EVALUATION OF A DENTAL BENEFIT PLAN FOR CHILDREN CONDUCTED IN AUVERGNE, FRANCE, SINCE 1992

Usually, the French dental insurance system covers the cost of restora tive treatment but does not reimburse the cost of preventive therapies . A French sick-fund covering self-employed persons tested a new denta l benefit plan for children intended to provide an incentive to develo p office-based preventive activities. The programme, which started in 1992, concerns all 4-year-old children of self-employed workers in a s ingle French region (Auvergne). Participants undergo an annual examina tion by the dentist of their choice until their 15th birthday. If the child is seen every year, all services related to dental caries (preve ntive and restorative) are provided free of charge. An ongoing evaluat ion of the programme was necessary to determine its influence on the d evelopment of office-based preventive activities and the dental health of the participants. A cohort of children enrolled in the programme i n 1992 was followed over 4 years to examine the patterns of service us e. In addition, a cross-sectional study comparing the caries experienc e of all 8-year-old children participating continuously in the program me (test sample) with that of a sample of control children (n=90) was conducted in 1996. Data from the longitudinal follow-up indicate that 43.37% of the 551 children to whom the programme was offered in 1992 u nderwent an annual examination in the first year. Of the children enro lled in 1992, 55.2% were still participating in the programme in 1996. Results showed that independent practitioners continued to focus on r estorative treatment rather than preventive therapy. Results from the cross-sectional study are in accordance with this trend. The number of caries-free children was identical in test and control samples and th e mean dft, DMFT, DT and dt did not vary between the two groups (Stude nt's t-test, P>0.05). However the mean number of filled teeth was sign ificantly higher in the test children than in the controls (P<0.01). F or children with caries, the mean dft was 23.5% greater in the test gr oup than in the control group (P<0.05). In Auvergne, a large number of families were not ready to participate in a plan that required them t o take their child to the dentist every year. There was not a perceive d need for regular preventive dental care, an attitude probably reinfo rced by the interventionist approach undertaken by the dentists over t he survey period. Moreover, the plan did not provide an incentive for dentists to develop office-based preventive activities.