A Comparative Study of Oral Health Care Systems and Insurance Models in Selected Countries for Development of Suitable Iranian Model

This study aimed to determine and compare health care systems'' components and national health insurance in selected countries and to present a suitable model for providing primary oral health care in Iran.

It was a two-staged qualitative، comparative، cross-sectional study. Finland، UK، France، Canada، and Japan were selected as sample countries. The first phase، a review study to compare dental health systems of the countries، resulted in drawing tables including five characteristics: financing methods، setting، types of services، practitioners and reimbursement methods، and recipients of services. The tables determined the framework of the proposed model. In the second phase، to develop consensuses for the framework suitable for health care system in Iran، the Delphi consensus technique was used. Each Delphi round comprised a questionnaire، analysis، and a feedback report. A total of 25 senior oral and health experts agreed to participate and completed all questionnaires.

With considering dental treatment needs among Iranians، a basic package of services including primary care with emphasis on preventive services should be defined. To affordability of the services، the mentioned package should be covered by public health insurance for all Iranians. To accessibility and availability of the service at the first contact with dental hygienist or dentist، who provide regular check-ups and preventive services، defined clinics should be established. Reimbursement to practitioner could be arranged via capitation. If patients need more services، clinics will be responsible for the referral affairs to the private practitioners، through a fee-for-service contract with insurance companies. Tax and premium is the best way to financing the system. To continue health benefits، obligatory regular check-ups are required.

Attempting to universal health insurance coverage; preparing a targeted dental service package with focus on preventive care; encouraging private practitioners to participate in public health insurance plan; financing services through government revenues، premium، and health taxes are essential components to establish a suitable model on oral health care delivery system in Iran.