Representatives of faculties of dentistry and agencies working to improve the oral health of groups with restricted access to dental care were invited to address the access and care symposium held in Toronto in May 2004. They told of their clients" sometimes desperate needs in graphic terms. The agencies" response ranged from simple documentation of the need, to expression of frustration with current trends and the apparent indifference of policy makers, to the achievement of some success in arranging alternative models of care. The presenters consistently identified the need to change methods of financing dental education and both the financing and models of care delivery to meet the needs of those with restricted access to oral health care.
The aim of this study was to inform policy leaders of the opinions of Canada's major dental care service provider regarding publicly financed dental care.
Using provincial/territorial dental regulatory authority listings, a 26-item questionnaire was sent to a representative sample of Canadian dentists (n = 2219, response rate = 45.8 percent). Descriptive statistics were produced, and bivariate and multivariate logistic regressions were conducted to assess what predicts dentists' responses.
Canadian dentists support governmental involvement in dental care, preferring investments in prevention to direct delivery. The majority of dentists have less than 10 percent of their practice represented by publicly insured patients, with a small minority having greater than 50 percent. The majority would accept new publicly insured patients, preferring fee for service remuneration. Dentists generally appear dissatisfied with public forms of third-party financing.
Dentists prefer a targeted effort at meeting public needs and are influenced in their opinions largely in relation to ideology. In order to move forward, policy leaders will need to devote some attention to the influence and complexity of public and private tensions in dentistry At the very least, public and private practitioners must come to appreciate each other's challenges and balance public and private expectations in public programming.
Inequalities in oral health and care are long recognized in Canada, with public health environments increasingly focusing on issues of equity and access to care. How does Canada publicly insure for diseases that are largely preventable, minimally experienced by the majority, but that still cause tremendous suffering among the socially marginalized? We consider this dynamic by asking Canadians their opinions on publicly financed dental care.
Data were collected from 1,006 Canadian adults through a telephone interview survey using random digit dialling and computer-assisted telephone interview technology. Simple descriptive and bivariate analyses were undertaken to assess relationships among variables, with logistic regression odds ratios calculated for significant relations.
Canadians support the idea of universal coverage for dental care, also recognizing the need for care to specific groups. Generally preferring to access public care through the private sector, Canadians support the idea of opting out, and expect those who access such care to financially contribute at point of service.
Support for publicly financed dental care is indicative of a general support for a basic right to health care. Within the limits of economy, the distribution of oral disease, and Canadian values on health, the challenge remains to define what we think is equitable within this sector of the health care system. This question is ultimately unanswerable through any survey or statistical means, and must, to become relevant, be openly promoted and debated in the social arena, engaging Canadians and their sense of individual and social responsibility.
The aim was--in a longitudinal respect--to study whether 15-year-old children, in caries-free groups, and groups with high frequency of carious lesions, had a stable caries development from 15 to 19 years of age, when they left the organised Public Dental Care. Caries index values were analysed for the period 1986/7-1990/1 for patients born 1971-72 and residing in Göteborg. The groups of caries-free children seemed to be stable in their dental health in about 60-70% according to the prevalence indices used; and about 80% according to the incidence index DS-a. The caries prevalence index mean values of the 15-year-old patient groups with high frequencies of lesions showed between 1.5 to 3.5 percentile units higher mean values when the individuals were 19 years of age. However, the corresponding caries incidence index values were as low as half the size, indicating a possible treatment effect of the caries prevention programme used. Related to the DFS-a index, the 20% groups with the highest caries index values were registered for about 80% of all approximal lesions, of special interest for dental care costs.
This work is a part of a project, which aims at studying the utilization of dental care by young adults and the effects of subsidization reform (SR) on it. SR was introduced in 1986 for the Finnish population born after 1960 and comprised a decrease of about 50% in the out-of-pocket price for dental care both in the public and private sector. The copayments are paid by the National Health Insurance in the private and municipalities through taxation in the public sector. In this work, the choice of dental care sector (private or public) before and after the reform and the effect of the reform on the choice are examined. The choice was measured by revealed preference; i.e. by actual choice in a period of two years before and after the reform. A random sample was drawn at the end of 1985 (before) and 1987 (after) from the population of 19-26/27 years of age in four towns, in which the conditions of supply of dental services differed essentially (n = 2250 at both occasions). The data were gathered by using a self-administered questionnaire. The method of analysis was discrete logit analysis and applied Chow-test. The changes in choices between 1985 and 1987 were counted by estimated model by using means of independent variables. The change in the choice of sector caused by the subsidization reform was marginal. The probability of choosing public sector increased 3%-points in the target group of the reform (19-25 aged), but the relative importance of different factors explaining the choice did not change. However, changes in the relative importance of explanatory factors took place in the first age group left outside the reform, but no clear picture was obtained about a possible change in the probability of choosing public sector in this group.
We examine the determinants of the utilization of dentists' services among adults entitled to age-based subsidized dental care, using data from the Finnish Health Care Survey of 1996. We apply a three-part model to investigate the care-seeking decision, the choice of a private/public dentist, and the number of visits to each chosen dentist. Seeking care is found to be determined mainly by dentist's recall and mostly deterred by the expense of private care. Insufficient public availability and recall positively affect the choice of a private dentist, whereas income and dentist density increase the number of private visits. Need and socioeconomic variables are controlled for and are also important determinants. The findings suggest that lowering copayments and user fees and increasing the public supply of dental care, accompanied by an efficient recall system, might improve access to dental care and better steer the choice between sectors.