BACKGROUND: Oral health, coupled with rising awareness on the impact that limited dental care coverage has on oral health and general health and well-being, has received increased attention over the past few years. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries using a vignette approach. METHODS: We used three patient vignettes to highlight the differences of the dimensions of coverage and access to dental care (coverage, cost-sharing and accessibility). The three vignettes describe typical care pathways for patients with the most common oral health conditions (caries, periodontal disease, edentulism). The vignettes were completed by health services researchers knowledgeable on dental care, dentists, or teams consisting of a health systems expert working together with dental specialists. RESULTS: Completed vignettes were received from 11 countries: Bulgaria, Estonia, France, Germany, Republic of Ireland (Ireland), Lithuania, the Netherlands, Poland, Portugal, Slovakia and Sweden. While emergency dental care, tooth extraction and restorative care for acute pain due to carious lesions are covered in most responding countries, root canal treatment, periodontal care and prosthetic restoration often require cost-sharing or are entirely excluded from the benefit basket. Regular dental visits are also limited to one visit per year in many countries. Beyond financial barriers due to out-of-pocket payments, patients may experience very different physical barriers to accessing dental care. The limited availability of contracted dentists (especially in rural areas) and the unequal distribution and lack of specialised dentists are major access barriers to public dental care. CONCLUSIONS: According to the results, statutory coverage of dental care varies across European countries, while access barriers are largely similar. Many dental services require substantial cost-sharing in most countries, leading to high out-of-pocket spending. Socioeconomic status is thus a main determinant for access to dental care, but other factors such as geography, age and comorbidities can also inhibit access and affect outcomes. Moreover, coverage in most oral health systems is targeted at treatment and less at preventative oral health care.

Charité Universitätsmedizin Department of Oral Diagnostics Digital Health and Health Services Research Aßmannshauser Straße 4 6 14197 Berlin Germany

Department of Healthcare Management Technische Universität Berlin H 80 Straße des 17 Juni 135 10623 Berlin Germany

Department of Public Health Institute of Health Sciences Faculty of Medicine Vilnius University M K Čiurlionio g 21 27 03101 Vilnius Lithuania

European Observatory on Health Systems and Policies WHO European Centre for Health Policy Eurostation Place Victor Horta Victor Hortaplein 40 10 1060 Brussels Belgium

Faculty of Health Science Institute of Public Health Jagiellonian University Medical College ul Skawińska 8 31 066 Kraków Poland

Independent Health Care Expert Bratislava Slovakia

Institute for Research and Information in Health Economics 117 bis Rue Manin 75019 Paris France

Institute of Dentistry Faculty of Medicine Jagiellonian University Medical College Kraków Poland

Medical University Varna 55 Marin Drinov str Varna 9002 Bulgaria

Nivel Netherlands Institute for Health Services Research Otterstraat 118 3513 CR Utrecht The Netherlands

Oral Health Services Research Centre and School of Public Health University College Cork Cork T12K8AF Ireland

Prague University of Economics and Business W Churchill Sq 1938 4 130 67 Prague 3 Žižkov Czech Republic

Public Health Research Centre National School of Public Health Nova University Lisbon Rua da Junqueira 100 1349 008 Lisbon Portugal

University of Tartu Ülikooli 18 5090 Tartu Estonia

Vardanalys Drottninggatan 89 113 60 Stockholm Sweden

WHO Barcelona Office for Health Systems Financing Sant Pau Art Nouveau Site Sant Antoni Maria Claret 167 08025 Barcelona Spain

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