Ten years since the 2008 introduction of dental vouchers in the Portuguese NHS

Abstract

Since the creation of the National Health Service (NHS) in Portugal, in 1979, dental care is neither provided nor funded by the NHS. Thus, most dental care is paid through out-of-pocket payments, either by patients themselves or through voluntary health insurance or health subsystems. In 2008 the government created the dental voucher targeting children, pregnant women, elderly who receive social benefits, and certain patient groups (HIV/AIDS patients and those who need early intervention due to oral cancer), to be used in private dentists who contracted with the programme. The reform was well received by the different stakeholders, especially dentists and beneficiaries, and the impact of the dental voucher in access and coverage of dental care in Portugal is positive: from May 2008 until December 2017, dental voucher reached 3.3 million NHS users in Portugal and dental care indicators have dramatically improved over the last ten years. Aiming to implement dental care provision within the NHS, the Ministry of Health has announced the foreseen integration of dentists in primary healthcare units, although the current budget constraints might hamper this possibility.

Oral Health in Portugal: Small Steps in the Right Direction

“…This program started with the promotion of oral health in schools and, subsequently, preventive and curative measures were introduced, with the integration of oral hygienists in the NHS and the expansion of the partnership with private dental services [10,11]. In 2008 the "Dental Voucher" strategy was added to the program, with an extension of beneficiary groups and a model of contracting between the NHS and private providers in the dental area [10,12]. Dental Vouchers are awarded by primary care health centers to certain beneficiary patients, allowing access to a range of preventive and curative treatments provided, free of charge, by any private dentist that has agreement with the NHS [9].…”

“…Dental Vouchers are awarded by primary care health centers to certain beneficiary patients, allowing access to a range of preventive and curative treatments provided, free of charge, by any private dentist that has agreement with the NHS [9]. Specifically, the beneficiary patients are children and adults with active dental problems included in some specific populations: children aged 6 years and under, children and young people of intermediate ages (children and young people from the age cohorts of 8, 9, 11, 12, and 14 years old), 16-and 18-year-olds, pregnant women followed in the NHS, receivers of specific social protection benefits, namely, the complementary income for elderly, and people diagnosed with human immunodeficiency virus / acquired immunodeficiency syndrome (HIV / AIDS) [10][11][12].…”

“…Finally, another strategy was implemented since 2016, namely, oral health consultations were created, on an experimental basis, in NHS primary health care, with the integration of dentists in primary care health centers, in order to provide treatment to patients referred by the primary care physicians [12]. Consequently, oral health indicators used to measure the prevalence of oral diseases have been improving over the years, with greater expression in the last decade [13][14][15].…”

“…On the other hand, in adults the situation is quite different. Recent data show that almost all adults, in Portugal, have at least one of the three major chronic oral diseases: dental caries, periodontitis or peri-implant pathology [12]. Nevertheless, another survey with 1,102 interviews found that 32.7% of individuals never visited a dentist or only in case of emergency, 41.6% have not visited a dentist for over a year.…”

“…Globally, the improvement of oral health is considered one of the most important achievements in health and quality of life. However, in Portugal and around the world, due to their high prevalence, dental diseases remain one of the major health problems of the population with strong socioeconomic asymmetries [1,12,14,15]. Despite the evident improvements described in Portugal, it is essential to continue improving oral health promotion policies and, across all these political measures, it is essential to maintain the focus promoting health literacy, particularly in the areas of oral health and nutrition by empowering citizens of different socioeconomic and age groups, especially from the most disadvantaged groups, for health-friendly choices and practices [7,10,11].…”