If the treatment begins before the age of 20, a portion of the patient's expenses is refunded by the National Insurance Scheme if they meet specific criteria for the need for treatment. Nonetheless, most individuals still pay a relatively significant out-of-pocket expense, and orthodontic treatment is one of the few examples where a health service is charged for when provided to children. Therefore, it has been important to examine how this affects the demand for the service among various population groups. The report first provides an overview of the number of recipients of orthodontic treatment reimbursements and the costs associated with this from 2012 to 2022. While the number of patients increased in many parts of the period, from around 180,000 in 2012 to 207,000 in 2019, the total expenditures peaked at nearly 580 million Norwegian kroner as early as 2015. During the period from 2014 to 2019, the amounts per patient decreased by approximately 15 percent, as reimbursement amounts for certain treatments were slightly adjusted downward (Chapter 3).

Until 2019, the criteria for orthodontic treatment and patient distribution by severity and need remained mostly unchanged. However, starting on January 1, 2020, new criteria for receiving reimbursement for orthodontic treatment were introduced. These criteria required additional qualifications for reimbursement in cases of the least severe of three defined bite irregularity categories. As of 2020, there was a reduction in the number of patients, partly due to the COVID-19 pandemic, which coincided with the reform. Notably, the reform did not affect patients already undergoing treatment, and the decline mainly affected new patients targeted by the reform (Chapter 4). The pandemic's effects were most pronounced in 2020 but also impacted dental services in 2021 and 2022.

A comprehensive assessment of orthodontic treatment intake across patient categories suggests that the reform may have reduced recruitment by around 10% (Chapter 4). This means that the percentage of children and young people with reimbursement for assessment or treatment has dropped by about 4-6 percentage points, down from nearly 60% before the reform (Chapter 5). These estimates are uncertain due to the short implementation period and the concurrent pandemic. It's too early to determine how many new recipients that actually will get orthodontic treatment. If the rate of those progressing to treatment remains at four out of five, then the percentage of children undergoing active treatment may be slightly over 40% of the cohorts. The costs for a complete treatment course per patient have consistently been just under 30,000 Norwegian kroner (Chapter 6).

Chapters 7 and 8 of the report delve into the analysis of orthodontic treatment reimbursement based on socioeconomic and regional backgrounds. The results reveal clear social disparities in which children and young people receive orthodontic treatment reimbursements. Children of parents with high education and income levels are more likely to receive orthodontic treatment compared to children of parents with lower education and income. Furthermore, it's more common for children of parents not receiving benefits to receive orthodontic treatment reimbursements than children of parents who do receive benefits. These social disparities have somewhat decreased from 2012 to 2022, especially after the tightening of criteria for the group with clear treatment needs from January 1, 2020. Nonetheless, these disparities remain evident throughout the period. There are also significant regional differences, with children on the West Coast more likely to receive treatment than those in Northern Norway. These regional differences have increased from 2012 to 2022, and access to orthodontists doesn't fully explain the variations. Other structural factors play a role, as discussed in Chapter 8.