A multi-country comparison of reasons for dental non-attendance

Income-related inequality and inequity in the use of dental services in Finland after a major subsidization reform

OBJECTIVES

In Finland, a major oral healthcare reform (OHCR), implemented during 2001-2002, opened the public dental services (PDS) and extended subsidies for private dental services to entire adult population. Before the reform, adults born earlier than 1956 were not entitled to use PDS nor did they receive any reimbursements for their private dental costs. We aimed to examine changes in the income-related inequality and inequity in the use of dental services among the adult Finns after the reform.

METHODS

Representative data from Finnish adults born in 1970 or earlier were gathered from three identical postal surveys concerning the use of dental services and subjective perceptions of oral health. Those surveys were conducted before the OHCR in 2001 (n = 1907) and after the OHCR in 2004 (n = 1629) and 2007 (n = 1509). We used concentration index and its decomposition to analyse income-related inequality and inequity in the use of dental services and factors associated with them.

RESULTS

Results showed that pro-rich inequality and inequity in the overall use of dental services narrowed from 2001 to 2004. However, between 2004 and 2007, pro-rich inequality and inequity widened, so it returned to a rather similar level in 2007 as it had been in 2001. Most of the pro-rich inequality and inequity were related to regular dental visiting habit and income level. While there was pro-poor inequality and inequity in the use of PDS, there was pro-rich inequality and inequity in the use of private dental services throughout the study years.

CONCLUSION

It seems that income-related inequality and inequity in the use of dental services narrowed only temporarily after the reform.

Factors influencing dental care access in Jordanian adults

Background

The aims of this study are to assess the influences of demographic and personal factors on Jordanian adults’ abilities to use dental services and the barriers to regular attendance.

Methods

A self-administered questionnaire was distributed to a sample of 650 Jordanian adults attending King Abdullah University Hospital (KAUH) (n = 200), Jordan University of Science and Technology–Dental Health Teaching Center (JUST–DHTC) (n = 150), Yarmouk University Health Clinics (YUHC) (n = 150), and United Nations Relief and Works Agency (UNRWA) clinics (n = 150). 614 questionnaires were completed. Statistical Package for Social Sciences (SPSS) was used to analyze data, generate descriptive statistics and perform multiple logistic regressions. The level of significance was set at α = 0.05.

Results

Approximately 93% of participants were dental services users. 89% were irregular users, while only 11% were regular users. The main reasons given for not visiting dental offices regularly were lack of time (39.2%), cost of treatment (26.9%), treatment not needed (22.2%), and fear of dentists (15.1%). Only 6.7% of respondents stated that they had never visited a dentist, while more than half (56.1%) reported the lack of need for dental treatment as a major reason for not using dental services. Restorative therapy was the most frequently sought treatment (61.6%), while periodontal treatment was the least frequently sought (14.1%). Although respondents who were married and/or those having missing teeth were significantly more likely to use dental services, respondents who were single were more likely to be regular attendees.

Conclusion

The overwhelming majority of adults were irregular attendees. Time and cost constraints, lack of need for treatment, and fear of dentists were reported as major barriers to regular attendance. The study findings call for planning of educational and promotional programs to increase Jordanians’ awareness of and regular use of available dental services to maintain health, which will be both socially and economically beneficial.

Forgoing dental care for economic reasons in Switzerland: a six-year cross-sectional population-based study

Background

While oral health is part of general health and well-being, oral health disparities nevertheless persist. Potential mechanisms include socioeconomic factors that may influence access to dental care in the absence of universal dental care insurance coverage. We investigated the evolution, prevalence and determinants (including socioeconomic) of forgoing of dental care for economic reasons in a Swiss region, over the course of six years.

Methods

Repeated population-based surveys (2007–2012) of a representative sample of the adult population of the Canton of Geneva, Switzerland. Forgone dental care, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods.

Results

A total of 4313 subjects were included, 10.6% (457/4313) of whom reported having forgone dental care for economic reasons in the previous 12 months. The crude percentage varied from 2.4% in the wealthiest group (monthly income ≥13,000CHF, 1CHF ≈ 1$) to 23.5% among participants with the lowest income (<3,000CHF). Since 2007/8, forgoing dental care remained stable overall, but in subjects with a monthly income of <3,000CHF, the adjusted percentage increased from 16.3% in 2007/8 to 20.6% in 2012 (P trend = 0.002). Forgoing dental care for economic reasons was independently associated with lower income, younger age, female gender, current smoking, having dependent children, divorced status and not living with a partner, not having a supplementary health insurance, and receipt of a health insurance premium cost-subsidy.

Conclusions

In a Swiss region without universal dental care insurance coverage, prevalence of forgoing dental care for economic reasons was high and highly dependent on income. Efforts should be made to prevent high-risk populations from forgoing dental care.

Electronic supplementary material

The online version of this article (doi:10.1186/1472-6831-14-121) contains supplementary material, which is available to authorized users.

Cost-related dental non-attendance in older adulthood: evidence from eleven European countries and Israel

BACKGROUND

Although relevant for health policy, so far only little is known about the extent to which persons avoid dental attendance because of associated costs.

OBJECTIVES

To examine the cost-relatedness of dental non-attendance in various older adulthood populations.

MATERIAL AND METHODS

Secondary analyses were conducted of data from wave 1 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), which includes unique information on recent dental non-attendance and care foregone due to costs by persons aged 50+ from eleven European countries and Israel. Multivariate logistic regression analysis was used to detect differences in the extent to which dental non-attendance is attributable to associated costs.

RESULTS

The study sample comprised 13 935 persons who did not access dental care within the past year. Levels of cost-related non-attendance differed between the twelve examined countries, ranging from 6.8% in Israel to 0.5% in Austria. Cost-related non-attendance was 47% less likely among persons with good as compared to compromised chewing ability (Odds Ratio: 0.53; 95% CI: 0.43-0.66). Cost-related non-attendance was 33% less likely among persons with tertiary as compared to (pre-) primary educational attainment (Odds Ratio: 0.67; 95% CI: 0.47-0.96). Cost-related dental non-attendance was significantly more likely among persons with low levels of general health (Odds Ratio for lowest vs. highest level of general health: 3.05; 95% CI: 1.88-4.95).

CONCLUSIONS

The findings of the present study suggest that a relatively small proportion of dental non-attendance in older adulthood is cost-related. For specific population subgroups in various countries, however, dental care costs may still pose a relevant barrier to dental care.