Uniformity in selection for subsidized orthodontic care--focus on borderline treatment need

In the county of Stockholm, subsidized orthodontic care is offered to roughly 25% of persons under the age of 19. Stockholm County Council has signed contracts with experienced orthodontists (consultants) to carry the responsibility of screening and offering subsidized treatment to those having the most urgent treatment need. For this purpose the orthodontist is free to use whatever yardstick he/she finds most useful. The Swedish Medical Board Index (SMBI) is most commonly used, and was used by the consultants in this study. It is obvious that the selection process under these conditions must be affected by a subjective opinion and consequently the inter-examiner variation would be large, especially for subjects presenting with borderline treatment need. The aim of the study was to evaluate the uniformity in selection of subjects for subsidized orthodontic care with focus on borderline treatment need. Six consultant orthodontists volunteered to participate. Each orthodontist was asked to recruit patients whom they considered to have borderline treatment need. 34 adolescents; 25 girls and 9 boys (mean age 14.5 +/- 1.68 years), were recruited. These patients were individually assessed by each orthodontist. The interexaminer agreement was tested by use of Cohen's kappa statistics (kappa = 0.324). Since all six orthodontists fully agreed in only one third of the cases the validity of the assessments with the present guidelines is insignificant, at least in subjects with borderline treatment need.