Care in Europe: Financing, Access and Provision Horizon Europe: the DELIVER (DELiberative ImproVEment of oRal care quality) project

in which sparked a group of states to embark on a remarkable policy development process dedicated to oral health. We now have a Global Strategy for Oral Health and will soon have a Global Action Plan complemented by a comprehensive Monitoring Framework. In addition, work on defining Best Buys in Oral Health and other supportive workstreams are under way. The presentation will provide an introduction and overview to these global policy guidance frameworks that are shaping a new reform agenda for oral health as part of NCDs, Universal Health Coverage and the SDGs towards 2030. Particular implications for public oral health in Europe will be discussed. Abstract Oral Health and the composition of the health workforce is starting to change in many countries. Dental care is provided in group practices and by practices that are part of private equity firms. Although there are early signs of a shift towards more prevention of oral diseases, dental care overall remains focused on treatment. A lack of data affects all areas of oral health care and impede to inform policy-making on the underlying causes and the prevalence of oral disease, as well as the effectiveness of community preventive activities and oral health services. Abstract Oral diseases and conditions affect more than 3.5 billion people worldwide. They are the 3rd most expensive diseases to treat in the EU and disproportionally affect vulnerable groups. In deviation from the UN and WHO goal of Universal Health Coverage, many EU citizens do not have access to quality oral care without financial hardship. To this end, the DELIVER (DELiberative ImproVEment of oRal care quality) project aims to enhance the quality of oral care through deliberative dialogue and action involving citizens, patients, providers, payers and policymakers. DELIVER will create a synergistic problem-solving ecosystem to convert deliberative dialogues into meaningful improvement of oral care quality. Using a mixed-methods research approach, DELIVER will co-develop and co-produce new quality improvement approaches in three phases. The 1st phase involves situational analysis, consenting of core quality indicators, and development of a EU-wide monitoring framework. The 2nd phase involves in-depth analysis of select quality improvement approaches: (i) PROMs/ PREMs-based quality improvement in dental practices; (ii) community-based quality improvement for vulnerable groups; (iii) quality-oriented commissioning of oral health services. The regulatory determinants of oral care quality improvement will be scrutinized. In the 3rd and final phase, the knowledge gained in the 1st and 2nd phases will be merged into the DELIVER Quality Toolkit with manuals and digital tools for concretely actionable and context-adaptive approaches for oral care quality improvement. This presentation will give an overview of the DELIVER project and discuss how it can contribute to improving oral health systems. and occupational health social protections of low-wage and self-employed digital platform workers are described and compared. Specifically, we examine how, across advanced economy countries, laws, policies, and collective agreements protected the health of low wage (e.g., service workers) and digital platform workers (usually classified as self-employed) including during the first three waves (2019-2021) of the COVID-19 pandemic. The overall goal is to inspire conversa-tion, comment, critique and new research questions to tackle the issue of the employment, work and health of low wage workers and self-employed digital platform workers. Methods: Taking a comparative focus on eight advanced economy countries, this paper identifies legal efforts to address employment misclassification and challenges related to employee definitions that vary by the legal act. Debates about minimum wage and occupational health and safety standards as these relate to worker well being are considered. Finally, we discuss promising changes introduced during the COVID-19 pan- demic that protect the health of low-wage and self-employed workers. Results: Overall, we describe an ongoing ‘‘haves’’ and a ‘‘haves not’’ divide, with on the one extreme, traditional job arrangements with good work-and-health social protections and, on the other extreme, low-wage and self-employed digital platform workers who are mostly left out of schemes. However, during the pandemic small and often temporary gains occurred and are discussed. Conclusions: In the context of an evolving social contract during the COVID-19 pandemic, this paper provides views on avenues for policy reform and research from employment and occupational health specialists across eight advanced economy countries. Precarious work, sickness absence sharing Background: The COVID-19 pandemic has revealed the importance of social protection systems including income security when health problems arise. Particularly the protection of those with precarious work felt short in some countries. For some time there has been an interest in the European variation in sick-pay schemes but still we still lack

With growing awareness of the large burden of oral diseases and how limited coverage affects both access and affordability, oral health policy has been receiving increased attention in recent years. This culminated in the adoption of the WHO resolution on Oral Health in 2021, which urges Member States to better integrate oral health into their universal health coverage and noncommunicable disease agendas. This study investigates major patterns and developments in oral health status, financing, coverage, access, and service provision of oral health care in 31 European countries. While most countries cover oral health care for vulnerable population groups, the level of statutory coverage varies widely across Europe resulting in different coverage and financing schemes for the adult population. On average, one third of dental care spending is borne by public sources and the remaining part is paid out-of-pocket or by voluntary health insurance. This has important ramifications for financial protection and access to care, leaving many dental problems untreated. Overall, unmet needs for dental care are higher than for other types of care and particularly affect low-income groups. Dental care is undergoing various structural changes. The number of dentists is increasing, and the composition of the health workforce is starting to change in many countries. Dental care is increasingly provided in group practices and by practices that are part of private equity firms. Although there are early signs of a shift towards more prevention of oral diseases, dental care overall remains focused on treatment. A lack of data affects all areas of oral health care and impede to inform policy-making on the underlying causes and the prevalence of oral disease, as well as the effectiveness of community preventive activities and oral health services. Oral diseases and conditions affect more than 3.5 billion people worldwide. They are the 3rd most expensive diseases to treat in the EU and disproportionally affect vulnerable groups. In deviation from the UN and WHO goal of Universal Health Coverage, many EU citizens do not have access to quality oral care without financial hardship. To this end, the DELIVER (DELiberative ImproVEment of oRal care quality) project aims to enhance the quality of oral care through deliberative dialogue and action involving citizens, patients, providers, payers and policymakers. DELIVER will create a synergistic problem-solving ecosystem to convert deliberative dialogues into meaningful improvement of oral care quality. Using a mixed-methods research approach, DELIVER will co-develop and co-produce new quality improvement approaches in three phases. The 1st phase involves situational analysis, consenting of core quality indicators, and development of a EU-wide monitoring framework. The 2nd phase involves in-depth analysis of select quality improvement approaches: (i) PROMs/ PREMs-based quality improvement in dental practices; (ii) community-based quality improvement for vulnerable groups; (iii) quality-oriented commissioning of oral health services. The regulatory determinants of oral care quality improvement will be scrutinized. In the 3rd and final phase, the knowledge gained in the 1st and 2nd phases will be merged into the DELIVER Quality Toolkit with manuals and digital tools for concretely actionable and context-adaptive approaches for oral care quality improvement. This presentation will give an overview of the DELIVER project and discuss how it can contribute to improving oral health systems. The changing nature of work, resulting from technology, globalization, shifts in demographics, and other economic and political forces, poses many potential problems for workers, employers, and society today and for the foreseeable future. Moreover, the COVID-19 pandemic has revealed the importance of social protection systems, e.g. income security for injured or sick-listed workers. The pace of work is increasing, driven by increasing productivity demands and greater use of technology. The nature of employer-employee relationships is also changing rapidly, best exemplified by increases in what has been termed ''nonstandard employment arrangements'', such as gig economy work and short-term contracts. However, what is viewed as greater employment flexibility by employers may represent a more precarious job for workers, as compared to pay, benefits and security for those with long-term employment arrangements. Nonstandard employment is typically shorter in duration, leading to more jobs over a lifetime, with the potential for exposure to multiple and simultaneous risks, some of them new, combined with the possibility of more time spent in periods of unemployment or underemployment. Precarious employment has been linked to adverse effects on worker health and well-being. Although these employment arrangements can affect workers of all education and income levels, they disproportionately affect workers in lower socioeconomic strata. One of the major consequences of nonstandard employment arrangements is the potential loss of social protections, including social security, yet this has not been well addressed. Our workshop focuses on the changing work life across different EU member states and beyond, examining different types of precarious employment and their effects on health and social security benefits. Prof. Ellen MacEachen will focus on how laws, policies and collective agreements in six EU countries, New Zealand and Canada protect the health of low wage and digital platform workers. She will address occupational and public health interventions for these workers in light of health risks related to the COVID-19 pandemic. Dr. Solveig Osborg Ose will focus on precarious work, sickness absence and risk sharing between employers, employees and social insurance in nine north-western EU countries. Moreover, she will discuss the adaptation of social protection systems to cover all types of employment to avoid increasing inequalities. Two experts Dr. Anita Tisch and Prof. Angelique de Rijk will reflect on the findings and discuss with the presenters and the audience the challenges, policies and practices needed towards employment and occupational safety and health social protections of precarious workers.

Key messages:
Precarious employment has been linked to adverse effects on worker health and well-being. Workers in lower socioeconomic strata are disproportionately affected. A major consequences of nonstandard employment arrangements is the potential loss of social protections, including social security, yet this has to be addressed.

Background:
In the context of the COVID-19 pandemic, shifting employment and occupational health social protections of low-wage and self-employed digital platform workers are described and compared. Specifically, we examine how, across advanced economy countries, laws, policies, and collective agreements protected the health of low wage (e.g., service workers) and digital platform workers (usually classified as self-employed) including during the first three waves (2019-2021) of the COVID-19 pandemic. The overall goal is to inspire conversation, comment, critique and new research questions to tackle the issue of the employment, work and health of low wage workers and self-employed digital platform workers.

Methods:
Taking a comparative focus on eight advanced economy countries, this paper identifies legal efforts to address employment misclassification and challenges related to employee definitions that vary by the legal act. Debates about minimum wage and occupational health and safety standards as these relate to worker well being are considered. Finally, we discuss promising changes introduced during the COVID-19 pandemic that protect the health of low-wage and self-employed workers.

Results:
Overall, we describe an ongoing ''haves'' and a ''haves not'' divide, with on the one extreme, traditional job arrangements with good work-and-health social protections and, on the other extreme, low-wage and self-employed digital platform workers who are mostly left out of schemes. However, during the pandemic small and often temporary gains occurred and are discussed.

Conclusions:
In the context of an evolving social contract during the COVID-19 pandemic, this paper provides views on avenues for policy reform and research from employment and occupational health specialists across eight advanced economy countries.
Abstract citation ID: ckac129.376 Precarious work, sickness absence and risk sharing between employers, employees and social insurance

Background:
The COVID-19 pandemic has revealed the importance of social protection systems including income security when health problems arise. Particularly the protection of those with precarious work felt short in some countries. For some time there has been an interest in the European variation in sick-pay schemes but still we still lack knowledge on country differences and similarities. This is particularly the case regarding precarious workers, while they have higher chances for sickness absence. Our aim is to understand, in the context of precarious work, the differences in risk sharing of sickness absence between employer, worker and social insurance.

Methods:
Data had been collected in a study on sickness absence followup regimes in nine countries (the Nordic countries (Sweden, Denmark, Finland, Norway and Iceland) and in Germany, the Netherlands, Belgium and the UK). Comparative statistics were collected and scholars familiar with their countries system were invited to answer a list of 51 questions on system characteristics. Data were re-analysed from the perspective of precarious work, using actor-network theory and insideroutsider theory of employment.

Results:
Countries with shorter employer periods of sick pay have stricter follow-up responsibility for employers as they are regarded gatekeeper except for The Netherlands. The tax-based systems that target all citizens offer more protection for precarious workers while the employee-focused systems define their target population more strictly, leaving precarious workers underserved. There is a large difference in how selfemployed are supported or not.

Conclusions:
Despite small economic differences in the nine countries studied, the systems for dealing with sickness absence in the context of precarious work vary largely. Even though, in all systems those with secure jobs seem insiders and those with precarious work outsiders. Social protection systems should be updated to avoid an increasing inequality.