Abstract: The delivery of oral health care has to be dynamic, responding to the changes in population demographics and the patterns of oral diseases. In a European perspective, this report presents a qualitative approach of the oral health care system in Belgium, mainly with respect to children. According to the characteristics of any oral health care delivery system, the following questions need to be dealt with: what are the objectives, who should provide what service to whom, with what resources and with what effects? There are no clear nationally articulated oral health objectives in Belgium as oral health care objectives are considered as part of general health care objectives. Basically in Belgium health promotion, education and research is decentralised and the responsibility of the different federal regions. Health care is a national matter. The most frequently used structures for delivery of oral health care are independent dental practices and there is no oral health care provided at a community level. The population is targeted as a whole. This could result in a limited access to oral health care for those groups who are most in need.
At the time of this analysis, in 1998, the number of active dentists in Belgium was 8,095 of whom approximately 85% were self-employed in private practices. The dentist-population ratio was 1:1,266 that is comparable with the neighbouring countries of France (1:1,504) and Germany (1:1,300). The Netherlands (1:2,240) and United Kingdom (1:2,260) and the Central European countries have remarkable higher ratios. The Nordic countries, such as Sweden (1:980), Denmark (1:1,032) and Norway (1:1,089) have the lowest ratios. In Belgium only a minority of dental practices employs dental assistants and dental hygienists do not exist at all.
Private fee-for-service payment is the traditional form for payment and reimbursement for dental services in Belgium. The National Health Insurance is responsible for the reimbursement of the patient. In 1998 the cost of dental care amounted to 0.18% of the GNP. In a European context, the cost of oral health care in Belgium is rather low. Although efforts to promote preventive care have already occurred to some extent, there is still a clear over-reliance in the Belgian oral health care system on treatment of oral disease rather than prevention of oral disease.