Comparing the Current US and Philippine models to create a hybrid model

Trinity:  The Philippines and the U.S. are very different countries, geographically, economically. The Philippines has a smaller population size , and its healthcare system operates within different financial constraints. However, comparing these two countries can help us understand how systemic factors like education costs, access to providers, and government policies shape oral health outcomes across different healthcare models in order to create a hybrid      model for dentistry in the United States.

Trinity: Mark Ross, is oral health epidemiologist at East Carolina University, who specializes in socio-economic factors that contribute to oral health issues in  the United States. East Carolina University is representative of many dental schools across the United States, with a mission to develop leaders with a passion to care for the underserved and to improve the health of North Carolina and the nation.

Mark: ECU has a very strong mission to address barriers to care and to help dentists learn about what it means to live in an underserved community, and how do we address some of the challenges that many patients face with respect to oral health.

Trinity: One of the biggest barriers to dental care is patient cost. Income and the price of care play large roles in individuals seeking oral care in the Philippines. Lower income families sometimes use alternative toothpaste methods such as gargling with saltwater and brushing with baking soda. Excessive use of both of these products can lead to breaking down the enamel that is found on the teeth that helps protect them from damage. In turn to help address this access gap the Philippine Department of Health implemented the school oral health dental program which includes distributing dental care supplies to children from kindergarten to grade 6 and applying fluoride varnish to all kindergarten and grade 3 students. Due to dental tourism cosmetic procedures such as getting veneers are cheaper in the Philippines. Dental tourism is the practice of traveling to another country for dental care seeking lower costs. 

Mark: There's this cascade of factors that keep people from going to the dentist. They may have grown up in a family that never went to the dentist, so they don't go. They think that it's optional, that it's not. They only go if you have a problem. And. Until when they go, it's generally not pleasant. And so they reinforce the lack of care that you don't want to go because that hurt the last time I went. And I don't like pain so I'm going   to  avoid going to the dentist, so it's hard for people to get in a cycle of prevention and once they don't have a lot of resources financially. So there's two sides to it: dentistry as a consumer is very expensive if you don't have dental insurance. If you don't have an employer who offers a dental benefit plan, it's really a lot of money to pay out of pocket. It costs a lot of money for people to become a dentist. Typically, people graduate with student loan debt of about $300,000.

Trinity:In the Philippines, dental school costs range from 30,000 to 150,000 pesos per year, which is about $525 to $2,650 USD. with most graduates leaving dental school with 150,000 to 900,000 pesos in debt. This is considerably less than dental schools in the United states but for most living in the philippines this is unaffordable.

Mark:When our students graduate they already have a financial burden. And so it's costly for them to set up a practice, and their primary focus is on making money to pay off their loan and also to have a nice life. 

Trinity: Dental schools in the United states are so expensive and recent graduates have the financial burden of paying their debts off. It leads to a raise in consumer prices which if you don't have the money to come out of pocket or dental insurance to cover the costs leads to an access gap in oral health care. The Philippines have what's called the  Universal Health Care Act, which aims to provide comprehensive medical and dental services for all Filipino citizens. 100% of the citizens in the Philippines are covered by PhilHealth which is the insurance company that covers the Universal  Health Care Act. However, until November of 2024 PhilHealth  only covered limited dental care, such as emergency treatments and surgeries, not routine check-ups or preventive care. In November the PhilHealth board approved the PhilHealth benefit for preventive oral health services in primary care. The purpose of approving this was to address access gaps, and reduce out of pocket expenses.

Mark: If you don't have an employer who offers a dental benefit or dental insurance, it's really a lot of money to pay out of pocket. Just to get some teeth fixed. Even just to go for a check up, it's quite expensive for most people. So if you don't have dental insurance, that's a big barrier to getting dental care. And if you don't go in for dental care on a regular basis, you tend to have.  bigger problems. So in the U.S., we have Medicaid for low-income families, and states vary a little bit about whether adults are covered. But the program mandates that children are covered for dental services if they're low-income and on Medicaid. Requiring all children to have benefits in a federal plan would be the first step. The second step would be to make sure all ages are covered. And the other piece would be to get school children into clinics more readily.

Trinity: In the Philippines, there are several government-funded child oral health programs, such as the “Fit for School” program, which promotes daily toothbrushing with fluoride toothpaste alongside other health interventions. These programs aim to combat the country’s widespread oral health issues.  

Mark:So many Gov. Places have school based programs where there's prevention taught, and it's easy to get access to dental services because. A mobile van will come to the school and people will provide a screening and. Treatment and referral for treatment if they. There. So those types of programs where you can get children healthy and you know dental problems or generally chronic ones that once it starts to cycle of destruction. And loss. So early intervention and establishing a healthy foundation, healthy behaviors really would help a lot.

Trinity: The United States should focus on creating a hybrid dental care model that works to expand their government funded insurance companies that also should also implement oral health programs for school aged children because research shows that about 50% of  children aged 6-9 have had cavities in their primary or permanent teeth. While also lowering the tuition rates for dental students by increasing government funding for both private and public dental schools. In 2022 government funding for dental schools decreased to 10% which in turn caused tuition to increase and become a large part of the operating budget of dental schools. Without government funding dental schools have to find a way to offset the burden on students. This can be done by having students work in community based dental clinics. Students would see more clients and it would increase their confidence by working on an actual patient.  

Mark: ECU is a great champion for this to have dentists work in the communities. But. That are underserved. So having dental clinics in the communities that need care is a way for both the students to learn how to become dentists and to provide access to care for groups that might not otherwise get it. So it's a small thing in many ways because. It's not going to address all the needs . The need is big, but it's a small step toward helping students see what the barriers are and understand the need for policy change.

Trinity:    Failing to address these problems will continue to an increase in the financial burden placed on dental students to the point of dental school not being attainable for most even with scholarships and grants.

This podcast was produced by Trinity Whitfield for the spring 2025 Global Health Course at Guilford College