The implications of foreign dental coverage for U.S. National Health Insurance

Although foreign experience with public medical insurance has played an important role in U.S. policy debates, little attention has been paid to foreign dental benefits. This article examines principally the experience of four countries: New Zealand, the United Kingdom, Sweden and Canada. The most common dental benefit considered for U.S. national health insurance has been coverage for children. Foreign dental programs for children are evaluated in four main areas: quality, cost, access, and disease prevention. In New Zealand, and in parts of the systems in the other three countries, dental nurses treat children in the schools. The quality of care they provide is found comparable to that provided by dentists, and the estimated and experienced costs of such treatment are often considerably lower than when dentists provide it. Access is a serious problem for children's programs that simply provide private office benefits without any additional means of encouraging participation; those who fail to use the system come disproportionately from low income, poorly educated families. The problem can be overcome by school-based treatment or possibly by inspections at school followed by assiduous contact of parents. None of the systems appears to instill in patients a life-long concern for dental health. Dental benefits for adults are provided in Sweden and the U.K.; in the latter, where such care has been provided for thirty years, there has been little problem controlling the overall cost of the system and some apparent impact on dental health, yet overall utilization rates have remained modest, with the poor participating far less than those better off. Raising adult utilization rates remains an elusive goal, even at a theoretical level.