Dental care benefits provide all adults with the opportunity to visit a dentist at least once a year
Carmen-Kristiina Parik, Specialist of the Division of the Primary Care Package Development, Estonian Health Insurance Fund
Last year, the Riigikogu passed a law, according to which from July 1, 2017, the Health Insurance Fund will start to compensate dental care for adults for up to 30 euros per year. The dental care benefit for the elderly, pregnant women, mothers of children under one-year-old, and the other people already receiving the benefit will increase to 85 euros per year.
In order to make the use of the service for all the Estonian people with health insurance, as well as for the dental care providers as quick and easy as possible, the calculation and accounting of the limit of the benefit between the Health Insurance Fund and dental service providers will be carried out electronically. The dentists’ software developers are already dealing with the additional developments related to the benefits. In order to enable a non-monetary benefit, the Health Insurance Fund will enter into contracts with all the dental care service providers who wish to be included. In the first week of February, the fund sent out the the first information letter to dentists all over Estonia, and we are pleased to note that a number of dentists have already expressed a desire to examine the contract being developed. In the first half of each month, we will continue informing the dentists of the new benefit, to make sure that accurate and up to date information reaches everybody.
It must be emphasized that becoming a partner of the Health Insurance Fund does not mean that the dentist must provide all services according to the price list provided in the list of health care services. For the provision of the benefit, our contract partners will be able to use the price list specifically for the services included in the benefit package, among other things, for diagnostics (including X-rays), drug placement and placement of temporary fillings, placement of fillings, amputation and tooth removal, opening and treatments of an abscess, root canal treatment services, curettage, surface and injection anesthesia.
If the patient has received dental services included in the benefits package to the extent of the entire 30 euro benefit, then until the end of the year, the dentist has an opportunity to provide services to them according to his or her price list. The same principle will apply to a dentures benefit as of next year. The denture assembly will be compensated to the patient up to 255 euros over three years, and the patient pays the remainder of the cost. In agreement with the dentist, a person can choose the price range of the dentures from those provided in the list of health care services the patient wishes to receive, and the Health Insurance Fund will reimburse the service price to the patient within the amount of the denture benefit.
The pricing we will be based on activity-based cost calculations, as in the case of all the other medical specialties, which shall be based on reference treatment facilities, or clinics providing dental care who transmit data on the actual costs (including the cost of equipment and instruments, staff time cost, cost of premises). Additionally, the Estonian Dental Association has forwarded the proposals for changing the prices. After a complete analysis, the reasoned proposals were accepted. With the Estonian Dental Association, we have also discussed the cooperation points for the year 2017. This year is the first year of the new list of services and the implementation of price limits. Therefore, we are sure to monitor the implementation of the services in the second half of the year and check whether the new descriptions and prices of the services correspond to the actual costs.
Accordingly, the adult dental care benefit is a welcome addition to our citizens, to motivate them to visit a dentist. With the new benefit, we can give people the opportunity to visit the dentist at least once a year to check the condition of their mouth, and with the support of the benefit to carrying out minor procedures that keep dental health, and overall oral hygiene at a good level. Thus, we prevent the emergence of major problems, thereby saving both human health and the amounts spent on dental treatment. We believe that the new benefit will help even more people to visit the dentist. Starting today, with the support of health insurance, we can offer children up to 19 years of age the opportunity to start their lives with healthy teeth, and now it is also possible to continue on this path from 20 years of age and to develop a regular habit of visiting a dentist into adulthood.