Oral Health Care in Europe: Financing, Access and Provision

Abstract

With growing awareness of the large burden of oral diseases and how limited coverage affects both access and affordability, oral health policy has been receiving increased attention in recent years. This culminated in the adoption of the WHO resolution on Oral Health in 2021, which urges Member States to better integrate oral health into their universal health coverage and noncommunicable disease agendas. This study investigates major patterns and developments in oral health status, financing, coverage, access, and service provision of oral health care in 31 European countries. While most countries cover oral health care for vulnerable population groups, the level of statutory coverage varies widely across Europe resulting in different coverage and financing schemes for the adult population. On average, one third of dental care spending is borne by public sources and the remaining part is paid out-of-pocket or by voluntary health insurance. This has important ramifications for financial protection and access to care, leaving many dental problems untreated. Overall, unmet needs for dental care are higher than for other types of care and particularly affect low-income groups. Dental care is undergoing various structural changes. The number of dentists is increasing, and the composition of the health workforce is starting to change in many countries. Dental care is increasingly provided in group practices and by practices that are part of private equity firms. Although there are early signs of a shift towards more prevention of oral diseases, dental care overall remains focused on treatment. A lack of data affects all areas of oral health care and impede to inform policy-making on the underlying causes and the prevalence of oral disease, as well as the effectiveness of community preventive activities and oral health services.

Universal health coverage cannot be universal without oral health

“…Consequently, patients are burdened with high out-of-pocket payments, leading to more frequent financial burdens and unmet needs for oral health care than for other types of care. 3 , 4 Data from LMICs are scarce. Despite being home to 80% of the world's population, LMICs report only 20% of the world's oral health-care expenditure.…”

“…Considering the three dimensions of UHC (population coverage, service coverage, and cost coverage), citizens, patients, care providers, policy makers, and payors need to find solutions to better cover and integrate oral health services in primary health care. 3 , 6 A key question is who benefits from coverage; however, this question cannot be answered without also defining the type and quantity of services that are publicly covered, including cost-sharing for these services. 7 …”

“…Current coverage models for oral health care vary considerably between countries, ranging from no public coverage, limited or partial coverage, to comprehensive coverage ( panel ). 3 Several countries have recognised that no or limited public coverage for oral health is a major challenge, and have gradually extended coverage for specific population groups (eg, Canada and Ireland) or for entire populations (eg, Brazil, France, and Thailand). The realisation of UHC for oral health could start by first introducing a focused, limited set of benefits, but with commitment to gradual expansion towards more comprehensive benefits for all population groups ( panel ).…”

“…The design and funding of covered interventions should ensure that public services are competitive with the private sector with regards to reimbursement levels, quality, safety, and professional working conditions. 3 Monitoring UHC for oral health across countries is challenging and requires a standardised set of UHC indicators for oral health, which so far is not available. The first draft of WHO's Global Oral Health Action Plan 10 proposed a 75% global coverage target for essential oral health care by 2030.…”

Distribution of dental practices in Jazan of Saudi Arabia: a GIS-based approach

“…According to a study conducted in Jazan, the ratio of MOH- affiliated dentists to people in the Jazan region is 1:6,600 [ 23 ]. However, when considering public and private dental clinics, as reported in the MOH statistical yearly book [ 17 ], the ratio in Jazan is 1:2422, similar to the ratio in the Eastern region (1:2477) and higher than the ratios in Riyadh and Jeddah, which are 1:1522 and 1:1688 respectively and also higher than the ratios found in the USA (1:1,639) [ 24 ], Netherlands (1:1818) [ 25 ], and the UK (1:1886) [ 26 ]. The study also found that there is only one dental clinic for every 6,279 people in the Jazan region, indicating a heavy burden on the region’s government-run public dental facilities.…”