Oral health care system, what the differences in countries?

In Denmark, according to Videnskab & Klinik, the oral health care system consists of a public and a private sector, where it is free for the young and children up to 18 years old, or those adults who have difficulties to private dental care. Most adults have ‘Danske Regioner’ as the national health insurance for private sector, which include preventive and basic oral care and reimbursed rate vary from 30% to 65%. In addition, there are private dental insurance in Denmark. How about the oral health care in other countries?

A study published in Network for Canadian Oral Health Research did a comparative analysis of oral health care systems in the United States, United Kingdom, France, Canada, and Brazil by collecting information from literature search and public database such as World Health Organization (WHO) and the Organization for Economic Co-operation and Development (OECD).

The comparisons were focused on four indicators, coverage for oral health care, financing, oral health care organization, management and delivery as well as oral health outcome.

The following table is from the study by Neumann, where comparative framework of the oral health care system. TOHCE(Total Oral Health Care Expenditure). DMFT (Decayed, Missing, and Filled Teeth).

The oral healthcare system in the USA is mostly covered by private insurance, where 59.5% of the adults age 21-64 have private insurance coverage, and only 5% have public dental coverage. While in the UK, NHS assure 100% of the citizens are entitled to public dental coverage with co-payment, however, specific patient group can receive NHS without any charge. In France, similarly, all legal residents have access to oral healthcare system SHI, where patients have to pay first and claim some reimbursement back. In addition, around 95% of people use complementary insurance scheme to cover part of the dental care. The Canadian oral health care scheme is predominant covered by private dental insurance. Unlike the US, surgical-dental services are covered by public hospital fund. In Brazil, 37% of the population are covered by oral healthcare teams provided by oral health policy, and 9.5% have private insurance. One can have public and private coverage at the same time.

Financing of total oral health care expenditure (TOHCE) per capita show that oral health care is most expensive in the US, followed by Canada, France, the UK then Brazil. However, in Brazil patients have the highest percentage of out-of-pocket payment (about 64%).

However, the outcome indicators suggest that, having more expensive oral health care may not indicate better outcome. In the UK, there are the least percentage of patients who did not feel having no access to oral health care when it is needed and have the lowest average DMFT number at the age of 12. Although the outcome does not suggest co-relation due to other factors, it is still an interesting finding.