The oral health component of «100% santé¼ reform: initial descriptive elements / Le volet bucco-dentaire de la réforme 100 % santé : premiers éléments descriptifs

The "100% Santé" (100% Health) reform constitutes a major change to oral health pricing and insurance practices in France. The objective of this study was to observe the evolution of dental care consumption, and in particular prosthetic care, over a period including the years before and after the reform. This exploratory study, based on descriptive data, provides the first elements of analysis useful for evaluating the oral health component of the "100% Santé" reform. The study is based on the health care consumption data of 3,466,764 state health insurance beneficiaries aged three to twenty-five years in Occitania, covering the period from January 1, 2016, to December 31, 2020. The descriptive analysis of this data revealed that prosthodontic care is the only area to show an increase in the average amount of care consumed between 2019 and 2020: a relative increase of +4 percent among 3­25-year-olds and +6.7 percent among 21­25-year-olds. Moreover, among 21­25-year-olds, we observe a drop in the share of prostheses in the care consumed in 2019, and then a recovery approaching 0.3 percent of the initial share in 2020. Although it is not possible to conclude that there is an impact, these results show a positive trend whereby the reform's objective of increasing prosthodontic care consumption seems to have been achieved. This study highlights the importance of assessing the long-term impact of the COVID-19 crisis and the "100% Santé" reform on dental care consumption.

La réforme 100 % Santé est un choc important dans les pratiques tarifaires et assurantielles en santé orale en France. L'objectif de l'étude est d'observer l'évolution de la consommation de soins dentaires et notamment prothétiques sur une période regroupant des années ante- et post-réforme. Cette étude exploratoire, soutenue par des travaux de recherche descriptifs, fournit les premiers éléments d'analyse utiles pour évaluer la réforme 100 % santé sur le volet bucco-dentaire. Il s'agit d'une étude exploratoire reposant sur les données de consommation de soins de 3 466 764 bénéficiaires de 3-25 ans de l'Assurance maladie en Occitanie, sur la période allant du 1er janvier 2016 au 31 décembre 2020. L'analyse descriptive de ces données a permis de mettre en évidence que les soins prothétiques sont les seuls soins consommés dont la moyenne augmente entre 2019 et 2020 : hausse relative de +4 % chez les 3-25 ans et +6,7 % chez les 21-25 ans. De plus, chez les 21-25 ans, on observe un recul de la part des prothèses dans les soins consommés en 2019, puis un regain se rapprochant de 0,3 % de la part initiale en 2020. Malgré l'impossibilité de conclure à un réel effet, ces résultats montrent une tendance positive selon laquelle l'objectif d'augmentation de la consommation des soins prothétiques de la réforme semble se réaliser. Cette étude souligne l'importance d'évaluer les répercussions à long terme de la crise Covid et de la réforme 100 % Santé sur les consommations de soins dentaires.

Access to oral care in the «100% Santé¼ reform: Context and perspectives / L'accès aux soins bucco-dentaires dans la réforme 100 % santé : contexte et perspectives

The "100% Santé" (100% Health) reform was intended to address the major problem of social inequalities in access to dental care in France. We explain the reform as well as the numerous challenges that come with its application. The difficulties encountered in accessing dental care were associated with particularly high out-of-pocket expenses for users. The main objectives of the dental component of the "100% Santé" reform are to improve access to dental care and to strengthen preventive health policy. The main tool of this reform is a cap on the price of certain treatments. This makes it possible for health insurance organizations to be responsible for the total financing of such care. There are now three baskets of care, each with a different pricing and financing structure. The first basket proposes capped fees with no payment for users. This reform constitutes a significant change in the regulation of dental care, which could have very different consequences depending on the region and the number of dentists operating in it. The effectiveness of the reform on the evolution of health care consumption and on reducing inequalities of access must be monitored.

Le volet bucco-dentaire de la réforme « 100 % santé ¼ devait répondre au problème majeur des inégalités sociales d'accès aux soins dentaires en France. Nous proposons ici un résumé du contexte qui a appelé à cette réforme de la régulation des soins dentaires, une présentation de la réforme « 100 % santé ¼ ainsi que des enjeux auxquels son application devra faire face. Les difficultés d'accès aux soins dentaires constatées étaient notamment associées à des restes à charge particulièrement élevés pour les usagers. La participation financière des usagers étaient ainsi la première cible de la réforme « 100 % santé ¼, juste avant le renforcement d'une politique de santé préventive. L'outil principal de cette réforme est un plafonnement du tarif de certains soins. Cela permet d'organiser le financement total de ces soins par les assurances santé. Il existe désormais trois paniers de soins ayant chacun une tarification et un financement différent. Le premier panier propose des soins sans reste à charge pour le patient. Cette réforme constitue un choc dans la régulation des soins dentaires qui pourrait avoir des conséquences très différentes selon les territoires et leur dotation en chirurgiens-dentistes. L'efficacité de la réforme sur l'évolution de la consommation de soins et son efficience en matière de réduction des inégalités d'accès doivent être surveillées.

Socio-Economic Determinants of Dental Service Expenditure: Findings from a French National Survey.

(1) Background: This study investigated how individual enabling resources influence (i) their probability of using dental services and (ii) consumers' expenditure on dental treatment. (2) Methods: Data were derived from a self-administered national health survey questionnaire and from expenditure data from national health insurance. Multiple linear regression methods were used to analyze entry into the dental health system (yes/no) and, independently, the individual expenditure of dental care users. (3) Results: People with the highest incomes were more likely to use dental service (aOR = 1.59; 95% CI = 1.28, 1.97), as were those with complementary health insurance and the lowest deprivation scores. For people using dental services, good dental health status was associated with less expenditure (-70.81 EUR; 95% CI = -116.53, -25.08). For dental service users, the highest deprivation score was associated with EUR +43.61 dental expenditure (95% CI = -0.15; 87.39). (4) Conclusion: Socioeconomic determinants that were especially important for entry into the dental health service system were relatively insignificant for ongoing service utilization. These results are consistent with our hypothesis of a dental care utilization process in two steps. Public policies in countries with private fees for dentistry should improve the clarity of dental fees and insurance payments.

Impact of fees on access to dental care: evidence from France.

BACKGROUND: For financial reasons, dental prosthetics is one of the major unmet dental healthcare needs [Financial-SUN (F-SUN)]. Private fees for dental prosthetics result in significant out-of-pocket payments for users. This study analyzes the impact of geo-variations in protheses fees on dental F-SUN. METHODS: Using a nationwide French declarative survey and French National Health Insurance administrative data, we empirically tested the impact of prosthetic fees on dental F-SUN, taking into account several other enabling factors. Our empirical strategy was built on the homogeneous quality of the dental prosthesis selected and used to compute our price index. RESULTS: Unmet dental care needs due to financial issues concern not only the poorest but also people with middle incomes. The major finding is the positive association between dental fees and difficulty in gaining access to dental care when other enabling factors are taken into account (median fee in the highest quintile: OR = 1.35; P value = 0.024; 95% CI 1.04-1.76). People with dental F-SUN are those who have to make a greater financial effort due to a low/middle income or a lack of complementary health insurance. For identical financial reasons, the tendency to give up on healthcare increases as health deteriorates. CONCLUSIONS: The results underscore the need for fee regulation regarding dental prosthetics. This is in line with the current French government dental care reform.

Evaluation of children's participation in a national dental programme in France.

OBJECTIVES: The current national oral health programme for children in France, called the DHE "Dental Health Examination," began in 2007. The aims of the current study were to evaluate the efficiency and effectiveness of the DHE programme in improving resource allocation to preventive dental services and providing access to dental care, especially for the children who need it most. The main questions were as follows: How many children participate in it? Does it reach the children who need it most? And does it save dental care costs? METHODS: The study examined data for 1937 children aged 6-16 years. Data came from two data sets: (a) a 2010 French self-reported survey on health, health care and insurance; and (b) the data set of the National Health Insurance Fund on healthcare consumption, based on reimbursement data to families and payments to providers; this data set contains information on healthcare expenditures. We investigated participation in the DHE programme, the wider use of dental care services and the total amount spent on dental care in 2010, by dental health status and socio-demographic characteristics. Data analysis used multiple logistic and linear regressions. RESULTS: Children in households with higher income were more likely to participate in the DHE programme (OR = 3.09, 95% CI [1.78, 5.36]). Families with higher incomes were more likely to use dental care (OR = 2.23, 95% CI [1.40, 3.55]). Households with private complementary health insurance utilized more children's dental care services than households without it (OR = 2.79, 95% CI [1.04, 7.49]). Families that were aware of the DHE prevention programme were more likely to utilize dental care (OR = 1.77, 95 % CI [1.34, 2.33]) and had lower dental care expenses (coeff. = -142.93, 95% CI [-207.68, -78.18]). CONCLUSION: Financial barriers remain the major obstacle to dental care utilization in France, even with DHE, a free secondary prevention programme aimed at all French children. Participation in the DHE programme is associated with better access to dental care and with lower costs for both the National Health Insurance Fund and participating households.