Oral health status and coverage of oral health care: A five-country comparison

Henschke, Cornelia; Winkelmann, Juliane; Eriksen, Astrid; Orejas Pérez, Eugenia; Klingenberger, David

doi:10.1016/j.healthpol.2023.104913

Cited by 4 publications

(8 citation statements)

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“…The role of prevention has already been highlighted by , who outlined preventive approaches as one of the most essential opportunities to improve global oral health. Many high-income countries already recognized and integrated that idea and included many basic preventive measures in the benefits basket (Allin et al, 2020;Henschke et al, 2023;Winkelmann, Gómez Rossi, & van Ginneken, 2022;Winkelmann, Gómez Rossi, Schwendicke, et al, 2022). However, gaps still exist, as there is limited availability of population-wide and self-care prevention measures (Winkelmann et al, 2023).…”

Section: Discussionmentioning

confidence: 99%

“…Unlike other health services, public coverage of OH varies widely across countries (Henschke et al, 2023;Klingenberger et al, 2021). Many high-income countries in Europe and Canada commit to a minimum level of basic dental care that usually includes preventive care, such as routine oral exams, X-rays, fillings, management of gum diseases and tooth extractions (Allin et al, 2020;Henschke et al, 2023;Winkelmann, Gómez Rossi, Schwendicke, et al, 2022) (although for most population groups these still require co-payment from individuals).…”

Section: Introductionmentioning

confidence: 99%

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Consenting on essential oral health care benefit basket

Waitzberg,

Durvy,

Schöner

et al. 2024

Preprint

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Introduction Most countries worldwide cover oral health (OH) only partially within public systems compared to other health services. As a result, OH care can incur financial hardship for those in need and is the second main driver of catastrophic health spending in Europe. Efforts to improve OH coverage and integration into public health systems have gained momentum; however, the lack of consensus on defining ‘essential’ OH and how to set an essential OH benefits basket remains a challenge. Objectives This study aims to address these research gaps by conceptualizing what is deemed ‘essential’ in OH care in Europe and exploring criteria and perspectives to inform systematic and evidence-based prioritization mechanisms. Methods Study Design: This exploratory qualitative study employs focus group discussions (FGDs) to gather diverse perspectives on essential oral health (OH) services. Ethical approval was obtained from Newcastle University (Ref: 33388/2023). Participants and Recruitment: Employing a maximum variation sampling strategy, participants were purposefully sampled. We recruited 33 experts in OH, law and health economics from Denmark, Estonia, France, Hungary, Netherlands, Portugal, and the UK, and the 182 members of the general population in Germany and Hungary. Data Collection and Analysis: Data collection involved open-ended discussions and was conducted in English and French, utilizing a specially developed topic guide. Thematic and content analyses were conducted using ATLAS.ti 22, involving coding, theme development, and category structuring. Findings The definition of 'essential' in OH is a fluid and context-specific concept, varying with individual, cultural, socioeconomic, and temporal factors. ‘Essential’ in OH was also associated with Maslow's hierarchy of needs pyramid. A third dimension of ‘essential’ OH is 'good' OH, encompassing both survival functions and psychosocial needs, and recognized the strong link between oral health and general health. Participants highlighted broader factors beyond coverage of OH services, such as the impact of high sugar consumption on oral health. Participants stressed the importance of achieving various goals within the OH system, including equity in access, quality of care, responsiveness, and affordability, to enhance overall oral health outcomes. When discussing the considerations to define OH coverage, participants recognized the diverse forms an OH benefits basket could take, including positive or negative lists of services, conditions, or population groups. Regarding the decision-making process, interdisciplinary involvement of stakeholders like patient representatives and oral health professionals was deemed crucial, emphasizing evidence-based decision-making. Various criteria for decision-making were mentioned, including contribution to OH, economic factors, people-centered care, societal values, and feasibility, aiming for effective and equitable access to care, while considering resource implications and administrative burdens Most OH service groups were considered essential, particularly preventive measures, with individual preventive oral services being most frequently labeled 'essential' (n=49). Population-wide and self-care prevention measures followed as the second essential group of services (n=44). Emergency care was also frequently regarded as essential (n=40). Diagnostic oral services, advanced oral healthcare, and treatments for prevalent oral health issues were also considered essential, albeit to a lesser extent. When asked to prioritize population groups for coverage under limited resources, participants favored coverage for ‘everyone’ or coverage ‘based on need’. Children and adolescents were highly prioritized, followed by high-risk patients, older adults, and low-income populations. Notably, no population group was classified as non-essential across all focus group discussions. Cosmetic dental services were seldom seen as essential for specific population groups, except for a few instances linking them to low-income populations. Conclusions This work highlights the complexities of defining an OH benefits basket and proposes a four-step model to guide its formulation, emphasizing transparency, evidence-based decision-making, and stakeholder involvement. The study advocates for equitable coverage, particularly for vulnerable populations, reflecting a nuanced understanding of 'essential' OH services, with a consensus on prioritizing preventive measures and urgent care, especially for children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Consenting on essential oral health care benefit basket

Waitzberg,

Durvy,

Schöner

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…To assess 'coverage' the authors developed a table following the "Coverage cube" framework (Busse & Schlette, 2007), which identifies three dimensions of coverage: population, services, and costs. The populations and services listed in the table were compiled based on previous reviews (Allin et al, 2020;Henschke et al, 2023;Winkelmann, Gómez Rossi, & van Ginneken, 2022) and in consultation with dentists and specialists in OH policies. To assess 'financing' of oral health, we compiled questions based on three financing frameworks that describe the flow of funds, financing functions, and funding players Kutzin, 2001;Mossialos et al, 2002;T.…”

Section: Data Collection Tool: a Templatementioning

confidence: 99%

“…The need to better cover OH and integrate it into public health systems has recently gained increased momentum in policy agendas (Benzian & Listl, 2021;Winkelmann et al, 2023). Since 2019, the WHO has been developing a global OH action plan that aims to integrate OH care into universal health coverage (UHC) (WHO SEVENTY-FOURTH WORLD HEALTH ASSEMBLY, 2021;World Health Organization, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…Yet these initiatives do not define what to cover and how to fund the covered care. Unlike other health services, public coverage of OH varies widely across countries (Henschke et al, 2023;Klingenberger et al, 2021). Many high-income countries in Europe and Canada commit to a minimum level of basic dental care that usually includes preventive care, such as routine oral exams, X-rays, fillings, management of gum diseases and tooth extractions (Allin et al, 2020;Henschke et al, 2023;Winkelmann, Gómez Rossi, Schwendicke, et al, 2022) -although for most population groups these still require co-payment from individuals.…”

Section: Introductionmentioning

confidence: 99%

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Situation analysis and typology of oral health coverage and financing in Europe – Working paper

Schöner,

Waitzberg

2024

Preprint

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Background and objectives In many countries oral health (OH) services are insufficiently covered by public insurances, which results in financial hardship and OH care being the second main driver of catastrophic health spending in Europe. To suggest feasible and suitable policies that promote the expansion of OH coverage and its integration into health systems, it is imperative to map the current situation of OH coverage and financing. This work aims to perform a situation analysis by mapping the current coverage situation and funding mechanisms of OH care in European countries. It will develop a typology for OH financing and identify market failures, as a baseline for policy recommendations. Methods This study uses qualitative, cross-country, and comparative analysis, based on document analysis. A template was developed based on two analytical frameworks to collect comprehensive and up-to-date data on the coverage and financing of OH services in selected European countries (Denmark, Estonia, France, Germany, Hungary, Ireland, Malta, the Netherlands and Portugal). Data was collected in collaboration with partners from the PRUDENT (Prioritization, incentives and Resource use for sUstainable DENTistry) consortium who consulted health authorities and experts (from e.g. ministries of health, payer agencies, and regulators), and reviewed policy documents from their respective countries. The results presented in this working paper are only preliminary, and include data from Germany, Hungary, Estonia and Denmark. Any interpretation should be made with caution, as this is a working paper. Preliminary results While children mostly receive broader coverage across countries, the degree of coverage varies more for adults. Albeit partially, all countries cover most preventive care and simple treatments such as fillings and extractions, while implants and dentures are either not or only partially covered. Some countries provide special coverage for specific population groups such as chronically ill people or other vulnerable groups such as low-income or disabled. Regarding funding, in many countries (e.g. Germany) there are no earmarked budgets specific for OH. Public OH is financed from the general health budgets, and funds flow through the same mechanisms as other health services: same funds collection methods and sources, same allocation mechanisms to payer agencies, and in many cases, similar methods of payment for providers. Discussion Countries should design OH coverage for populations and services based on their cultural values and priorities. Coverage should be accompanied by sufficient funds to translate in-theory legislation into in-practice availability. It will be important to shape funds collection as progressively as possible and to protect low-income and vulnerable populations from financial hardships. Health systems reforms in funding mechanisms, allocation strategies, and payment mechanisms for OH professionals are essential to mitigate financial barriers and ensure quality care provision.

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Preparation and properties optimization of CeO2–Y2O3 Co-stabilized zirconia via vat photopolymerization

Zhang,

Huang,

et al. 2024

Ceramics International

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Oral health status and coverage of oral health care: A five-country comparison

Cited by 4 publications

References 25 publications

Consenting on essential oral health care benefit basket

Consenting on essential oral health care benefit basket

Situation analysis and typology of oral health coverage and financing in Europe – Working paper

Preparation and properties optimization of CeO2–Y2O3 Co-stabilized zirconia via vat photopolymerization

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