European dental care systems investigated

A gathering of dental experts meeting in Dublin over the weekend examined the current status of the provision and financing of dental care in six different regions across Europe, extending from Ireland to the Russian Federation.

While there is great diversity and complexity in how dentistry operates within the different regions, a relative shortage of resources threatens the sustainability of current models, even in the wealthiest regions.

The Nordic model of dental care is the most comprehensive and will have to meet any projected shortfalls in funding by increasing already high taxes even further to maintain or improve existing levels of care.

The Bismarckian system (in Germany and Austria), on the other hand, based on employer/employee insurance fund contributions, faces an uncertain future mainly because of impending demographic change with fewer workers available to support a rapidly ageing population. Charges have been introduced to control expenditure on some dental treatments and many modern dental treatments are not covered by the insurance funds.

Southern European countries in general have little or no public funding for dental care, with citizens having to pay the full cost themselves.

Spain is producing large numbers of dentists in comparison with other European countries.

Eastern European countries like Poland are making a transition from state-funded and provided dental care to a Bismarckian type system based on employer and employee contributions to insurance funds. Early indications are that priorities will have to be established to maintain the stability of the funds with disciplines like dentistry being curtailed to priority groups and treatments.

The UK Beveridgian system of universal health coverage has gone through a number of reforms with dentistry still available from the NHS in differing formats within devolved administrative regions. Privately funded dentistry now exceeds the amount provided through the NHS with this trend likely to become more pronounced with anticipated shrinking health budgets in the future.

A hybrid system like the Netherlands responded more quickly to pressures within its healthcare system by embracing a series of rolling reforms leading to a system based on a competitive health insurance model with compulsory purchase required for all citizens. Additional private insurance is required for elements of care not covered in the basic healthcare package, such as dentistry.

Conclusions

Many healthcare systems in the European region are challenged by issues such as ageing of their populations, rising unemployment, loss of competitiveness, mass migration and increase in public and private sector debt.

Rising costs of dental care are linked to new diagnosis and treatment technologies, increasing numbers of older people retaining their own teeth, increased awareness of gum disease and greater interest in aesthetic dental care in all age groups.

These pressures have led to changes in the funding and provision of dental care with a gradual movement away from state funded dental care to privately funded and privately provided dental care, especially in the adult population.

The care of the child population and special need groups remains the responsibility of the public sector. These changes have led to opportunities for growth in the private dental insurance sector and in corporate dentistry.

There is widespread support for initiatives aimed at improving the quality of dental care which should be monitored by institutes that are independent of healthcare providers and funding agencies.

There is a need for collaboration across boundaries and sectors to ensure availability of affordable, quality assured dental care for the citizens of Europe.

The meeting was hosted by DeCare Dental Insurance Ireland and took place at the Merrion Hotel on Friday 25 February.