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Income-related inequality in the use of dental services in Finland

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Abstract

The aim of this article is to measure and explain income-related inequalities in dentist utilisation. We apply concentration and horizontal inequity indices and the decomposition method to decompose observed inequalities into sources. The data are from the Finnish Health Care Survey of 1996. We examine three measures of utilisation: (a) the total number of visits; (b) the probability of visiting a dentist; and (c) the conditional number of positive visits for (i) visits to all dentists, (ii) those to public dentists and (iii) those to private dentists. The results for the whole sample show pro-poor inequities in all three measures of utilisation in public care, whereas in the first two measures there are pro-rich inequities nationwide and in private care. Among those entitled to age-based subsidised dental care, we find equality and equity in all three measures of utilisation nationwide. The two main factors related to pro-rich distributions of use are income and dentist’s recall. To enhance equity in dental care across income groups, attention should be focused on supply factors and other incentives to encourage the poor to contact dentists more often.

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Notes

  1. 1The central government gives recommendations on maximum user fees for dental care services, but each municipality determines its own user fees.

  2. 2All the methods used in this study —methods applied in previous studies[3,10,23–25] and our decomposition made simultaneously by explanatory variable and by type of service —are described in detail in a separate short paper (unpublished) that is available from the authors on request.

  3. 3That is, municipal dental services were charged at subsidised fees, while service fees paid to private dentists could be claimed for reimbursement.

  4. 4Technically, visiting a dentist is coded 0 (for those having no visit) and 1 (for those having at least one visit). In estimating the probability of visiting a dentist and the total use, all individuals in the sample are analysed, whereas in estimating the conditional use only those who have at least one visit are analysed.

  5. 5There were 65 individuals in the whole sample and 26 individuals in the subsample who visited both public and private dentists. We have regrouped these mixed-users such that those who had an equal or higher number of visits to private dentists than to public dentists were private service users. The rest were public service users.

  6. 6We thank Professor Andrew M. Jones for pointing this out.

  7. 7Each weighted contribution is obtained by multiplying the corresponding unweighted contribution with (μj/μ), where μj is the mean use by type of service (j = public, private) and μ is the mean use of the sample.

  8. 8All unobservable characteristics relating to inequalities that we are not able to explain are supposed to be captured in the residual terms.

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Acknowledgements

We would like to thank Professor Andrew M. Jones for econometric advice, M. Kamrul Islam and Jens Gundgaard for useful suggestions, and participants at the ECuity workshop held at STAKES, Helsinki in June 2004, for their comments. Lien Nguyen is grateful to the graduate school Doctoral Program in Public Health, to STAKES and the Yrjö Jahnsson Foundation for their financial support. ## The authors find no conflicts of interest that would have biased this work.

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Authors and Affiliations

  1. Centre for Health Economics, National Research and Development Centre for Welfare and Health (STAKES), Lintulahdenkuja 4, PO Box 220, FIN-00531, Helsinki, Finland

    Lien Nguyen & Unto Häkkinen

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  1. Lien Nguyen
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  2. Unto Häkkinen
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Correspondence to Lien Nguyen.

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Nguyen, L., Häkkinen, U. Income-related inequality in the use of dental services in Finland. Appl Health Econ Health Policy 3, 251–262 (2004). https://doi.org/10.2165/00148365-200403040-00008

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