How dental system reform impacts equality in access – 100T-Dent

The stated objectives of the "100% health" reform are to improve dental care access, with an increase in the volume of care consumed and in the share of preventive and primary care. They are based on a break in continuity in the pricing of care and their financial coverage. The reform institutes a system of three baskets, the first combines "100% financial coverage" and "fixed tariffs" while the last has free prices and limited coverage by health insurance. The major changes resulting from this reform are as follows:
- The capping of the prices of certain dental prostheses, enabling the organization of total solvency for users, through the participation of NHI and CHI.
- The revaluation of the tariffs for conservative care of carious lesions. These treatments had a ceiling before the reform, but the ceiling has been raised.
The strong shock in terms of the price should induce important changes in terms of quantities of care as well as in the type of care provided. In parallel, on the demand side, the strong shock in terms of the reduction of out-of-pocket should induce an important increase in the demand
We would like to test the 100% health system on 3 axes of study:
- the consumption of dental care,
- the activity structure of dentists and their income,
- the conformity of the care baskets with the population's expectations.
Although the year 2020 has forced us to wait, the administrative databases allowing the study of the consumption of care but also the incomes of dentists will be available soon. We will study the evolution of the volume and structure of dental care provided over the period 2014-2023, under the hypothesis of inducing an increase in post-reform care. At the same time, we will analyze the reaction of dentists and in particular whether the changes in their practices and income are sufficiently favorable to provide insight into the sustainability of the effects of the reform. Finally, to interpret the previous results in terms of social benefit, we will study the genesis and the criteria for constituting the care baskets during the negotiations of the National Dental Convention (2018). We will seek to compare these criteria with dental care access priorities expressed by users. We will thus question the legitimacy of the effects induced by the classification by baskets.
This health economics research project integrates qualitative methods and evaluates the impacts of the "100% health" reform on access to dental care in France. The results could support the reform, or help to improve the system put in place.