The Estonian Health Insurance Fund’s adult dental care benefit does not reach the people who need it the most

Priit Simson | 11/23/2021 | 11:00 AM

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TALLINN, November 23, 2021 – After the adult dental care benefit was made available in 2017, the number of people attending their first visit to the dentist and the number of people who visited the doctor more often increased. However, the benefit offered by the Estonian Health Insurance Fund is used more by people with higher income, i.e., people who would be able to pay for dental care themselves. On the other hand, 42% of adults, mostly low-income earners, have never visited a dentist in the last five years according to an audit by the National Audit Office published today.

When the dental care benefit was introduced four years ago, the government considered it necessary to encourage people to attend their first visit and that the benefit would motivate people to take sufficient care of their oral health. The benefit is needed the most by low-income earners who have the most issues with oral health according to the studies. People on subsistence benefit whose income is the lowest have the worst access to dental care. The audit revealed that the majority, i.e., on average 95% of the recipients of subsistence benefit did not visit a dentist during the time of receiving the benefit.

“The Health Insurance Fund’s dental care benefit is used more by people with higher income whose oral health is better and whose need for treatment is lower. In short, the situation is the opposite of what should be achieved in terms of public health,” explained Ines Metsalu-Nurminen, the Director of Audit at the National Audit Office. “The largest share of people taking advantage of the benefit is among the people whose income is the Estonian average or higher.”

The current terms and conditions of the benefit do not help people in greater need of treatment. The audit report outlines that not even benefit’s preferential terms would improve access to dental care because the financial protection of people in greater need of treatment would be low and ineffective. People’s out-of-pocket payments are high in dental care – nearly three times higher than in health care in general according to the latest data. For a person in high need for treatment who must visit the doctor repeatedly, the total out-of-pocket payment is 70–85%.

The National Audit Office recommends that the Ministry of Social Affairs and the Health Insurance Fund amend the terms and conditions of the benefit so that it would consider a person’s income and health care costs. The aim is for the benefit to reach foremost people whose income is lower. The Ministry of Social Affairs recently issued a statement that from next year, the unemployed and recipients of subsistence benefit will also be able to use the benefit on preferential terms. “This is a step in the right direction, but the terms and conditions of benefit still need to be restructured more fundamentally,” found Ines Metsalu-Nurminen, the Director of Audit.

The National Audit Office believes that there should be greater emphasis on prevention in the list of reimbursable services as this would help to avoid or detect diseases at an early stage. Although the benefit covers essential dental care services, the reimbursable services are presently more focused on treating the existing health problems, i.e., dealing with the consequences. For example, while the share of filling and putting a temporary crown formed 24% of the services used and the share of diagnostics and preparing a treatment plan constituted 31%, the share of cleaning biofilm from teeth aimed at prevention constituted only 2%.

Following the introduction of the benefit in the second half of 2017, the Health Insurance Fund had problems with finding dental care institutions to sign a contract with and where people could use the benefit. Although the benefit can now be used in most cities and municipalities, the availability of the benefit is uneven, given the ratio of the number of dentists at the institutions who have signed a contract to the population of the city or municipality. This ratio is lower than recommended by the World Health Organization (WHO) in two-thirds of the cities and municipalities.

The National Audit Office noticed that the Health Insurance Fund has not fully complied with the guidelines for changing the maximum prices for health care services. The Health Insurance Fund has not collected information on how much of the resources needed to provide some services are actually used. The information collected from reference institutions is also not sufficiently representative for pricing, so the price list of reimbursable services may not be up-to-date or relevant. According to the National Audit Office, the Health Insurance Fund should look for other ways to collect the data necessary for calculating the prices of dental care services.

Background

The dental care benefit for adults in the amount of up to 40 euros a year is available to everyone who is at least 19 years of age and has health insurance, and the patient’s out-of-pocket payment rate is 50%.

Pregnant women, mothers of children under 1 year of age, people of retirement age, people with partial or no work ability and people with increased need for dental care can use the benefit on preferential conditions (up to 85 euros a year, out-of-pocket payment rate 15%).

The benefit can be used at a medical institution that has contract with the Health Insurance Fund. The benefit is in kind, i.e., the patient does not receive the money and it goes directly from the Health Insurance Fund to the service provider.

Priit Simson
Head of Communications of the National Audit Office of Estonia
+372 640 0102
+372 5615 0280
priit.simson@riigikontroll.ee
press@riigikontroll.ee
http://www.riigikontroll.ee/

  • Posted: 11/23/2021 11:00 AM
  • Last Update: 11/23/2021 10:00 AM
  • Last Review: 11/23/2021 10:00 AM

42% of adults, mostly low-income earners, have never visited a dentist in the last five years.

Scanpix/Caro/Neumann

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