Report on dental complaints and Claims in Spain: 2013-2015

REPORT ON DENTAL COMPLAINTS IN SPAIN: OBJECTIVES STUDY OBJECTIVES Carry out a quantitative and qualitative analysis of the complaints that come to the Official Colleges and Provincial Boards of Dentists in order to generate a centralized database at the national level SPECIFICS OBJECTIVES * Carry out a detailed analysis at the national level of complaints received * Analyze the annual evolution of complaints in the period 2013-2015 * Analyze the distribution of complaints according to the type of dental clinic (private, franchise or insurer) * Analyze the main reasons for complaints received during the study period

REPORT ON DENTAL COMPLAINTS IN SPAIN: METHODOLOGY All the Official Boards of dentists in Spain received a questionnaire in Excel format in which they collected the data of complaints corresponding to the period 2013-2015, specifying the year of the same. Once completed, the questionnaires were sent to the General Council for the generation of the database and its subsequent analysis. Calculation of the total number of dental clinics: for its calculation the data of the General Register of Health Centres of the Ministry of Health (Regcess) has been used. All dental health centres have been identified by selecting the code C251 (Dental clinics) in the variable "Classes of Centres" and the code U44 (dentistry-stomatology) in the variable "care offer". The search was carried out at the provincial level, later grouping at the Autonomous and National level. Types of dental clinics considered: * Franchises clinics: the following have been included : Vitaldent, Dentix, Unidental, Caredent and Idental and other centres with similar characteristics * Insurance clinics: the following have been included: Adeslas, Asisa and Sanitas (Milenium) * Private clinics: those that do not belong to either of the two groups above.

Privates Franchises Insurance REPORT ON DENTAL COMPLAINTS IN SPAIN: RESULTS National distribution by type of dental clinics (Total dental cllinics 21.628) 1.7 % 3.9 % Privates Franchises Insurance (20.411) (852) 94.4% (365)

REPORT ON DENTAL COMPLAINTS IN SPAIN: RESULTS National distribution of complaints according to type of dental clinic TOTAL COMPLAINTS 4648 PRIVATES CLINICS: 2213 FRANCHISE CLINICS: 2258 INSURANCE CLINICS: 177 48.6% 3.9% Franchise clinics represent 4% of total of dental centres and accumulate about 49% of Total of complaints.

During the period 2013-2015 dental complaints increase by 14.5% REPORT ON DENTAL COMPLAINTS IN SPAIN: RESULTS During the period 2013-2015 dental complaints increase by 14.5% Evolution of dental complaints during the period +14.5 % * Total of complaints : 4648

REPORT ON DENTAL COMPLAINTS IN SPAIN: RESULTS Franchises clinics have an upward trend in complaints: they have increased by 48.6% in the last two years Private clinics recorded a downward trend in complaints: they fell by 11.3% in the last two years Evolution of dental complaints in franchise clinics Evolution of dental complaints in private clinics + 48.6% - 11.3% * Total of complaints : 4648

REPORT ON DENTAL COMPLAINTS IN SPAIN: RESULTS Given the large number of private clinics versus franchise clinics (20,411 vs 852), the weighted data conclude that : Weighted data according to type of dental clinic Distribution of complaints by type of clinic Private 2213 Franchise 2258 Insurance 177 Total 4648 In proportion to the number of centres, the franchise clinics have received 25 times more complaints than the private clinics. * Total of complaints : 4648

Reasons for complaints

REPORT ON DENTAL COMPLAINTS IN SPAIN: RESULTS Why do patients complain? The majority of complaints are due to clinical reasons (70%), followed by economic(10%) and administrative reasons(8%) Administrative Clinic Diagnostic Economic Data protection Other * Total of complaints : 4648

Clinical reasons: 7 out of 10 complaints

(30%) REPORT ON DENTAL COMPLAINTS IN SPAIN: RESULTS Dental implants are the treatments that register more claims 3 out of 10 claims for clinical reasons are for treatment with implants, followed by treatment with prosthesis, orthodontics, endodontics, conservative dentistry and surgery. Implants Prosthodontics Orthodontics Endodontics Conservative dentistry Oral surgery Other (30%)

Implants The treatment with more complaints

14.9 % REPORT ON DENTAL COMPLAINTS IN SPAIN: RESULTS Implants: the treatment with more complaints Claims due to treatment by implant have increased by 15% 14.9 % * Total of complaints : 920

REPORT ON DENTAL COMPLAINTS IN SPAIN: RESULTS Claims about implants: Why do they claim? Claims about implants: Who do they claim? Mainly claim the franchise clinics For each claim for treatment with implant of a private clinic, a franchise clinic receives 21. Lack of professionalism Bad patient care Treatment failure Patient dissatisfaction Unfinished treatment * Total of complaints : 920

Complaints for economical reasons The reason for claims that has increased the most

REPORT ON DENTAL COMPLAINTS IN SPAIN: RESULTS Given the large number of private clinics versus franchise clinics (20,411 vs 852), the weighted data conclude that Increased claims for economic reasons Between 2013 and 2015, complaints for economic reasons have increased by 42% 42% Private Franchise Insurance For each claim for economic reason recieved from a private clinic, a franchise clinic receives 24.

Complaints for administrative reasons

48.5% REPORT ON DENTAL COMPLAINTS IN SPAIN: RESULTS Closure of the clinic is the most frequently requested administrative motive Nearly half (48.5%) of all administrative complaints are due to clinic closure, all of which come from the type of clinic franchise Clinic closure Bad patient care Bad communication Do not submit medical history Lack of information 48.5%

+ 138.7 % REPORT ON DENTAL COMPLAINTS IN SPAIN: RESULTS Closure of the clinic is the most frequently requested administrative motive Clinic closure reasons have increased 139% in the period 2013-15 + 138.7 %

REPORT ON DENTAL COMPLAINTS IN SPAIN: CONCLUSIONS In the analyzed period, a total of 4648 complaints were registered, with an increase of 14% between 2013 and 2015. Complaints at franchise clinics have increased by 49% while decreasing by 11% in private clinics. In proportion to the number of centres, for each claim of a private clinic, 25 claims have been received from franchise clinics. Franchise clinics represent 4% of all dental centres and nevertheless accounted for 49% of total claims

7 out of 10 claims are for clinical reasons REPORT ON DENTAL COMPLAINTS IN SPAIN: CONCLUSIONS 7 out of 10 claims are for clinical reasons . Treatment with implant represents 30% of the clinical causes of claims. For each implant claim received by a private clinic, a franchise clinic receives 21. Complaints for economic reasons have increased by 42% in the period. In proportion to the number of centres, the franchise clinics receive 24 times more claims for this reason . 1 in 2 complaints of administrative cause is due to closure of the clinic. All of them have occurred in franchise clinics and have increased 139% in the period studied