Access Crisis is not Uniquely British
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- Published: Friday, 10 January 2025 10:44
- Written by Peter Ingle
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British expatriates in France at risk of becoming homesick, can take comfort in one aspect of life in the UK that is still available in their new home.
A recent story in The Connexion, an English language paper published in France, referred to measures being taken to deal with the problems of medical and dental deserts across the country.
French health ministry figures from 2021 showed that there were around 62 dentists per 100,000 people in France. While this is lower than the EU average (74 per 100,000), it is still substantially higher than recent figures in the UK (42.3) Despite this, over 60% of communes in France have a ‘very low’ level of access to dental care.
New regulations aimed at easing the lack of dentists in many areas of France came into force from January 1, 2025. With a different set of levers to operate when compared to the UK, the French authorities have sought to influence where dentists choose to practice. In contrast to the UK approach of opening more dental schools in underserved areas, the French have set out to discourage dentists from working in already over provided locations.
Practices opening in areas with an existing high number of dentists will not receive state reimbursement. Dentists will not receive approval from state insurer Assurance Maladie to work in areas where the number of dentists is considered to be ‘very high’ or ‘high’ by the health ministry.
In contrast, they will be granted approval if they set up practice in an area where there is an existing lack of dentists. The changes have been backed by France’s main dental unions – together representing 95% of dentists – but some students oppose the rules seeing them as restrictive.
While starting with dentistry, similar rules may later be applied for doctors as France looks to tackle the problem of uneven medical access.
After January 1, dentists are still able to take over existing practices or replace retiring practitioners in areas with already-sufficient dental coverage and maintain the state reimbursement. Nor do the new rules prevent someone from opening a practice if it is completely private.
In practice less than 5% of areas will be affected, many in larger cities or high-population areas.
In echoes of the UK’s find a dentist website, the health ministry provides an official ‘Cartosante’ interactive map to show the public the level of healthcare professionals in different areas.
French dental workforce problems have been building for decades. Over the past 20 years, while the population grew by more than 10%, the number of dentists only increased by 4%.
Dental organisations have said that changes aiming to address France’s shortage of dentists will take several years to make an impact. Even DIY dentistry is not restricted to the UK, with coverage of an agricultural labourer in Charente-Maritime who pulled out his own tooth after failing to find an appointment.
In costs too, there are similar problems on both sides of the channel. Papers in the UK have been running stories on the increasing cost of private treatment while those able to access NHS care will know of the steady rises in patient charges. Those who have moved to France need not feel left out. The French social security fund Assurance Maladie, is now directly refunding less of the cost of dental treatment. Just over year ago its share of dental bills that were reimbursed dropped from 70% to 60%, in a bid to cut €500 million a year from its budget.
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