Consenting oral health indicators to assess health system performance in the EU: a Delphi study

Abstract Background Oral diseases affect around 50% of the EU population and are recognized as a public health challenge, impacting well-being, finances, and quality of life. Relatively high unmet needs and out-of-pocket spending on oral health in the EU highlight the need to secure access to oral health care without financial hardship. However, approaches to evaluate the performance of EU health systems regarding oral health are lacking. Agreeing on a set of indicators to assess health systems’ performance in oral health is a prerequisite to analyze and compare the achievements and to provide data for evidence-based policy-making. Methods This study is part of the Horizon Europe's PRUDENT project (Prioritisation, incentives and Resource use for sUstainable DENTistry). It develops a set of performance indicators to assess oral health financing and care in the EU. A modified three-round Delphi study among relevant stakeholders from research, health policy, (inter-)national health information systems, and patient and provider organizations is used to reach a consensus on oral health indicators. Results A total of 1,221 oral health indicators were identified from international (327 indicators) and national (EU) databases (544) and scientific publications (871) with a mapping approach. These indicators were then grouped and clustered into the dimensions of the WHO Health Systems Framework (e.g. health workforce, access, quality). The Delphi participants are evaluating the 102 clustered indicators regarding their relevance and feasibility, to reach consensus. Conclusions Oral health is an important area in public health, however, there is a lack of systematic approaches to monitor it in the EU. Assessing the performance of health systems with a focus on oral health is a prerequisite to analyze how well health systems perform in the EU countries. It can support cross-country learning, provides evidence in a systematic manner and thus improves policy-making in the EU. Key messages • Oral and dental diseases are recognized as a public health challenge, however, approaches to evaluate the performance of EU health systems regarding oral health lack so far. • Agreeing on a set of indicators to assess oral health is a prerequisite to analyze and compare the achievements of health systems and to provide data for evidence-based policy-making.