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Old 08.06.2015, 16:30
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Dentists

While the dental services are highly expensive in Switzerland and people prefer to travel to nearby countries for cheaper services, my question is how the dentists earn money then?!!

You can wait for one person in a month and earn 1000CHF or you can see 5 people in a month and take 300CHF for each. Which one is preferred??!! This is an unrealistic example though....
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Old 08.06.2015, 17:02
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Re: Dentists

While we're happy to travel for the dentist, the locals I know won't do it.
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Old 08.06.2015, 17:57
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Re: Dentists

Decent dentists are pretty busy. I think they're pretty happy with the cost/customer ratio. "Bargain Dentist" doesn't really have a ring to it.
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Old 08.06.2015, 18:11
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Re: Dentists

Not quite sure I understand your post- but as said above, good dentists are not short of customers. Our dentist in just on the other side of the border, 5 mins away- he is VERY VERY busy, and very good too. He is not cheap, but cheaper than the local Swiss dentists (that are further away from us).

A recent article in the French speaking consumer magazine, 'Bon à Savoir' does expose the massive differences in cost for the same treatment in Switzerland- the highest prices being for the so'called 'clinics' with longer hours and week-end work- for the same treatment. So caution is required to balance quality versus cost (talking about 4 x the cost for some).
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Old 08.06.2015, 20:12
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Re: Dentists

Yes I understand that. I said, if people prefer to go out side switzerland for their tooth, then the dentists inside switzerland become idle and I think it is better for them to change their profession!
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Old 08.06.2015, 22:32
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Re: Dentists

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While the dental services are highly expensive in Switzerland and people prefer to travel to nearby countries for cheaper services, my question is how the dentists earn money then?!!

You can wait for one person in a month and earn 1000CHF or you can see 5 people in a month and take 300CHF for each. Which one is preferred??!! This is an unrealistic example though....
I think you're overestimating the number of those who prefer to travel for dental services. Yes, there are people who do that (especially cheap expats he he, I'm kidding of course), but most don't because it's not practical (time wise) if you don't live close to the border....as for the prices yes they are high but so are the salaries.
Plus I suppose the swiss are just like everyone else and develop some sort of loyalty for "their" dentist, "their" GP etc etc. It's always better what you know.
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Old 08.06.2015, 22:51
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Re: Dentists

I respect such loyalty which is good indeed. I asked that since i saw prior discussions...

Anyway.... Swiss people are among top 3 in the world in my opinion

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Old 10.06.2015, 12:24
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Re: Dentists

Let me bring some insider perspective as my wife (the dentist) and I (corporate finance dude) own a practice in Cham.


First, let's start with your initial question: why is the dentist waiting for 1000 CHF patient versus seeing 3 people for 300 CHF each. Clearly behind the premise of your question lies the thought that the dentist has 0 variable costs per patient so what he gets is pure margin. Now, stop and think whether that is realistic. Take cement for example. You can buy a whole bag of 30 kg for 50 CHF at Coop Bau. But the moment the word 'dental' appears on the bag, pricing goes haywire - the typical dental cement costs 100 CHF for 5 g, while the more specialized cements go for 550 CHF for 2 g.


On a side note, we have a bit of a personal drama on the cost of components. My wife is German-educated and prior to private practice here worked as a lead Prosthetics dentist for 7 years at a University hospital (in Germany). This University/research background is driving me, the US corporate finance guy from manufacturing, insane as she does not know how to compromise on cost of components. She always goes for products from companies that can show results from scientific studies on their materials. Those happen to be the expensive products. Budget options? She won't compromise if there is no study-evidence on the product.


Now this is important as we follow the pricing guide set by SSO - the Swiss Dental Association. Given that our point factor is low - we are in Cham, not downtown Zurich, so we have to adjust to customer base - there are a few procedures that are loss-makers even at variable cost level... Ok, I digressed here. The point being is that most dentists in Switzerland adhere to a pricing guide set by the dental association; such practice exists in many other countries, though for countries with a central payer (like in Germany or the UK) the dentist can charge different prices for what the central payer pays versus what the private payer pays. In SSO price guide each part of the procedure is worth a specific number of 'points', which get multiplied by the point factor to arrive at a price for the patient. So the math is: take the points for a procedure (say, 35) multiply by the point factor (in our case 3.3) and price you charge the patient is 115.5 CHF. Now, here and there some dentists may overcharge by adding procedures that were not done, but these are limited cases and are cases of 'fraud' that doesn't only happen here, but can happen everywhere.


As for comparisons with cost in Germany... There is a bit of a fact and fiction. About 27% of our patients are German expats. The border is 45 min away. If we charged so much more than what the dentists at the border charge, we won't have these patients, would we? We give patients the option of the lab work being done by a Swiss lab or by a German lab. The trade-off is timing (work can be complete in 1-3 days versus 1-3 weeks) and cost (yes, the German lab is cheaper, on some procedures 50% cheaper, as the lab scale is much different).


There are dental tourism options even further than Germany. There is advertising from dental clinics from Hungary, Poland, Bulgaria, etc. I am sure there are great stories of happy patients - we only see the bad ones as new patients come in with complications after such dental tourism. Which is why dentistry is such a loyalty-based business. You are not getting a pair of shoes, which you can simply throw away and buy a new one if these get torn in a few months. My wife had a very interesting case (she still gets exulted when she gets complicated Prosthetics cases) a few months back with a new patient who came in after his upper jaw structure broke. Turned out the structure was 3-yr old and was done incompetently; the problem wasn't just the cost of the structure, but that the way the structure was constructed had resulted in significant bone erosion over these years. The initial work was done in ... Switzerland ... by a German dentist; one of those 'get in, maximize profits, sell out' practice examples that are, sadly, not infrequent. Then there was also a new patient who came in after her extensive dental work, done in Hungary, broke off after less than a year. It was planned very poorly, with 4 of the 6 implants set incorrectly. My wife attempted to use 2 of the implants ... except the patient was not given an implant book nor any record as to what type of implant was used. Why is that important? Because an implant is a screw; to build anything on it, you need to put it on a bolt that is part of the 'system.' Systems from different makers are proprietary, so a bolt from one will not fit the screw from the other. The dental office in Hungary refused to provide what implant systems they work with - likely because they use grey market implants from China. So the implants had to be removed and, after bone-regeneration procedure, new implants had to be put in.


This post is getting much longer than intended. To answer your question succinctly, dentists in Switzerland are adhering to pricing set by the dental association and their point factor; the lower the point factor, the lower the overall price of the procedure. The dentist, like most businesses, also incurs variable costs with each patient. Finally, the cost of bad quality in dental work can be significantly higher than the initial investment so dentistry is very much a relationship business, rather than purely a pricing-driven business. From personal experience: over the last 2 years we doubled the number of patients; all the advertising combined, including discounted coupons, accounted only for 10% of that growth, while 90% has come from referrals (i.e. not due to a monetary incentive). So though there is plenty of discussion on 'price' alone, most people understand value quite well and quality is a big component of that value proposition. And though from a pricing perspective it is difficult to comprehend why two of our German patients or a French patient (a nun, who always brings exceptional wine that makes me eternally grateful for her visits) travel over 800 km twice a year to see my wife, when there are thousands of dentists in-between, there must be a value for them, as they have been seeing her for many years. Thus good dentists are busy, be it in Switzerland, Germany, Hungary, Poland or Bulgaria. They are even busier in the US ... but that is a protected market and a different discussion. :-)


Wow, this post did get quite long. Let's hope it was at least helpful ...

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Old 10.06.2015, 12:34
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Re: Dentists

I suppose I'm quite a profitable patient for my Swiss dentist. 14 school years of school dinners with a sticky dessert each day probably party the cause.
But I wouldn't want to go abroad for cheaper treatment however good it might be, as I appreciate being able to ring up and say "I'm flying to New Zealand in two days time and I suddenly have a rough corner on a tooth. I don't know what's happened to it but I'd like to have it seen before I go'. 'Can you come in at 14.30 this afternoon'. 'Yes'.
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Old 10.06.2015, 14:18
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Re: Dentists

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Wow, this post did get quite long. Let's hope it was at least helpful ...
Many thanks. I can subscribe to every word.

There's only one not quite unimportant thing you didn't mention: The Swiss media often tell people to ask their dentist what point factor (Taxpunktwert) they use, because, as the media say, that shows you if your dentist is expensive or not.

Complete bollocks. The range of point factors allowed by the SSO is small (a few dozen %), while the range of procedures a dentist can do or not do is absolutely huge (up to several 1000%) , and that is what makes the difference in the invoice you get.

For instance, one dentist (point factor, say, CHF 3.80) may say, "There's a little black spot here. Maybe that's a beginning caries, maybe it's just some food pigments in that narrow fissure that is a natural structure. I'm marking that spot in your record, and we'll have another glance at it next year to see what's going on." Cost: zilch.

Another dentist (point factor, say, 3.20) may say: "Gosh, there's a caries here. Wow, it's all black, lookie here on the introral video camera" (points at the screen at 120 X magnification, where it looks like a huge cave); "We must tackle that immediately. Best thing is we place a computer-milled full-ceramic filling -- nay, since there already is a big filling in that tooth, I think it's better we use a ceramic crown, but since the old filling is pretty deep according to the x-rays, that will need a root canal therapy first." Cost: CHF 2800.

Now who's the more expensive dentist? And how much does the point factor tell you?

By the way, I have tens of thousands of such little discolorations on my patients' "lists of potential terrorist" that haven't changed the tiniest bit in more than 30 years. But once I retire, there is the risk that other dentists will talk my patients in fixing them all, completely oblivious to the fact that those spots had been around for decades without the slightest problems.
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Old 10.06.2015, 14:37
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Re: Dentists

Absolutely, which is why the report in 'Bon à Savoir' compared both the cost of 'points' but also the 'devis'/quote, for the same tooth with the same 'problem' (or non problem, eg the litte discoloration/black mark mentioned above. The difference in price was huge- quality is less difficult to judge of course.
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Old 10.06.2015, 23:50
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Re: Dentists

Captain Greybeard,
The point factor, as you say, is just one variable; though it is the most visible to the patient, it should not be the main focus of the patient. Dentists pushing onto patients unnecessary procedures is indeed a big problem both for the patients and for the dental profession; it creates mistrust. We have seen some really whacky examples and I am sure you have seen many more. One of the most outrageous … A Swiss patient in his mid 50s comes in with pain in his jaw joint. After examination, my wife prescribes a session of physiotherapy to relax his clenched jaw muscles. Upon returning home, the patient’s daughter, believing the prescription to be not serious enough, talks him into getting a second opinion. The dentist they go to somehow convinces them that all the patient’s teeth should be pulled and replaced with implants and crowns in order to fix his TMJ. Four months later, my wife gets a call from the daughter, in tears, who tells her the story of what happened, that they had spent close to CHF 40k, that her father unfortunately still has pain in his jaw joint and can she please write him a prescription for physiotherapy.
It ultimately goes back to the relationship thing. You patients come to see you, and we adhere to similar conservative philosophy, because they know you are not trying to force upon them unnecessary procedures. There is also a bigger role the dental community can play here. Dentists talk among themselves and it quickly becomes clear who in the kanton uses pressure tactics to drive procedures. Yet little gets done to reprimand that as SSO has very limited power. Over time the ‘butchers’ lose patients and rely more and more on unaware walk-ins with whom they can score a big bill. That, of course, helps nobody, as the crazy examples circulate like wildfire and create even more mistrust in local dentists.
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Old 10.06.2015, 23:58
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Re: Dentists

Well the Swiss don't question the prices... that's just how much the dentist costs.

My husband didn't think of going elsewhere to see a dentist until he met me, now he goes in the UK when we are over there... last month he paid £200 for a check-up, x-ray, scale and polish and a white filling in the UK (private not NHS), god knows how much that would have been here.
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Old 11.06.2015, 00:02
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Re: Dentists

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Captain Greybeard,
The point factor, as you say, is just one variable; though it is the most visible to the patient, it should not be the main focus of the patient. Dentists pushing onto patients unnecessary procedures is indeed a big problem both for the patients and for the dental profession; it creates mistrust. We have seen some really whacky examples and I am sure you have seen many more. One of the most outrageous … A Swiss patient in his mid 50s comes in with pain in his jaw joint. After examination, my wife prescribes a session of physiotherapy to relax his clenched jaw muscles. Upon returning home, the patient’s daughter, believing the prescription to be not serious enough, talks him into getting a second opinion. The dentist they go to somehow convinces them that all the patient’s teeth should be pulled and replaced with implants and crowns in order to fix his TMJ. Four months later, my wife gets a call from the daughter, in tears, who tells her the story of what happened, that they had spent close to CHF 40k, that her father unfortunately still has pain in his jaw joint and can she please write him a prescription for physiotherapy.
It ultimately goes back to the relationship thing. You patients come to see you, and we adhere to similar conservative philosophy, because they know you are not trying to force upon them unnecessary procedures. There is also a bigger role the dental community can play here. Dentists talk among themselves and it quickly becomes clear who in the kanton uses pressure tactics to drive procedures. Yet little gets done to reprimand that as SSO has very limited power. Over time the ‘butchers’ lose patients and rely more and more on unaware walk-ins with whom they can score a big bill. That, of course, helps nobody, as the crazy examples circulate like wildfire and create even more mistrust in local dentists.
That's terrible... I had a Swiss dentist tell me I needed 4 fillings, when I needed none and I thought that was bad enough ... I hope they sued that dentist?

I did go to a very good dental surgeon here in Switzerland who made me a splint which has almost cured my TMJ, and he got my health insurance to pay part too.
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Old 11.06.2015, 00:29
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Re: Dentists

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Captain Greybeard,
The point factor, as you say, is just one variable; though it is the most visible to the patient, it should not be the main focus of the patient. Dentists pushing onto patients unnecessary procedures is indeed a big problem both for the patients and for the dental profession; it creates mistrust. We have seen some really whacky examples and I am sure you have seen many more. One of the most outrageous … A Swiss patient in his mid 50s comes in with pain in his jaw joint. After examination, my wife prescribes a session of physiotherapy to relax his clenched jaw muscles. Upon returning home, the patient’s daughter, believing the prescription to be not serious enough, talks him into getting a second opinion. The dentist they go to somehow convinces them that all the patient’s teeth should be pulled and replaced with implants and crowns in order to fix his TMJ. Four months later, my wife gets a call from the daughter, in tears, who tells her the story of what happened, that they had spent close to CHF 40k, that her father unfortunately still has pain in his jaw joint and can she please write him a prescription for physiotherapy.
It ultimately goes back to the relationship thing. You patients come to see you, and we adhere to similar conservative philosophy, because they know you are not trying to force upon them unnecessary procedures. There is also a bigger role the dental community can play here. Dentists talk among themselves and it quickly becomes clear who in the kanton uses pressure tactics to drive procedures. Yet little gets done to reprimand that as SSO has very limited power. Over time the ‘butchers’ lose patients and rely more and more on unaware walk-ins with whom they can score a big bill. That, of course, helps nobody, as the crazy examples circulate like wildfire and create even more mistrust in local dentists.
Couldn't agree more. After more than 40 years in the trade I could write several books on that topic. It isn't any better in other countries, though, just cheaper in many of them, but the level at which patients are exploited generally is the same, just adjusted to the national economy.
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last month he paid £200 for a check-up, x-ray, scale and polish and a white filling in the UK (private not NHS), god knows how much that would have been here.
Roughly the same, depending on the size of the filling.
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Old 11.06.2015, 00:41
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Re: Dentists

I have had identical work done here and in the US (albeit on different teeth) during the same year.

It was much less here, nearly half the US price.

Tom
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Old 11.06.2015, 00:45
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Re: Dentists

My experience is that the cost of a dentist in suburban Sydney (Australia) is similar to Switzerland, and the difference is here if I bundle the kids together and get them all checked and cleaned at the same time, they give me a discount...

On the other hand, I know someone who headed for an Eastern European country for substantial teeth work, had it all done in one trip, returned to Switzerland with a blood infection, three days in intensive care, two weeks total in a Swiss hospital... Had she done it in Switzerland she could have done it over a longer time period, reducing the risk of infection and at the very least would not have had a delay between seeing the dentist and getting medical attention for the resulting infection...
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Old 11.06.2015, 00:50
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Re: Dentists

I actually wouldn't mind paying a bit more here for dental work, for the convenience. But after my past experience, I wouldn't trust whether I need work doing or not. I know in the UK, my dentist won't do anything unless it is necessary... They've been monitoring a cavity for 8 years now and still haven't felt the need to drill half my tooth out to get to it!
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Old 11.06.2015, 00:56
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Re: Dentists

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I have had identical work done here and in the US (albeit on different teeth) during the same year.

It was much less here, nearly half the US price.

Tom
I know, and that although prices for dental materials and equipment in the USA often are just a fraction of the Swiss prices.

For instance, in the USA you can buy a dental air turbine handpiece made in Switzerland at less than 1/5 of the Swiss price. The only difference: In the USA you get a three year guarantee, in Switzerland, so far, it's always been only one year, which now may change under pressure from the EU.

When in the USA, I regularly buy a special dental material at $7.85 per vial (plus taxes). As long as I carry only about four of them in my luggage, I just get waved through when I present the receipt at the customs desk at ZRH, and seconds later each vial is worth CHF241.00 (plus VAT) without me doing anything. That's the regular retail price in Switzerland. I kid you not.

If I tried to sell that stuff to Swiss colleagues at a reasonable price, they would say, "Come on buddy, that can't be the same." But it is.
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Old 11.06.2015, 09:52
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Re: Dentists

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I know, and that although prices for dental materials and equipment in the USA often are just a fraction of the Swiss prices.

For instance, in the USA you can buy a dental air turbine handpiece made in Switzerland at less than 1/5 of the Swiss price. The only difference: In the USA you get a three year guarantee, in Switzerland, so far, it's always been only one year, which now may change under pressure from the EU.

When in the USA, I regularly buy a special dental material at $7.85 per vial (plus taxes). As long as I carry only about four of them in my luggage, I just get waved through when I present the receipt at the customs desk at ZRH, and seconds later each vial is worth CHF241.00 (plus VAT) without me doing anything. That's the regular retail price in Switzerland. I kid you not.

If I tried to sell that stuff to Swiss colleagues at a reasonable price, they would say, "Come on buddy, that can't be the same." But it is.

We do buy dental materials in the US as well and take them back with us, though nothing with such a wide price difference as what you have mentioned.



Dentists are being gouged on pricing - must be too many anti-dentites running manufacturing companies (to borrow the word from Seinfeld's Kramer). Some manufacturers have similar products for their Dental business unit and their Medical business unit - identical items, just different SKUs - but the product sold by the Dental unit is 30%-40% more expensive.


Then there is the issue of more specialized materials/tools that are not being widely used. We recently drove 2 hours each way to a manufacturing plant in Germany to pick up a set of levers for wisdom tooth extraction. There are plenty of pliers around, for cheap, but levers, apparently, are low volume sale item so carry a large premium. As a salesman from one of the depot explained it to us, most dentists in Switzerland are male and rely on strength to pull the wisdom teeth out with pliers. My wife though, being of smaller build, does not have the upper-body strength to yank the tooth, so she uses levers to wiggle it out (leaving aside the cases where the teeth are sideways and need to be chopped up into pieces). This particular lever - a patented design sold by just one manufacturer - she had previously used at the Ulm University clinic and felt it provided for a better grip on the tooth and shortened the actual extraction time to under 4 minutes per tooth plus further reduced the post-extraction pain (don't ask me how, she explained it to me, I just couldn't relate to it having never pulled a tooth out). The lever was offered by one of the large dental depots here for CHF 620. She found it at the manufacturer's own shop for EUR 160. That's quite a markup ...
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