Dental & Oral Health

In France, dental care prices consist of a public basic fee plus overbilling applied by dentists. Public health insurance proposes very low reimbursement for the basic fee. Extra billings make the most part of costs actually bore by patients. Former studies indeed showed strong out-of pocket and significant inequalities in access to dental care. Dental care concentrated the highest rates of unmet need for financial reasons in France that is 18% of the French population (data ESPS 2012). Dentists decide the overbillings on prosthesis. The general aim of the study is to assess if dentist choices in the pricing process can drive potential financial barriers and social gradient in access to dental care, and how. Our database concerns the years 2006, 2008 and 2010. It is from a match between the French Health, Healthcare and Insurance Survey General Population Survey: ESPS (Enquête Santé et Protection Sociale) and individual consumption from Public Health Insurance data. We explain the unmet need of dental care for financial reason, especially through price. We focus on the inlay-core prosthesis, easy to identify in the data-base and with uniform quality. As a proxy for overbilling distribution in a department, we calculate the median of observed prices in 2010. From an empirical view, we show that unmet needs bring complementary items on access to care. We observed that the individuals living in departments with highest dental fees are 40% more likely to declare to have given up to dental care. The amount of the overbillings on fees, and thus the price which results from, is a barrier of access to dental care.