Evaluation of children's participation in a national dental programme in France

Abstract

Objectives: The current national oral health programme for children in France, called the DHE "Dental Health Examination," began in 2007. The aims of the current study were to evaluate the efficiency and effectiveness of the DHE programme in improving resource allocation to preventive dental services and providing access to dental care, especially for the children who need it most. The main questions were as follows: How many children participate in it? Does it reach the children who need it most? And does it save dental care costs?

Methods: The study examined data for 1937 children aged 6-16 years. Data came from two data sets: (a) a 2010 French self-reported survey on health, health care and insurance; and (b) the data set of the National Health Insurance Fund on healthcare consumption, based on reimbursement data to families and payments to providers; this data set contains information on healthcare expenditures. We investigated participation in the DHE programme, the wider use of dental care services and the total amount spent on dental care in 2010, by dental health status and socio-demographic characteristics. Data analysis used multiple logistic and linear regressions.

Results: Children in households with higher income were more likely to participate in the DHE programme (OR = 3.09, 95% CI [1.78, 5.36]). Families with higher incomes were more likely to use dental care (OR = 2.23, 95% CI [1.40, 3.55]). Households with private complementary health insurance utilized more children's dental care services than households without it (OR = 2.79, 95% CI [1.04, 7.49]). Families that were aware of the DHE prevention programme were more likely to utilize dental care (OR = 1.77, 95 % CI [1.34, 2.33]) and had lower dental care expenses (coeff. = -142.93, 95% CI [-207.68, -78.18]).

Conclusion: Financial barriers remain the major obstacle to dental care utilization in France, even with DHE, a free secondary prevention programme aimed at all French children. Participation in the DHE programme is associated with better access to dental care and with lower costs for both the National Health Insurance Fund and participating households.

Keywords: access to care; dental care; paediatric dentistry.