Conceptualising Essential Oral Health Benefits Baskets: A Thematic Analysis of Public and Expert Perspectives

Introduction: Despite its importance, oral health (OH) is often excluded from comprehensive public health coverage in Europe, resulting in financial hardship and exacerbating OH inequalities. Defining what ‘essential’ means in OH is a prerequisite for developing a public benefits basket to expand public coverage and financial protection. Method: This qualitative study explored the population's and experts' perspectives on ‘essential’ OH in Europe. Participants were purposively sampled from eight European countries. Data were collected through 37 focus group discussions (FGDs) gathering 228 participants. As data saturation was reached, data from 21 FGDs were analysed using thematic analysis. Results: ‘Essential’ in OH was perceived as a state of good OH, encompassing both performing basic functions and the psychosocial dimension, which aligns with the WHO definition of good OH. Participants highlighted multiple considerations to define an ‘essential’ OH benefits basket, including services' contributions to improving health, economic criteria, societal values, people-centred care and feasibility. Considering OH as part of a broader health system was seen as crucial. Conclusion: Findings emphasise the fluid and multidimensional nature of the ‘essential’ concept in OH and highlight the myriad considerations for priority-setting in public coverage. This underscores the importance of first defining what is ‘essential’ in each country's context. This study identifies three key lessons relevant for policy-making. First, people's expectations vary between and within countries but remain realistic, as considerations are similar to those used in other health fields. Second, OH should be better integrated into the general health system. Finally, involving patients and potential patients in the decision-making process is key to (re-)defining an OH benefits basket that responds to the health system's goals. Public Contribution: OH patients and potential patients were at the centre of this study, informing how to conceptualise ‘essential’ in OH in Europe. This is a concrete example of how public participation mechanisms can support decision-making over the definition of an (OH) benefits basket.