Challenges for leadership of oral health care in Finland.

T he age limits entitling to publicly subsidized dental care were abolished in Finland by the amended provisions of the Primary Health Care Act and the Health Insurance Act, which entered into force in their entirety on December 1, 2002. Before that, the local municipal authorities could limit the access to dental care on the basis of age. Likewise, the eligibility for reimbursement under health insurance was determined on the basis of age. After December 2002 according to the Primary Health Care Act, municipalities are obliged to arrange oral health care services to inhabitants without restrictions like age. The extension of care that was realized in two steps in 2001—at the first stage to those born in 1956 and after, and at the end of the year to those born in 1946 and after—succeeded relatively well. Even though most health centers have been able to provide dental care to those seeking their services, putting an end to the age-based prioritization of care as from December 1, 2002 has involved problems in quite many larger cities. All clients of private dental care are, irrespective of age, entitled to reimbursement from health insurance granted by the Social Insurance Institution according to the confirmed price rates. This reform has increased the health insurance expenditure, but the reform as such has been implemented almost without problems. Health centers indeed need a strong leadership when establishing new service delivery modes to increase the number of produced services. The personnel resources in oral health care are not sufficient to respond alone to the predictable need for increased dental care services. New service delivery modes as well as cross-professional network are needed. The cooperation on health promotion among various organizations, such as municipal health centers and private sector dental care services, municipal social welfare and health care, the school system, and public catering, greatly enhances the possibility of influencing and combining resources. The modes of cooperation are not limited to social and health care only. In Finland the leadership in oral health care at municipal health centers is mostly in the hands of women. More than half (54 percent) of the approximately 300 senior and chief dental officers working at health centers are women. In 2001 there were 4,730 dentists of working age in Finland, women’s proportion being about 70 percent. Half of those 4,730 dentists are working in the municipal sector, and three-quarters of them are women.