The Minamata Convention lists “discouraging insurance policies and programmes that favour dental amalgam use over mercury-free dental restoration” and “encouraging insurance policies and programmes that favour the use of quality alternatives to dental amalgam for dental restoration” as measures to phase down amalgam use.  Phasing down amalgam use in government programs is a positive first step.

Why is it effective?

Modifying government programs and insurance schemes to favor mercury-free dentistry is proven to help phase down amalgam use.  “Many insurance companies have traditionally only covered the cost of amalgam fillings, for marginal price reasons,” according to an advisory note from the United Nations Environmental Programme. “However, the full long-term environmental cost burden is not reflected in these price differences.”

As the WHO report Future Use of Materials for Dental Restoration states, “existing or planned third-party payment systems must consider reimbursement schemes incorporating dental care which make use of materials alternative to dental amalgam.”

Where has it been effective?

Many nations that phased down or phased out amalgam use took steps to modify government programs and insurance schemes.  For example:

• Sweden: In 1999, the Swedish Parliament decided that no financial support should be given for amalgam via the national dental insurance.
• Mongolia: In 2011, the government ordered a ban on further procurement of amalgam and authorized directors of city and provincial health care departments and managers of health care organizations to take measures to reduce amalgam and replace it with mercury-free alternatives.

How can it be implemented?

Nations can modify government programs and insurance schemes to favor mercury-free dental restorations by utilizing the following strategies:

• End the future purchase of amalgam for use in government-run healthcare facilities and programs. Mercury-free dental restorations should be purchased instead.

• Limit amalgam use in government-run healthcare facilities and programs. For example, nations can prohibit these facilities and programs from using amalgam in children and pregnant women or restrict their amalgam use to permanent teeth only.

• Phase out financial support for amalgam via national insurance programs and government employee insurance policies, while phasing in financial support for mercury-free dental restorations.

• Instruct insurance companies to revise their policies to give preference to mercury-free dental restorations.

• Collaborate with dental suppliers to ensure adequate supply of mercury-free dental restorations.