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Harmonização das políticas de saúde oral na União Europeia: enquadramento e desafios de implementação – revisão de escopo
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A saúde oral constitui um componente fundamental da saúde pública, sendo influenciada por fatores estruturais, económicos e políticos que variam entre os Estados-Membros da União Europeia. Esta variabilidade tem implicações diretas na organização dos sistemas de saúde oral, no acesso aos cuidados e na equidade em saúde, colocando desafios significativos à harmonização das políticas a nível europeu. O objetivo da presente revisão de escopo foi analisar de que forma as diferenças estruturais, económicas e políticas entre os Estados-Membros da União Europeia influenciam a harmonização das políticas de saúde oral e a equidade no acesso aos cuidados. A metodologia adotada baseou-se nas diretrizes PRISMA-ScR, com definição da questão de investigação segundo o modelo PCC. A pesquisa bibliográfica foi realizada nas bases de dados PubMed, ScienceDirect e Scopus, utilizando descritores combinados com operadores booleanos. Foram incluídos estudos publicados entre 2000 e 2026, em língua inglesa, portuguesa, espanhola ou francesa, que abordassem sistemas de saúde oral, financiamento, acesso, desigualdades e políticas na União Europeia. Após o processo de seleção, foram incluídos 15 estudos na análise final. Os resultados evidenciaram uma elevada heterogeneidade na organização dos sistemas de saúde oral, refletindo modelos distintos e níveis variáveis de integração nos sistemas de saúde geral. Verificou-se que sistemas com maior financiamento público apresentam melhores níveis de cobertura e equidade, enquanto a dependência de financiamento privado está associada a maiores barreiras no acesso. A análise confirmou ainda a existência de desigualdades socioeconómicas persistentes, não totalmente mitigadas pela cobertura pública. No domínio das políticas, identificou-se uma fragmentação significativa, decorrente da predominância de abordagens nacionais e da ausência de mecanismos eficazes de coordenação a nível europeu. Conclui-se que as diferenças estruturais, económicas e políticas influenciam de forma determinante a harmonização das políticas de saúde oral na União Europeia, constituindo barreiras à convergência e à implementação de estratégias comuns. A harmonização requer uma abordagem integrada, baseada em evidência científica, reforço do financiamento público e maior coordenação institucional, com vista à promoção da equidade e melhoria dos resultados em saúde oral.
Oral health is a fundamental component of public health and is influenced by structural, economic, and political factors that vary across European Union Member States. These differences have direct implications for the organization of oral health systems, access to care, and health equity, posing significant challenges to policy harmonization at the European level. The aim of this scoping review was to analyse how structural, economic, and political differences among European Union Member States influence the harmonization of oral health policies and equity in access to care. The methodology followed the PRISMA-ScR guidelines, with the research question defined according to the PCC framework. The literature search was conducted in PubMed, ScienceDirect, and Scopus using keywords combined with Boolean operators. Studies published between 2000 and 2026 in English, Portuguese, Spanish or French and addressing oral health systems, financing, access, inequalities, and policies in the European Union were included. After the selection process, 15 studies were included in the final analysis. The results revealed significant heterogeneity in the organization of oral health systems, reflecting different models and levels of integration within general healthcare systems. Systems with higher public funding showed better coverage and equity, whereas reliance on private financing was associated with greater barriers to access. Persistent socioeconomic inequalities were also identified, not fully mitigated by public coverage. In terms of policy, a high degree of fragmentation was observed, resulting from predominantly national approaches and the absence of effective supranational coordination mechanisms. It is concluded that structural, economic, and political differences significantly influence the harmonization of oral health policies in the European Union, acting as barriers to convergence and the implementation of common strategies. Harmonization requires an integrated approach based on scientific evidence, strengthened public funding, and enhanced institutional coordination to promote equity and improve oral health outcomes.
Oral health is a fundamental component of public health and is influenced by structural, economic, and political factors that vary across European Union Member States. These differences have direct implications for the organization of oral health systems, access to care, and health equity, posing significant challenges to policy harmonization at the European level. The aim of this scoping review was to analyse how structural, economic, and political differences among European Union Member States influence the harmonization of oral health policies and equity in access to care. The methodology followed the PRISMA-ScR guidelines, with the research question defined according to the PCC framework. The literature search was conducted in PubMed, ScienceDirect, and Scopus using keywords combined with Boolean operators. Studies published between 2000 and 2026 in English, Portuguese, Spanish or French and addressing oral health systems, financing, access, inequalities, and policies in the European Union were included. After the selection process, 15 studies were included in the final analysis. The results revealed significant heterogeneity in the organization of oral health systems, reflecting different models and levels of integration within general healthcare systems. Systems with higher public funding showed better coverage and equity, whereas reliance on private financing was associated with greater barriers to access. Persistent socioeconomic inequalities were also identified, not fully mitigated by public coverage. In terms of policy, a high degree of fragmentation was observed, resulting from predominantly national approaches and the absence of effective supranational coordination mechanisms. It is concluded that structural, economic, and political differences significantly influence the harmonization of oral health policies in the European Union, acting as barriers to convergence and the implementation of common strategies. Harmonization requires an integrated approach based on scientific evidence, strengthened public funding, and enhanced institutional coordination to promote equity and improve oral health outcomes.
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Política de saúde oral Sistemas de saúde oral União Europeia Acesso a cuidados dentários Financiamento da saúde Desigualdades em saúde oral Oral health policy Oral healthcare systems European Union Access to dental care Healthcare financing Oral health inequalities