100% health: what’s new for dental care

For once, the unions of dental surgeons seem to be delighted with the global agreement on the implementation of “zero out-of-pocket expenses” for dental prostheses. In fact, negotiations on the moderation of dental prosthesis tariffs were accompanied by an increase in the cost of routine care, which the profession had been hoping for and demanding for many years. The compromise reached should have a far more positive impact on French oral health than on the financial equilibrium of the healthcare system.

The focus is on healthcare refusal and prevention

According to a 2016 Health Insurance survey of 29,000 people, 39% of insured people have already given up having dentures fitted, in the vast majority of cases for financial reasons.

And with good reason: the average out-of-pocket expense for dental prostheses is 40%1. For example, given that the average price of a metal-ceramic crown is €540, the out-of-pocket expense is €216. These amounts can even be tripled in the case of a bridge.

Although prostheses account for only 12%2 of the procedures carried out by dentists, they represent two-thirds of their sales and of the out-of-pocket expenses borne by policyholders. In fact, the prices of conservative treatments are regulated by the principle of opposable tariffs, whereas the prices of prostheses are free, which, according to Nicolas Revel, Director General of the Caisse nationale d’assurance-maladie (CNAM), generates a phenomenon of compensation between the two types of treatment.

This is why the creation of a “health care basket 100% health This is why the creation of a “100% health” care basket covering dental prosthesis needs had to include an increase in the cost of conservative care. And the increase in fees will not be homeopathic. For example, the devitalization of a molar will rise from €82 to €110. The aim is not only to satisfy dentists in the negotiations for the 2019-2023 agreement, but also to redirect care towards prevention by improving the coverage of routine care. With this in mind, an oral examination for young people aged 3 to 24 will be fully covered, and new effective treatments will be reimbursed, such as the application of fluoride varnish to children at risk of cavities.

3 levels of care for 3-stage implementation

To meet the promise of “zero out-of-pocket expenses” for dental prostheses, the reform provides for the creation of three levels of care. The “100% health” basket, containing fully reimbursed care, will cover 46% of dental prosthesis procedures (recorded in 2017). Ceramic crowns will be available for visible teeth (incisors, canines and first premolars), while metal crowns will be required for other teeth. On average, the switch to “zero out-of-pocket expenses” will save policyholders €100 to €200 per crown! The reform also introduces a basket of treatments at controlled rates, corresponding to 25% of the procedures performed. This will include ceramo-metallic crowns for second premolars. Patients will have to pay their own out-of-pocket expenses, but will be guaranteed a moderate out-of-pocket expense, since prices will be capped at 550 euros. Finally, 29% of procedures currently performed using more sophisticated techniques or materials will continue to be offered at free prices.

The transition to “reste à charge zéro” will take place over three key dates. On April 1, 2019, an initial price cap will apply to crowns. On January 1, 2020, a new price cap will apply to crowns and bridges. Finally, removable resin prostheses will be included in the “100% health” basket on January 1, 2021.

A public health impact commensurate with the financial effort?

The cost of these measures is estimated at 1.2 billion euros over 5 years, of which nearly 700 million will be covered by the French health insurance system, and 500 million by complementary health insurance organizations. organizations. This raises fears of an increase in premiums. In the short term, if the number of people giving up healthcare proves to be as high as studies suggest, a massive catch-up effect could well generate significant additional costs. In the longer term, on the other hand, the agreement signed with dental surgeons guarantees a degree of control over charges. Above all, it holds out the prospect of a reduction in overall expenditure, by promoting prevention and tooth-preserving treatments rather than forced recourse to dentures. Today, only 43%3 of French people consult their dentist at least once a year, while 85% of Danes and 71% of Germans do so. The current reform should raise this rate by eliminating the tariff barriers that keep the French away from their dentist. The financial equilibrium of the reform is therefore based on a daring gamble that is nonetheless proverbial: “prevention is better than cure”.

1-Health insurance

2-Mercer

3- Council of European Chief Dental Officers, CECDO data sheet 2014.