In 2024, the Competition Authority conducted a brief analysis to assess the competitive situation of orthodontic services in Estonia. The analysis focused on market trends over the past ten years and found that the provision of orthodontic services in Estonia is insufficient. The number of patients has increased manifold, but the number of orthodontists has not changed. This has resulted in a market failure with long waiting lists, which limits competition and reduces consumers’ opportunities to find the most suitable service providers and price offers, thereby increasing the price of orthodontic services.
According to the Competition Authority, the state can improve the situation by strategically improving the management of the sector. Important measures include regulating the field of orthodontic services in a way that would allow for an expansion of the range of service providers, as well as increasing the number of dental training and orthodontics residency places ordered from universities. A sufficient number of service providers would increase competition, motivating businesses to adjust prices according to market demand and consumer expectations.
The Competition Authority does not see the creation of a unified waiting list system as a solution to reducing waiting times, as it would limit competition and could lead to higher prices. If the state wants a regulated waiting list system, a uniform and regulated price list should also be established. The Authority also wants to dispel the misconception that there are more orthodontists in Estonia than elsewhere in Europe. In fact, Estonia is one of the few countries where dentists are not allowed to perform simple orthodontic work, which is why there is a greater need for specialists here. In any case, this does not eliminate the problem of long waiting lists in Estonia.
The Competition Authority also disagrees with the common claim that the reason for long waiting lists is the consumer behaviour of patients. This is a free market service and people should be able to use the service according to their needs. The real cause of long waiting lists is constraints on service provision, rather than consumer preferences. The current situation, where orthodontics is treated partly as a public good and partly as a free market service, is contradictory and limits the options of both patients and service providers.
The Authority’s initial conclusions were presented on 13 June at a roundtable attended by representatives of the Estonian Orthodontic Society, the Estonian Dental Association, the University of Tartu, the Health Board, the Health Insurance Fund and the Ministry of Social Affairs. Feedback collected at the meeting helped to refine the recommendations outlined in the brief analysis. Thus, the analysis has been prepared taking into account the feedback of all parties involved in the provision of the service. The Competition Authority emphasises that resolving the market failure in orthodontic services requires a strategic national vision, which ensures sufficient supply and competition so that consumers could make informed and favourable choices.