Situation analysis and typology of oral health coverage and financing in Europe – Working paper
Authors: Schöner Lukas , Waitzberg Ruth 
Published: April 2024

Abstract
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.