for Comments" also clarifies that it is necessary to "adhere to rising and falling, and straighten out the price-comparison relationship of relevant medical services."
Experts interviewed also believe that whether the price of dental implants can be reduced, or the “cliff-style” price reduction as expected by the people, still needs to wait for the implementation of specific policies.
"The price of medical services should take into account my country's national conditions. In my country, the basic concept of determining the price of medical services is low level and wide coverage. At the beginning of its development, prosthodontic implants have a certain connection with foreign countries, but this connection is carried out at a high starting point. It is not compatible with my country's overall consumption level. Therefore, this government's governance is an inevitable requirement for the localization of medical services." Deng Liqiang said.
According to Wang Yue, deputy dean of the School of Medical Humanities of Peking University, in addition to strengthening the control of chaos in the dental implant market, it is also necessary to strengthen the guidance of oral prevention, such as allowing the public to establish healthy teeth cleaning habits.
"The focus of work should be more on the prevention of dental diseases, rather than on the treatment of dental diseases. How to use the price lever and the baton of the price to make the common people get sick later and less sick, this is the core content of the medical and health system reform. We should focus on prevention, not treatment as before," Wang Yue said.