She once had a patient who did not return after a check-up, continued to suffer from toothache for a long time, took more and more medication and eventually ended up in the hospital with a stomach haemorrhage. Or just last week, a man who never went to the dentist and now had to have fifteen teeth extracted.
For dentist Didi Landman, who, in addition to her work in her practice, helps the homeless in Rotterdam for free one day a week, these kinds of stories are a daily occurrence: “Pulling a tooth costs 49 euros. But many people cannot afford that.” She not only treats homeless people, a few hundred per year, but also asylum seekers or others who simply do not have enough money – this is paid for, among other things, from a foundation she set up.
“There are first-class and second-class citizens, the result being perfect teeth as a status symbol,” concluded emeritus professor of social dentistry Geert van der Heijden earlier this year after his research Unwanted avoidance of oral care. That study, commissioned by the Ministry of Health, Welfare and Sport, referred to “oral care poverty”. 20 percent of adults do not visit a dentist, 80 percent of whom are poor and socially vulnerable people, with a pile of problems.
But there seems to be light at the end of the tunnel. More than two-thirds of the House of Representatives want to include the dentist for adults in the basic package. Some of the parties (including PVV, ChristenUnie, Volt) argue in their election manifestos for making check-ups, filling cavities and preventive treatments such as tartar removal free.
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Other parties (GroenLinks-PvdA, NSC) only want a free annual check for the time being. Almost all parties are concerned with basic oral care – although the SP also wants to make complicated and expensive procedures such as root canal treatments free. “Fantastic news,” Rotterdam ‘homeless dentist’ Didi Landman calls all the political attention. “I’ve been fighting for this for years.”
Before the major change to the healthcare system in 2006, including the introduction of compulsory basic insurance, only those insured by the health insurance fund were entitled to dental reimbursement. This was phased out from the 1990s onwards, and since 2006 the dentist has no longer been included in the package at all. Adults – children up to the age of eighteen are free – must either take out additional dental insurance or pay the dentist themselves.
It is not clear exactly how much dental care in the basic package will cost – it depends, among other things, on what exactly is reimbursed and how many people use it. Various studies estimate the costs between 1.2 and 1.9 billion euros per year, outgoing minister Kuipers (Zorg, D66) mentioned an amount of approximately 1.45 billion.
Kuipers was previously unenthusiastic about the idea in parliamentary debates and letters. According to him, this will lead to an increase in health insurance premiums with about 15 euros per year. According to Kuipers, the deductible (of 385 euros) is also still a barrier for many people.
Furthermore, having little money is not the only reason to avoid the dentist. Sometimes people are afraid of the dentist, they are ashamed of their teeth, they fear that they will need a much more expensive treatment, or they are simply not interested in it – they only come in when they experience pain. According to Minister Kuipers, one million people did not go to the dentist during the health insurance period. Emeritus professor Van der Heijden: “I hesitate to say: just include the basic package. It is probably only a paper solution.”
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Oral care in the basic package “is a fairly rough measure with major financial consequences,” Kuipers said in June this year against the House of Representatives. By the way, if everyone goes to the dentist, there is another problem: the major shortage of dentists. Many practices already have a waiting list.
Kuipers himself feels more in favor of prevention (encouraging children to go to the dentist as much as possible) and ‘customized oral care’, where people with lower incomes through municipal regulations or a municipal policy – a collective health insurance for people with low incomes – can receive reimbursement. The professional organization of dentists KNMT also thinks so. Oral care in the basic package is “not such a good idea”, KNMT chairman Hans de Vries recently wrote on the KNMT-website. He states that there has always been a group that does not visit a dentist. “The KNMT does not have the impression that this number is increasing. About 80 percent of people visit the dentist faithfully.” The KNMT does advocate making oral care free up to and including the age of 25, because only then the brain has fully grown and people can understand the consequences of poor dental maintenance.
Geert van der Heijden, who resigned as professor in September, advocates first making a cost-benefit analysis of oral care in the basic package: “What exactly does it cost and what does it yield in terms of health benefits and lower social expenditure? I expect this will be beneficial.”
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