When the dental benefit was introduced four years ago, the government felt it was important to encourage people to go to the dentist and take care of their dental and oral health. The benefit would be needed most of all for low-income people, who are increasingly struggling with oral hygiene, as a recent study showed, an audit released Tuesday by the National Audit Office (link in Estonian) has shown this.
The audit indicated that some 95 percent of people receiving living allowances did not go to a dentist during the period in which they received the allowance.
“The dental benefits of the Health Insurance Fund are used by people with higher incomes, who have better oral health and for whom the need for treatment is less. In short, the situation is opposite to what needs to be obtained from a perspective, ”said National Audit Office Auditor General Ines Metsalu-Nurminen, adding that the allocation has been mainly used by people whose the average wage exceeds the Estonian average wage.
The current conditions for receiving the allowance leave out those who need it most, the National Audit Office said. The report also states that the provision of dental care, even under more favorable conditions, does not improve the availability of dental care because the protection of people with medical needs against significant health costs is too weak and inefficient. The own costs of dental care are high, up to three times higher than in health care in general. A person needing treatment and repeat visits can cover up to 85% of treatments.
The National Audit Office recommended to the Ministry of Social Affairs and the Health Insurance Fund to change the conditions for providing dental care to take account of dental income and costs. The goal would be to make benefit measurement more accessible to low-income people.
The Ministry of Social Affairs recently announced that unemployed people and people receiving living allowances will be able to use dental benefits next year. “This is a step in the right direction, but the terms of the allocation still require fundamental restructuring,” said Ines Metsalu-Nurminen.
The National Audit Office said more emphasis needs to be placed on prevention, as this will help prevent the disease or catch it early. Although the provision of dental care includes essential dental services, current reimbursable services focus more on treating existing problems, i.e. managing the consequences.
Following the entry into force of the allowance in the second half of 2017, the Health Insurance Fund encountered difficulties in finding dental care establishments that would sign contracts for the use of the allowances. Although benefits are now available in most municipalities, the availability of the benefit is often inconsistent. The ratio is lower than the recommendation of the World Health Organization (WHO) in two thirds of Estonian municipalities.
The National Audit Office noted that the Health Insurance Fund did not fully follow the guidelines for changing the prices of health services. The fund has not received any information on the share of resources allocated to services that is used. The National Audit Office said the fund should seek other ways to monitor resource use and pricing.
Dental care benefits in Estonia
Dental care is free for people under 19, according to the Health Insurance Fund. Free dental care is only provided by dentists who have concluded the medical care financing contract with the Health Insurance Fund.
The fund will reimburse dental care to insured adults up to € 40 per year. The benefit applies to essential dental care services. The benefit will be taken into account at the time of payment to the dentist.
The allowance increases up to € 85 per year for:
- pregnant women and mothers of children under one year of age;
- retirees;
- people receiving an incapacity for work pension;
- people with partial or no capacity for work;
- people over 63;
- people with an increased need for dental care.
Once every three years, the Sickness Insurance Fund compensates old age and invalidity pensioners, sickness insured over 63 years old and people partially incapacitated or unfit for work for dentures up to € 260.
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