Situation analysis and typology of oral health coverage and financing in Europe – Working paper

Situation analysis and typology of oral health coverage and financing in Europe – Working paper | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Situation analysis and typology of oral health coverage and financing in Europe – Working paper Lukas Schöner, Ruth Waitzberg This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4191991/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version 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. Dentistry Health Economics & Outcomes Research Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4191991","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":285627449,"identity":"b5733395-1e9f-48ee-bc80-2ecf8298795d","order_by":0,"name":"Lukas Schöner","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEUlEQVRIiWNgGAWjYBACPgY2CMMAQtkAMQ8QF0gAiQSsWtjQtKRJQLQYEK/lMEwLA24tEmmJH38w1Mmbszcfe/Bxz/k6gwO8Bx9XGFjkMbAnH8Ch5bA0D8Nhw509x9INZzy7LWFwgC/Z8IyBRDEDzzOs1rBJpDdIMzAcSDC4kWMmzXMAqOX+GzPJBgOJxAaJHAMcWpp/Ah0G1JL/TfrPgXNAW3jMf0K05H/A4bBjEjwMzCBb2KQZDhwAaTFjhNqC3fs8z9KseQwOG244c8xMsudAsuRMoF/ADmvjeYbVYfzsacY3f1TUyRscb34m8eOAHT8fMMQ+NlTUJfazJz/Aag0YYPcmbvWjYBSMglEwCggAAB58Wc0IpyJBAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0003-0881-2145","institution":"TU Berlin","correspondingAuthor":true,"prefix":"","firstName":"Lukas","middleName":"","lastName":"Schöner","suffix":""},{"id":285627450,"identity":"a8512459-449a-48ef-9c0a-7f68e70f63fb","order_by":1,"name":"Ruth Waitzberg","email":"","orcid":"https://orcid.org/0000-0001-6358-5059","institution":"TU Berlin","correspondingAuthor":false,"prefix":"","firstName":"Ruth","middleName":"","lastName":"Waitzberg","suffix":""}],"badges":[],"createdAt":"2024-03-30 11:18:00","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4191991/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4191991/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53830530,"identity":"bd6102f0-55b1-432a-82fe-90cd2d1e7deb","added_by":"auto","created_at":"2024-04-01 04:34:04","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":669855,"visible":true,"origin":"","legend":"","description":"","filename":"20240330t2.3workingpapersubmit.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4191991/v1_covered_b4b31ce3-c137-462b-b579-2edb9df0f729.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eSituation analysis and typology of oral health coverage and financing in Europe – Working paper\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"TU Berlin","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4191991/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4191991/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eBackground and objectives\u003c/em\u003e\u003cbr\u003e\nIn 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.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMethods\u003c/em\u003e\u003cbr\u003e\nThis 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.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePreliminary results\u003c/em\u003e\u003cbr\u003e\nWhile 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.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDiscussion\u003c/em\u003e\u003cbr\u003e\nCountries 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.\u003c/p\u003e","manuscriptTitle":"Situation analysis and typology of oral health coverage and financing in Europe – Working paper","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-01 04:25:55","doi":"10.21203/rs.3.rs-4191991/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"37b4038f-4106-446c-8cbc-10637275c045","owner":[],"postedDate":"April 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":30068947,"name":"Dentistry"},{"id":30068948,"name":"Health Economics \u0026 Outcomes Research"}],"tags":[],"updatedAt":"2024-04-01T04:25:55+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-01 04:25:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4191991","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4191991","identity":"rs-4191991","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}