During the last 10-20 yr there has been a marked increase in demand for dental services in most western countries. An important issue is how this increase in demand has influenced inequalities in use of services among different income groups in the population. It is of particular interest to study this in Norway, as almost all the costs for dental care among adults are borne by the patient. The aim of the present study was to examine how the effect of family income on demand for dental services has changed over time. The analyses were performed on three sets of national data from 1977, 1983, and 1989. The samples were representative of the non-institutionalized Norwegian population aged 20 yr and above. Inequalities in use of dental services among different income groups have decreased between 1977 and 1989. However, separate analyses on the data from 1989 showed that some inequalities still exist. A non-selective subsidizing policy for dental care is unlikely to have any great effect in reducing these inequalities. Subsidized dental care is likely to raise the total amount of dental care demanded. However, it is difficult to assess accurately the size of this increase as the elasticity of demand for dental care in Norway with respect to price is unknown.
This study examines the relationship between supply of primary physicians and consumer satisfaction with access to, and quality of, primary physician services in Norway. The purpose is to throw light on a long-standing controversy in the literature on supplier inducement (SID): the interpretation of the positive association between physician density and per capita utilization of health services. We find that an increase in the number of physicians leads to improved consumer satisfaction, and that the relationship between satisfaction and physician density exhibits diminishing returns to scale. Our results suggest that policy-makers can compute the socially optimal density of physicians without knowledge about whether SID exists, if one accepts the (controversial) assumption that consumer satisfaction is a valid proxy for patient utility.
The aim of the present study was to examine the effect of the price of dental services on their demand and utilisation. These effects cannot be examined in cross-sectional studies when prices are fixed, as they are in Norway, but they can be studied over a period of time, as the price for dental services has changed relative to the prices for other goods. The analyses were performed on 7 sets of data, collected every second year, over the period 1977 to 1989. The samples were representative of the non-institutionalised Norwegian population aged 20 years and over. Price had a different effect on demand than on utilisation. There was no statistically significant association between price and demand. Utilisation decreased with increasing price, and this can be explained in two ways. First, it may express patients' response to reduced prices, and second, it may express the dentists' response to reduced prices. If the latter explanation is correct, this means that the dental care market is rather special. Consumers are not dominant. Dentists, as providers, can, to a certain extent, influence the uptake of the services they provide.
The aim of this study was to identify possible factors associated with the marked geographical variation in supply of public dental services in Norway. We identified three sources for this uneven distribution: differences in dental care needs, differences in revenue levels between counties, and differences in the party composition of the county councils. Analyses were undertaken to ascertain whether these factors were related to the variation in the number of man-labor years of public dental officers. The analyses were performed on a set of data from Norwegian counties for the period 1985-92. There was an association between the number of man-labor years of public dental officers and our indicators of dental care needs, county revenue, and party composition of the county councils. Our findings are encouraging, as they indicate that the county councils seemed to respond to the dental care needs of the local population. On the other hand, there were inequalities in supply of public dental services that were due to differences in revenue between counties. From an equity point of view, this inequality is undesirable. The inequality could most likely be reduced by decreasing the variation in revenue between counties. Differences in party composition of the county councils had only a small effect on the geographical variation in the number of man-labor years of public dental officers.
Several studies have shown that demand for dental services decreases with increasing age. There is a lack of research to examine how utilization (as opposed to demand) varies with age. This relationship is likely to depend on family income and number of teeth. This study had two aims: Firstly, to examine the relationship between age, family income, number of teeth, and expenditure for dental services in Norway. Secondly, to compare a model where expenditure was the dependent variable with a model where demand was the dependent variable, using the same set of explanatory variables (age, income, and number of teeth). The analysis was performed on a set of national data collected in 1987, which was representative of the non-institutionalized Norwegian population 20 yr and above. The sample size was 1216 individuals. The data were analyzed according to a path analysis design, using regression analysis (OLS). Age had no effect on expenditure after controlling for family income and number of teeth. Expenditure decreased and demand increased with increasing number of teeth. This has two implications: Firstly, expenditure will rise and demand decrease with increasing age because number of teeth decreases with age. Secondly, utilization of dental services is likely to decrease, and demand increase as oral health improves.
The present study examined the relative effect of supplier inducement on demand as opposed to on utilization. Supply of dentists was measured as population: dentist ratio at the level of trade areas. The dependent variable was number of dental visits during the last year. The probability of having any visit was used as the measure of demand. Number of visits, conditional upon having any visit, was used as the measure of utilization. The data were analyzed using Tobit analysis. This analysis gave the fraction of the total effect of a marginal increase in supply that is due to an increase in utilization as opposed to an increase in demand. The analysis was performed on a national sample comprising 1186 adult Norwegians. Supplier inducement had nearly the same effect on demand as on utilization. This finding may be a result of the payment system for dental care, which relates each item of service to the average time it takes to perform that item. Income opportunities for dentists are then fairly independent of whether they spend their time doing check-ups or treatment. The finding indicates that supplier induced demand is a factor to consider in addition to supplier induced utilization when one tries to explain how supplier inducement may affect the unequal distribution of dentists.
The focus of the present study is to examine whether supplier-induced demand exists for primary care physician services in Norway. We compare how two groups of physicians, with and without incentives to induce, respond to increased competition. Contract physicians receive their income from fee-for-item payments. They have an incentive to compensate for a lack of patients by inducing demand for services. Salaried physicians receive a salary which is independent of output. Even though increased competition for patients reduces the availability of patients, they have no financial incentive to induce. Neither of the two groups of physicians increased their output as a response to an increase in physician density. This result could be expected for salaried physicians, while it provides evidence against the inducement hypothesis for contract physicians.