Opinion story: Dental care benefit allows prevention of major dental damage, and improves the oral health of the Estonian people

Katrin Romanenkov, Head of Health and Communication Department

From 1 July 2017, the Estonian Health Insurance Fund will reimburse primary dental care for adult people with health insurance. Parental reimbursement of adult dental care is now a standard part of health insurance if it is a specialist medical examination or surgery. This is an important change, the goal of which is to allow people to go to the dentist at least once a year to check their health and, if necessary, make corrections that prevent major problems. By the end of the first week of the launch of the new service, about one hundred dental care offices across Estonia have concluded the adult dental care agreement with the Health Insurance Fund, and approximately 2,400 people have received the benefit.

As with any other reimbursable health insurance service, a person will be entitled to the benefit when they visit a dentist who has entered into an agreement with the Health Insurance Fund and has received dental care.

In cooperation with the representatives of the dental care profession, the essential services necessary for the control and treatment of teeth have been included in the list of adult dental care services reimbursable by the EHIF. What's important is that a person regularly visits a dentist each year, and then the provision of good oral health at lower costs is likely to be possible, which will also ensure better health for the whole human being. This has been the main goal of developing the new benefit  - to motivate people to visit a dentist on a regular basis and thereby support a healthier life. Instead of treating the symptoms, or “cavities" and “aching  tooth" that have already occurred, we need to move towards prevention of the cavities and health issues. partially For the benefit that has just entered into force, health insurance partially covers a limited number of services, but it is likely that as the adult health insurance budget capabilities increase, the adult dental care capabilities increase - whether in the form of higher benefits or more services.

The current system, or in-kind benefit, has several important advantages for the patient. First of all - this solution is especially convenient for the patient - there is no need to pay for the entire service in the full amount, and then file a claim for partial compensation for the Health Insurance Fund ,and wait for a reimbursement. The benefit will be calculated automatically by the dentist's computer program, and the person will be able to pay less on the spot. Also, the service provided by the EHIF contract allows insured persons to have a consistent level of prices and similar services throughout Estonia. This is one of the basic principles of solidary health insurance - all the insured people are provided with the same high-quality services they need. In case of a different arrangement, i.e., monetary compensation, at any service provider one patient can only receive an appointment for the same amount of money, but another, for example, may receive both an appointment and, to some extent,  treatment, depending on the price list of the dental care office.

The pricing of the Estonian Health Insurance Fund is based on real healthcare practices and the cost of healthcare facilities

It is important to know that the services of the Estonian Health Insurance Fund are priced on the principle that they would cover the costs of providing high-quality service. Necessary costs include the tools needed for direct treatment - such as supplies, medicines, fillings, as well as doctor’s and nurse’s remuneration, room rent, and equipment. Over recent months, public debate has been raised by the question of whether the prices set by the Health Insurance Fund for dental care services are at a level that would allow the provision of quality services and whether the list of services includes all the components necessary for the treatment of the patient. We will definitely pay significant attention to the reasoned feedback, and we will be monitoring this year how the pricelist enables the providing of the services. An analysis is already underway to make corrections in the price list if necessary.

It is not a temporary or one-time contribution to the development of healthcare services, but a long-term goal of developing an indispensable benefit to people.

 

How do service descriptions and prices develop? The price list of the Estonian Health Insurance Board is based on the input provided by a specialized professional association consisting of doctors, who advises on how the actual treatment practice looks, and what resources and activities must be included in the prices of services. The final outcome depends on how thoroughly all the activities are described. If the description has not been sufficient, then it  cannot be taken into account in the pricing. However, it is possible to always make corrections in prices if it turns out that this is necessary.

Once the description of the service is complete, we will obtain information from the medical institutions that will tell us what the costs of providing these services are. On the basis of the description of the services provided and the cost information received, the list of services and the costs will be formed.

Thus, pricing is primarily based on how dentists describe the treatment process and what materials are used during one appointment. After describing the new services, we will follow the use and implementation of dental care services in the following year to analyze if the services are described in sufficient detail and whether the prices will cover actual costs. If it turns out that something needs to be corrected, corrections will be made to the price list or service content. The list of services is generally updated once a year, and all professional associations have the opportunity to request changes to the list. Feedback from service providers is also important - if dentists see that the proportion of materials is too low or too high in pricing, the Health Insurance Fund should definitely be notified.

The service provider is always responsible for the quality of the services provided to the patient. As already mentioned, the list of EHIF services and pricing will be based on the activities and costs necessary to provide quality services. Therefore, we assume that in the development of the list of services, the activities, supplies, and quantities are described in such a way that they enable the provision of quality services. However, if it becomes apparent that the essential descriptions of the services need to be supplemented, then this must definitely be done.

In cooperation, we can prevent public health problems

In the first week of the commencement of the benefit, one-fifth of Estonian dentists have signed an agreement with the Health Insurance Fund. By the end of this week, partners are present in all counties of Estonia. It is perfectly understandable that the introduction of a new national benefit is a time-consuming process requiring explanation. For our part, the Health Insurance Fund is grateful for the feedback from both people and dentists, in order to have cooperation to ensure a smooth start-up and development of the benefit. Free dental care is provided for children up to the age of 19 just for the purpose of starting adult life with as healthy teeth as possible. Now, from this year, adults can continue on this habitual path and visit the dentist at least once a year. International health experts and researchers have increasingly highlighted the importance of prevention and preventive services for protecting public health. The Dental care benefit is undoubtedly one important step in caring for people's health.