The French 100% Santé Reform: Impacts on Dental Care Utilization

Abstract

In 2019, France implemented a large-scale reform aimed at reducing out-of-pocket health care expenditures, with the objective of preventing the forgoing of dental care for financial reasons. The aim of this study was to assess the impacts of this reform on dental care utilization, with a focus on full dentures as prosthetic care, which was the main target of the reform. The study was based on analyses of large-volume administrative data from the French social health insurance funds and comprised >1 billion dental treatments encountered in the years 2014 to 2023. Drawing from a quasi-experimental research design and segmented negative binomial regression, controlled interrupted time series analyses were conducted with a “control outcome” approach. Controlled interrupted time series analyses compared utilization rates for various types of care whose coverage was differentially affected by the reform. Models were adjusted for COVID-19 and seasonality covariates and stratified by socioeconomic status. Following the removal of out-of-pocket payments for resin-based full dentures, their utilization was 58.85% higher (95% CI, 37.18% to 83.95%) as compared with the control scenario. The utilization of other types of dental care, largely unaffected by the reform, remained unchanged. Prophylactic care use increased only slightly during the study period. These findings suggest that the removal of out-of-pocket expenditures through the French 100% santé reform led to higher utilization of full dentures. However, as the reform focuses on specific treatment items and mainly concerns patients with voluntary health insurance, the impacts of the reform should be carefully monitored in the future, particularly its effects on vulnerable populations.