When the dental care benefit was first implemented four years ago, the government deemed it important to encourage people to go for a dentist visit and to take care of their dental and oral health. The benefit would be most necessary to people with smaller incomes, who have more and more issues with oral hygiene, as a recent study has shown, an audit published by the National Audit Office (link in Estonian) on Tuesday showed.

The audit stated that some 95 percent of people receiving subsistence benefits have not gone to a dentist in the period, in which they have received benefits.

"The Health Insurance Fund's dental care benefits are used by people with larger incomes, who have better oral health and for who the need for treatment is smaller. To put it shortly, the situation is opposite to what needs to be achieved from a public health perspective," National Audit Office auditor general Ines Metsalu-Nurminen said, adding that the benefit has been used most by people whose average wage exceeds the Estonian average wage.

The current conditions for receiving the benefit leave the people who need the benefit most aside, the National Audit Office said. The report also stated that dental care benefits, even at more favorable terms, do not improve the availability of dental care, because the protection of people with medical needs from major healthcare costs is too little and ineffective. Own costs in dentalcare are high, up to three times as high as in healthcare, in general. A person with a need for treatment and for repeat visits may cover up to 85 percent of the treatments.

The National Audit Office made a recommendation to the Ministry of Social Affairs and the Health Insurance Fund to change the dental care benefit conditions in a way that would take income and dental costs into consideration. The goal would be to make the benefit measure more accessible for people with smaller incomes.

The social affairs ministry recently announced that the unemployed and people receiving subsistence benefits can use the dental care benefits next year. "It is a step in the right direction, but the benefit's conditions still require fundamental restructuring," Ines Metsalu-Nurminen said.

The National Audit Office said more of an emphasis should be placed on prevention, because it would help avoid illness or catch it early. Although the dental care benefit includes essential dental services, the current reimbursable services are more focused on treating existing problems, i.e. dealing with consequences.

After the benefit came into force in the second half of 2017, the Health Insurance Fund ran into issues with finding dental care institutions, who would sign contracts for the use of the benefits. Although the benefits are now available in most municipalities, the availability of the benefit is often inconsistent. The ratio is lower than the World Health Organization (WHO) recommendation in two thirds of Estonia's municipalities.

The National Audit Office noted that the Health Insurance Fund has not followed the guidelines for changing prices of healthcare services entirely. The fund has not received any information about how much of the resources allocated for the services is being used. The National Audit Office said the fund should look for other ways to monitor resource usage and pricing.

Dental care benefits in Estonia

Dental care is free of charge for persons under the age of 19, according to the Health Insurance Fund. Free dental care is provided only by dentists who have concluded the contract for financing medical treatment with the Health Insurance Fund.

The fund will reimburse dental care to adults with health insurance 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 benefit increases up to €85 per year for:

• pregnant women and mothers of children under one year of age;
• old age pensioners;
• persons receiving pension for incapacity for work;
• persons with partial or no work ability;
• persons over 63 years of age;
• persons with increased need for dental care.

Once every three years, the Health Insurance Fund compensates old-age and disability pensioners, health insured persons over the age of 63 and persons with partial or no ability to work for dentures in the amount of €260.

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