What should we expect from Switzerland\u2019s compulsory dental insurance reform?

Enrico Di Bella,Marcello Montefiori,Ivo Krejci,Lucia Leporatti,Stefano Ardu

doi:10.1186/s12913-018-3065-2

Enrico Di Bella, Marcello Montefiori + Show 3 more

Open Access

https://doi.org/10.1186/s12913-018-3065-2

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Abstract

BackgroundA vast and heated debate is arising in Switzerland as a result of some recent citizens’ initiatives aimed at introducing compulsory dental health care insurance. The Grand Conseils of the Vaud, Geneva, and Neuchâtel cantons recently approved three public initiatives and their citizens are expected to vote on the proposal in 2018. The process of collecting signatures has begun in several other cantons and the discussion has now moved to a national level.DiscussionAt present, there is no scientific research that can help policy-makers and citizens to understand the main economic implications of such reform. We attempt to fill this gap by analysing three critical issues: the level and determinants of unmet needs for dental care in Switzerland; the protection of vulnerable individuals; and the economic sustainability of reform.Results and short conclusionsThe results show that income is not a unique determinant of barriers to access to dental care but rather, cultural and socio-demographic factors impact the perceived level of unmet dental care needs. The reform might only partially, if at all, improve the equity of the current system. In addition, the results show that the 1% wage-based contribution that the reform promoters suggest should finance the insurance is inadequate to provide full and free dental care to Swiss residents, but is merely sufficient to guarantee basic preventive care, whereas this could be provided by dental hygienists for less.

Highlights

A vast and heated debate is arising in Switzerland as a result of some recent citizens’ initiatives aimed at introducing compulsory dental health care insurance
Periodontal diseases and dental decay are mainly originated from bad oral hygiene, lack of basic cleaning procedures, and irresponsible diet and habits that are more common in low level sociodemographic groups, the ones that experience economic barriers to dental care access
“dental status improved across all sociodemographic groups, with the greatest improvements being found in obese participants and in participants with the lowest incomes and educational levels” and that “even though dental treatment continues to be a self-paying system, the differences between sociodemographic groups decreased markedly”

Summary

Introduction

A vast and heated debate is arising in Switzerland as a result of some recent citizens’ initiatives aimed at introducing compulsory dental health care insurance. Kreider et al [20] highlighted the relevance of the selection problem that emerges when analysing the impact of insurance on dental care use: seeking dental care and obtaining insurance might be driven by unobserved factors (e.g. aversion to risk and expectations of future needs), making the relationship spurious. For this reason, recent approaches [7, 20, 32] have tended to use econometric specifications that can deal with the selection bias problem and have still produced results consistent with the previous ones

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Conclusion