A review on oral health care in four different health care systems

Abstract

Background : A universal approach to oral health is said to improve oral health outcomes, but research has shown mixed results. This study aimed at critically reviewing the literature available on the oral health care systems of four countries in terms of structure, scope, and delivery, along with their impact on oral health outcomes. Methods : A comparative literature review of the oral health care systems in Brazil, New Zealand, Canada, and Sweden was performed between August 2017 and January 2018 using PubMed/MEDLINE and the key words ‘universal’ OR ‘publicly funded’ AND ‘dental OR oral’ AND ‘care OR access’ AND ‘outcome’. This is a critical essay based on evidence available in the literature that was enriched by accounts from 12 key informants from these four countries. Results : All four countries provide some form of universal health care, but the administration, funding, and delivery of oral health care varied. Approximately 6% of oral health care expenditure in Canada is publicly funded. Brazil provides full publicly-funded oral health care at the point of use via salaried dental professionals, while Sweden offers a high-cost protection plan favouring those with greater needs, and New Zealand delivers publicly-funded oral health care to children up to their eighteenth birthday. With service utilization varying, 61% percent of Canadian children, 67% of Swedish children, 50% of Brazilian children, and 45% of New Zealand children are caries-free at age 12, while 6.4%, 0.8%, 6.5%, and 9.6% of adults between the ages of 20 and 79 years are edentulous, respectively. Conclusions : All countries have some form of publicly-funded oral health care, but vary in the way that the services are delivered, from salary-based providers to private-practice models. Service utilization and oral health outcomes differ in each country.