You Have Insurance. You May Not Have a Dentist. Your Postcode Shapes Access to Care

Health, regions & access

A register may contain a dentist, a practice, and a contract with an insurer. A patient may still hear that the practice is not accepting anyone, that the first appointment is months away, or that treatment is available only through direct payment. Access is not one number. It is a chain whose weakest link decides whether an insured person actually reaches the chair.

1. A Map Can Be Full of Dots While Every Call Ends Without an Appointment

A patient usually searches for a dentist in the opposite direction from a statistician. They do not begin with the number of doctors in a region, but with a phone call. They need to know whether a practice accepts their insurer, new patients, children or adults, whether it can offer a routine appointment, and whether the journey is manageable. A search tool may still display several practices nearby.

The contradiction need not be caused by one practice making a mistake. It arises from the difference between the administrative existence of a service and its immediate capacity. A map says where something exists. It does not say whether the chair has room for this particular person.

2. Access Is Not One Number but Six Consecutive Gates

At every gate, the available supply shrinks. A dentist may work at several addresses. Several people may share one workplace. A contract may not cover every insurer. And a contracted practice may have no room for a new registration. “There are enough dentists in the district” is therefore an unfinished sentence unless “enough” is defined.

3. A New National Data Summary Finally Connects Several Layers

A data summary published by the Institute of Health Information and Statistics on 27 July 2026 covers 2020–2025 and the levels of regions, districts, and municipalities with extended powers. It connects population, registered insured patients, staff capacity, places of provision, treated patients, all treatments, and preventive examinations.^[1]

This is an important advance. Earlier comparisons often placed a simple dentist count beside the number of residents. It is now possible to see how many registered patients correspond to a full-time equivalent and how many people actually received reimbursed care. Even this summary does not include appointment calendars, the live status of accepting new patients, or capacity for non-reimbursed care.

4. One Dentist Can Mean Several Different Numbers

In 2024, 8,211 individual dentists worked at sites contracted with public health insurance. Their combined capacity was 7,239.0 full-time equivalents. A year earlier, the figures were 8,126 people and 7,189.1 full-time equivalents. The headcount rose by 85, but capacity by only 49.9 FTE. On average, one person represented about 0.88 FTE.^[2]

The figures cover active work at contracted sites, not automatically work performed solely in private practice. Nor do they constitute a calendar of available hours. One dentist can spend part of the week at one practice and part at another, while an administrative FTE still says nothing about how many new patients will be accepted.

5. Dentist Numbers Rose Slightly While Independent Practices Declined

The Czech Statistical Office recorded 6,210 independent general dental practices in 2017 and 5,593 in 2024. The decline was 617 practices, or approximately 9.9 percent. This number is not a count of dentists, full-time equivalents, chairs, or practices currently accepting new patients.

The fall may reflect consolidation, changes in legal form, the rise of larger clinics, or departures. Without detailed longitudinal analysis, no single cause can honestly be assigned. The important point is that the number of sites, people, and volume of work do not necessarily move in the same direction.

6. The National Average Conceals a Large Regional Gap

In an older, methodologically different regional series for 2024, there were 824.5 residents per full-time-equivalent dentist in Prague, 2,455.3 in the Central Bohemian Region, and 1,479.5 nationwide. The difference between the extremes was almost threefold.^[3]

The newer national summary reaches the level of municipalities with extended powers. Any precise ranking, however, must be calculated from the current spreadsheet while stating absolute population and FTE counts. A small area with one FTE can create an extreme ratio that says little about the entire catchment. No ranking should therefore be built from an estimate or a media headline.

7. The Same Postcode Can Mean a Different Network for Each Insurer

A contract is always a relationship between a provider and a particular health insurer. Two people in the same building may therefore have different lists of contracted practices. Insurers also use their own indicators. ČPZP, for example, works with the number of its clients without a registered dentist, network density, and dentists’ age structure. VZP uses preferred areas for targeted bonuses.^[4]

An insurer’s search tool primarily confirms a contractual relationship according to published data. It does not guarantee that a practice is accepting new patients now. For the patient, that boundary matters more than the existence of an icon on a map.

8. A Contract Exists. Free Capacity Does Not Follow

Public data can usually say whether a site reported care and whether it has a contract. They cannot say in real time whether it has room. The status may change faster than the register is updated. A practice may have a full patient list, a waiting list, intake limited to children, or capacity only for urgent treatment.

Reporting must therefore distinguish a disconnected number, no answer, a refusal, a waiting-list offer, and an actual appointment. These five outcomes are not one category called “no dentist”.

9. What the Statutory 35 Minutes Mean

Government Regulation No. 307/2012 places dental care in the group with a maximum local-access time of 35 minutes. It is a standard under which the health insurer must secure local access to reimbursed care. It is not a guarantee of acceptance by the first practice, a right to a particular dentist, or an appointment within 35 minutes.

Time until a first routine visit is a different quantity from travel time. A map may show a practice within the limit while a phone call ends on a waiting list. The legal standard and everyday experience must therefore not be presented as the same thing.^[5]

10. Patients Travel for Care, but the Statistics Do Not Know Why

A new migration summary tracks patients between their region of residence and the region where dental care was provided. An outflow may mean that local care is insufficient. It may also reflect commuting for work, keeping a previous dentist after moving, specialist treatment, or free choice.

The data can show the direction of travel, not its cause. A text must not automatically say that “patients were forced to commute” unless interviews or other evidence establish the reason.^[6]

11. Registered Is Not the Same as Treated

A registered insured patient is administratively attached to a dentist. A treated insured patient actually received reported reimbursed care during the year. The number of treatments counts events, so one person can appear more than once. A preventive examination is another indicator, not a direct measure of dental health.

A fall in preventive care may be related to access, the price of non-reimbursed services, anxiety, postponement, or private care outside the register. The data alone cannot decide which cause dominates.

12. A Practice Does Not Automatically Open Where It Is Missing

A new practice needs premises, equipment, staff, hygienic facilities, and enough patients. The economics of a small practice in a sparsely populated area differ from those of a clinic in a large city. Insurers therefore try to influence capacity with bonuses, but a programme’s reported result is not the same as an independent measure of access.

VZP reported that since January 2023 it had supported 79 new dental practices in which almost 31,000 of its clients registered. This is a figure reported by the insurer, not a controlled experiment comparing equivalent areas without the programme.^[7]

13. Who Should Help When No Practice Is Accepting Patients

A patient should first verify that the practice is contracted with their insurer and ask a precise question: are you accepting new patients for regular care, and when can registration take place? If refused, it is useful to ask for a written reason and retain the date, contact details, and answer.

The patient can then ask their own insurer in writing to secure local and timely access to reimbursed dental care. If the insurer does not help, the Ministry of Health provides a form for complaints about unavailable care. Urgent treatment and emergency services are a different service; they do not replace registration or regular prevention.^[8]

14. Access Should Be Measured in Appointments, Not Only Headcounts

A public indicator should combine FTE capacity, contracts by insurer, acceptance of new patients, waiting time, travel time, patients per FTE, and the providers’ age structure. Only then can we answer whether a region lacks people, working hours, contracts, or organisation.

If an area has many dentists but long waits and a high patient outflow, the headcount has failed as an indicator. If it has fewer dentists but fast appointments and low outflow, productivity and organisation may matter more. The postcode is an important map, but not the whole mechanism.

What a Patient Actually Experiences

A patient does not enter the statistics as an average resident of a district. They arrive with a particular pain, working schedule, transport connection, and sometimes a child who must come along. Access is therefore not simply whether a practice exists on the map. It is the product of several conditions: someone must accept new patients, hold a contract with their insurer, offer an appointment within a reasonable time, and be reachable without an excessive journey.

Each condition can fail independently. A practice may be full despite having a contract. It may accept new patients, but only as self-payers. It may have an appointment, but only in several months. And it may be in the neighbouring town, inaccessible without a car. Combining these situations into one “number of dentists” indicator removes precisely the obstacle the patient is trying to solve.

Fewer Hours Do Not Mean Fewer Dentists

Czech statistics correctly distinguish individuals from full-time equivalents, but public debate often loses that distinction. Two dentists each working half time produce the same headcount as two full-time dentists, but a very different volume of work; conversely, two half-time posts may equal the capacity of one full-time post while offering different opening hours and resilience during illness or leave. FTE is not an academic detail. It is an approximation of actual labour volume.

Even a full-time post does not say how much time goes to prevention, administration, sterilisation, communication with insurers, or complex procedures. A one-dentist practice can have many registered patients and still have little room for new ones. Measuring access also requires hours, type of care, and the share of time that can genuinely be offered to additional people.

Provider age adds another timeline. A region with enough dentists today may face a problem in ten years if much of its capacity depends on professionals near retirement and no successors arrive. A new graduate cannot necessarily take over immediately either: they need equipment, a team, contracts, and a patient list. Headcounts without an age and generational structure create false security.

What a Fair Access Map Would Show

A fair map would show at least four layers for every region. The first would be full-time-equivalent capacity and its age distribution. The second would show how many sites hold contracts with each insurer. The third would measure willingness to accept new patients and the median wait. The fourth would track travel by public transport as well as by car, not just straight-line distance.

Such a map would not be a tool for publicly shaming individual practices. Its purpose would be to distinguish a capacity problem from an organisational one, and a regional-distribution problem from a contracting problem. Only then can the response be selected: support a new site, change an insurer’s network, strengthen prevention, offer shared facilities, or improve transport.

It should also tell a patient what they can do now: where to verify a contract, how to search outside their municipality, when to ask their insurer for help, and how to proceed after a refusal. Information about rights without a practical route to an appointment is as incomplete as a map that does not say whether anyone actually works at the address.

A Dental Practice Is Also a Small Business

A practice must treat patients while employing a team, sterilising instruments, keeping records, buying materials, and repaying equipment. In a low-income region, it may have social value yet fail economically without support or shared infrastructure. Concentrated in a wealthier city, it may be full and still financially inaccessible to some people.

This is why adding one practice does not solve everything. The mix of procedures, visit length, team size, and reimbursement rules also matter. A practice with many urgent cases has different capacity from one focused on long prosthetic procedures. Statistics that place both in a single column are crude tools for network planning.

Waiting Is Evidence, Not Merely a Complaint

Waiting time appears in public debate as a personal experience that can easily be dismissed. Repeated waiting is, however, a signal that one gate in the system is failing. If the median appointment moves further away, refusals become more frequent, or patients travel farther, these are measurable changes. They must be collected consistently by visit type and insurer, otherwise incomparable situations are merged.

The mean may not be the best measure. An average wait can look acceptable while a small group waits several times longer. It is therefore useful to publish the median, the upper decile, and the share of people who received no appointment at all. Such figures need not identify a practice, but they reveal whether the system works for most people or only for those with time to call dozens of places.

The Answer Is Not Always Another Dentist

Some regions need a new practice; others need better transport, shared facilities, or prevention that reduces urgent cases. An insurer can change its network and a municipality can offer premises, but no step substitutes for all the others. If support focuses only on new chairs, it may create a site without a team or without contracted capacity.

A fair solution therefore begins with a diagnosis: are dentists, hours, contracts, or information missing? Support can then be designed, and after a year the appointment time, travel, and treated-patient count can be checked. Otherwise the system will report the creation of a practice rather than improved access.

The same map could distinguish legitimate provider choice from systemic failure. A patient may prefer a particular specialist, but should not have to call an entire region to find basic preventive care. The difference between preference and unavailability can be measured by asking how many comparable options a person has within reach and how long they must wait.

The result should not be judged after one campaign or one opening. The trend matters: after a year, have new registrations, the wait for a first visit, the share receiving prevention, and travel outside the region changed? If not, only an administrative record may have changed. If they have, only then can we say access has improved.

The distinction between urgent and planned care is equally important. Someone in pain needs a different appointment from someone seeking a preventive examination, and the system may serve one group well and the other badly. A public indicator must always state which visit type it measures. Without that, it is unclear whether access improved or only urgent cases were handled faster.

The cost of time belongs in the same frame. Two practices may be equally distant, but one offers a morning appointment while the other offers only a slot in the middle of a work shift. For a parent or shift worker, that is a decisive difference. Access must consider whether care can realistically be used, not merely whether an address exists on the map.

A dentist is not accessible when they exist in a register. They are accessible when an insured person can actually obtain care at a reachable time, place, and price.

— Jiný Kontext