Dental Insurance in India: Tooth Matters

Oral health is probably still most neglected areas in Indian health. Cost of dental treatment is cited as one of the main reasons for its negligence and the expenses not being covered under most of the medical health insurances. There is just a lack of dental treatment insurance policies. However, there are some insurance companies who have started covering dental treatment expenses but to a limit. Dental insurance is insurance designed to pay the costs associated with dental care.

Dental and oral health in India

Fifty percent of school going children suffer from dental caries. Ninety percent of the adult population suffer from periodontitis and gingivitis. Tooth loss rate is greater due to periodontitis as compared to dental caries. Increased consumption of tobacco has increased prevalence of oral pre-cancer conditions and oral cancers. Oral cancer is a life-threatening condition and the available treatment modalities are expensive and are way beyond the reach of the common citizen. These can be prevented and controlled by public education and motivation to a significant level. Private fee for service is the only mechanism of payment for dental care in India and government hospitals and facilities providing treatment and care lack infrastructure, manpower, funds and hygiene. The major disadvantage of this type of payment structure is that many patients are unable to receive any care. Many NGO’s are also working but they also lack infrastructure, materials and funds. Government funds on medical healthcare in India is only 2% and out of this very few get for dental healthcare, as a result private dental care clinics are increasing.

Day by day dental graduates and specialists in India are increasing. Government has failed to provide job opportunities to them, resulting in private dental clinics mushrooming, and such facilities are beyond reach for a common man. To run a private practice also needs finance which cannot be maintained by keeping charges low; which means in India manpower is not less only cost of the treatment is the only issue regarding oral health care. Hence dental insurances can remove these barriers for oral health cares.

Why dental insurance is not common in India?

Our policy makers have given oral health last priority during National Oral Health Care Program. They are not aware of dental oral problems and its association with systemic health, that if not treated can be life threatening. Indian Dental Association (IDA) has failed to bring dental insurances policies in India, instead focussing on other off track work. Some private insurance companies have started covering dental expenses, but all these are not up to the mark and contain some serious shortcomings.

Also some private sector companies have started giving dental expenses to their employees with direct reimbursement plans. Under such schemes employees as a patient have the freedom to go any dentist they wish and present the bills of treatment done and employee will get some expenses reimbursed by the company. Companies are funding all these expenses because they know if small dental problems keep their employee home, companies lose their productivity. This however, is for a small percentage of the population. For the rest of the population, they still need proper planning and policies.

Types of dental insurances

In India

Stand-alone dental insurance plans

This type of plan covers the expenses related to general dental problems such as periodontitis and extraction of permanent teeth due caries. The amount of expense to be reimbursed as well as the period of such cover is fixed. Such insurances are provided by manufacturers like Pepsodent after buying their products.

Dental insurance cover as part of general health insurance plan

These are basically general medical insurances which cover some amount of dental expenses but not separate dental insurances. Some are shown in table with the types of coverage they provide.

In other countries

Indemnity plans

This type of dental plan pays the dental office on a traditional fee-for-service basis. A monthly premium is paid by the client and/or the employer to the insurance company, which then reimburses the dental office (dentist) for the services rendered. An insurance company usually pays from 50 to 80% of the dental office fees for a covered procedure; the remaining 20–50% is paid by the client.

Dental health maintenance organisations

They provide a comprehensive dental care to enrolled patients through their own fixed dentist. The dentist is paid on a per capita (per person) basis rather than for actual treatment provided.

Preferred provider organisations

If a patient takes a policy from a group of dentists, they get a discount as long as patient receives treatment from the particular group. If they wish to go out of the network dentists, they have to pay some extra fees.

Dental discount

The managing organizations negotiate with local dental offices to establish a set price for a particular dental procedure and offer deep discounts off the regular pricing code.

Benefits of dental insurances

1. Oral health care can be available to every person from all socioeconomic levels and locations.
2. Dental insurances can promote positive attitude in patients regarding oral health.
3. Patients will visit their dentist regularly and preventive measures can be undertaken in the early stages. Patients will become aware of available treatment option to treat them. Ultimately dentistry is not expensive, neglect is.
4. Basic preventive and few cosmetic treatments can be covered.
5. Affordability and access will give everyone a good reason to smile.

Conclusion

There is great initiative still required from the government to initiate such policies. Private policy companies need to modify their schemes by thinking from a patient perspective and dentist perspective. They need to come up with separate dental insurances covering most of the expenses.

DISCLAIMER : “Views expressed above are the author’s own.”