Publicly Funded Dental Care

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

As part of a plan for reforming social and health care, the Finnish government introduced a new policy aiming at offering publicly funded dental care for the whole population. The policy is a step forward to lowering costs of dental care for patients and municipalities to compensate higher expenditures. The new policy has led to amendments of the public health and sickness insurance acts.

Purpose of health policy or idea

• The publicly funded dental care were offered to the whole population on Dec 1, 2002. The reform is based on the legal amendments passed in 2000, which  extended in three stages the age groups receiving public funding from those born in1956 or later to all age groups.
• According to the reformed legislation the municipalities are obliged to provide basic dental services for their inhabitants. The municipalities can produce services themselves or contract them out to other municipalities or private providers. Persons using private dental services are eligible to be refunded by the public health insurance. For the public health insurance coverage the reform was actually accepted already in the 1991 amendment of the sickness insurance law but the enforcement of the legislation has temporarily been postponed several times due to economic reasons.
• In private services, the refunding rate is 60% of the fixed service specific charges determined by the Ministry of Social Affairs and Health. The reform decreased the refunding rate of preventive private dental care from 75% to 60% and allows only one annual dental check-up to be refunded by the health insurance. Since the actual fees in the private sector are higher than the fixed charges, the effective refunding rate is about 40%. In the public dental care, the patients' share of costs is lower than in the private services. For those aged 18 or less, the reform did not change the coverage: the services provided by the public sector remain free of charge.
• Prosthetic and orthodontic services, and technical works are not publicly supported or refunded by the health insurance except in cases when they are offered due to other diseases.
• Besides socioeconomic equity, a major objective of the reform was to equalise municipal differences in the coverage of dental services. Before the reform, one third of the Finns lived in municipalities providing dental services for all age groups in their health centres, one third lived in municipalities providing public services for those born 1956 or later which was stated as a minimum in the legislation, but due to a vague wording of the law, several, mainly urban, municipalities with the remaining third of the population had limited the age groups for whom they provided dental services.
• Concerning the costs of the reform, the increased expenditure of the municipalities are partly compensated by higher central government subsidies to the municipalities.

Main points

Main objectives

1. to offer publicly funded dental care for the whole population
2. to equalise access to dental care by socioeconomic groups and by municipalities

Type of incentives

1. for patients: lower costs of dental care
2. for the municipalities: an increase in central government subsidies in order to compensate higher expenditure

Groups affected

patients, municipalities, dentists in the private and public sector

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

• The reform comply with the basic equity objectives of the Finnish health policy stated in several health policy documents.
• The present reform was included in the program of the 1999-2003 Government (Lipponen II) and in the 2000-2003 goal and action plan for social and health care accepted by the Government.

Change of government

The reform was included in the new government's program in 1999

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

• For long, dental care has been considered as an exception in the health care system and reforms for the increase of public support have been considered several times. When the public health insurance was started in the 1960s, dental services were excluded from its benefit package because of lack of money. Similarly, for economic reasons the 1972 reform of the public health services only included the services for children to be provided by the municipal health care.
• In the early 1990, dental services for all age groups were already decided to be partly refunded by the public health insurance but once more the economic recession in the early 1990s made the Governments to postpone the reform.

Stakeholder positions

• The reform was accepted in negotiations on the1999-2003 Government's policies by the political parties involved. However, the reform were obviously offered on the agenda by the Ministry of Social Affairs and Health.
• The Ministry of Social Affairs and Health drafted the amendments for the laws with the participation of the Association of Finnish Local and Regional Authorities representing the municipalities, the Finnish Dental Association and the Social Insurance Institution running the public health insurance.
• The reform seems to have been relatively consensual.

Influences in policy making and legislation

• The reform led to the amendments of the Public Health and Sickness Insurance Acts.
• In the Government's original program, the reform was to implemented without any increases in public spending. During the preparation of the reform, the Parliament passed a resolution that this expenditure neutrality should be considered in wider terms and that the external savings due to improved dental health should be taken into account. Furthermore, the Parliament made a minor change to the draft amendment of the Public Health Care Act according to which the legal reform originally planned to be passed in two consecutive amendments was directly accepted in one amendment of the law.

Adoption and implementation

• The municipalities and municipal health centres are in the key positions in the implementation of the reform. For the municipalities the main issue is whether they have economic possibilities in the present situation to invest for new dental surgeries and to increase the funding of their dental service provision. In the municipal health centres the implementation is dependent on increased municipal funding but health centres have also a challenge to improve the efficiency of their services and to develop their practices to provide services for wider clientele (part of health centres have only provided services for children and young persons).
• Formally, the reform has been implemented but it is too early to say whether it has provided an effective access to municipal dental care in all municipalities or whether the end result is an inadequate increase in provision and longer waiting times. However, most municipalities have already provided quite adequate dental services in respect to the standards set by the reform.

Monitoring and evaluation

• There is no formal mechanism related to the legislative process for review the implementation of the reform but the Ministry of Social Affairs and Health has started a follow-up evaluation of the reform carried out by the government research institute (STAKES). The evaluation continues an earlier research and development project of dental care which was started to prepare the reform.
• In 2002 the evaluation of the first phases of the reform extending the dental care coverage to those born 1946 or later was favourable. Only less than 10% of the population lived in municipalities which had not increased the supply of dental care according to the requirements. Most municipalities which had had inadequate supply had hired more dentists and dental assistants or made contracts with private sector dentists. Due to increased demand, waiting times to municipal dental care had increased. In the private sector, nearly half of the dentists considered that the clientele had remained stable, 40% experienced an increase and 13% a decrease in the number of patients.

Expected outcome

• There is no formal mechanism related to the legislative process for review the implementation of the reform but the Ministry of Social Affairs and Health has started a follow-up evaluation of the reform carried out by the government research institute (STAKES). The evaluation continues an earlier research and development project of dental care which was started to prepare the reform.
• In 2002 the evaluation of the first phases of the reform extending the dental care coverage to those born 1946 or later was favourable. Only less than 10% of the population lived in municipalities which had not increased the supply of dental care according to the requirements. Most municipalities which had had inadequate supply had hired more dentists and dental assistants or made contracts with private sector dentists. Due to increased demand, waiting times to municipal dental care had increased. In the private sector, nearly half of the dentists considered that the clientele had remained stable, 40% experienced an increase and 13% a decrease in the number of patients.

References

Author/s and/or contributors to this survey

Ilmo Keskimäki

Empfohlene Zitierweise für diesen Online-Artikel:

Ilmo Keskimäki. "Publicly Funded Dental Care". Health Policy Monitor, 06/05/2003. Available at http://www.hpm.org/survey/fi/a1/4