The creation of the National Health Service (SNS) in Portugal had strong implications for improving access to quality health care, significantly contributing to the health outcomes of the Portuguese population.

This development of the role of the NHS has not been equal in all areas of health care. Oral health care has maintained a mostly private nature, both in terms of its provision and financing (and hence its access). Information on the use of oral health care systematically revealed the predominance of private provision (consistently above 90% of oral health care provided in the private sector) and the dominance of direct payments from families in achieving this access. The existence of unmet health needs has been, and is regularly detected by European surveys on the well-being of populations.

The recognition of this situation led to the National Program for the Promotion of Oral Health, which, however, did not prevent the Portuguese from being among the peoples of developed nations with the worst indicators of oral health. There are still different types of oral health care needs that are not met. For example, data from the European Union – Statistics on Income and Living Conditions show that Portugal is the second country in the European Union with the highest percentage of people over 16 years old reporting unmet needs in oral health care: 17.8% , well above the EU average (7.9%).

On the other hand, the financial barrier has been recorded in the access to oral health care, being one of the main obstacles, if not the main one, to a better oral health of the population. Let's see that, in 2010, practically one fifth of direct payments in Portugal refer to the area of dentistry, when in 2000 they represented only one tenth. These household consumption survey data demonstrate that the poorest are particularly affected by the financial barrier that prevents them from accessing this type of care.

These aspects of a financial nature and protection against illness are subject to intervention by health policies, with a margin for improvement in the oral health of the population that it is important to take advantage of. To take advantage of this margin for improvement, it is necessary to develop strategies that promote adequate oral hygiene, from a prevention perspective, and access to oral health care, when necessary.

Since it is not difficult to establish a goal of creating a national network of oral health care, where prevention and high quality treatment are a priority, it is in defining the path that should focus attention and the search for consensus by the various actors in the following strategies.

A study by the Nova Healthcare Initiative – Research, recently released by the Portuguese Dental Association, presents several evolution scenarios that are important to analyze and discuss. Of course, there are no miracle solutions and even less cost-free solutions. Among the different possible options, maintaining the current situation is clearly incompatible with improving oral health indicators. It is therefore necessary to face active intervention strategies. The discussion is open.

Study Oral Health Care - Universalization, available on here.

(Nova's Notes column is a contribution to reflection in the health area, by the members of the Nova Healthcare Initiative – Research. These are opinion articles under the sole responsibility of the authors)