ANALYSIS OF PUBLICLY FUNDED ORTHODONTIC SERVICES IN NORTH MACEDONIA

Abstract

Health is priceless, but it does have specific costs. Medical coverage is financing medical treatment, whereas access represents the method of receiving that care. Malocclusion, or deviation from the ideal occlusion, is typical in many children and teenagers. However, most of these deviations fall into what is considered a normal biological variation. Understanding the regulation of orthodontic services in publicly funded healthcare systems is essential to ensuring quality care and efficient resource allocation. When the funds are limited, the question is: How to ensure these limited resources are spent efficiently? Which kinds of orthodontic malocclusion might justify a legitimate claim for treatment financed by the public? This research aims to review the current regulation of orthodontic treatment covered by the Health Insurance Fund of North Macedonia, the only public institution implementing mandatory health insurance in the country, regarding treatment accessibility, outcome control, and payment methods. To achieve this goal, we sought guidelines, protocols, and legislative texts to understand how orthodontics is regulated in the country's publicly funded health system. We researched as follows: analysis of the legal and regulatory framework governing the provision of orthodontic services in the public health care systems of North Macedonia. Then, informative conversations with accountable persons working as general dental practitioners, orthodontists, and policymakers. At last, an unsystematic review of the literature was done.
Publicly funded orthodontic treatment is available to insured individuals up to 18 years of age in case of malocclusion, impaired articulation, and aesthetics. Only specialists in orthodontics can prescribe a removable appliance based on medical necessity determined by honoring the International Classification of Diseases (ICD) and age. Code K07: Dentofacial anomalies (including malocclusion) are eligible for publicly funded orthodontic treatment; no further guidelines or requirements are given. Fee-for-service is the primary payment method, and the orthodontist is reimbursed up to a maximum of three removable appliances. The efficiency of the removable appliances is most outstanding during the growth period. Studies show that compliance is suboptimal, and patients' motivation and cooperation significantly impact their effectiveness. There are no objective criteria to measure the treatment outcome. We suggest that the responsible healthcare authorities in North Macedonia improve the current regulation of orthodontic treatment. This includes the reforms and coverage of orthodontic treatment as per evidence-based dentistry instead of only funding certain appliances. A research project based on patients' and orthodontists' needs and the healthcare system conditions may help develop a framework for effective regulation on the provision of orthodontic care.