Is there equity in oral healthcare utilization: experience after achieving Universal Coverage

Abstract

Notwithstanding the UC policy implementation made impressive strides toward improving of welfare coverage and an increase in accessibility of health services among Thais, inequality and inequity in oral healthcare utilization persist even when the country achieved universal coverage. Decomposition analyses demonstrate the association of each determinant to inequality in utilization which provides information for policy amendment to achieve the goal of equity in healthcare system.

Inequity in Dental Care Utilization in the Indonesian Population with a Self-Assessed Need for Dental Treatment

“…This is a significant finding, but it is not surprising in a system where high dental care costs are mostly covered by out-of-pocket payments (Petersen 2003;WHO 2005). This finding is consistent with those of other studies Somkotra and Detsomboonrat 2008). This study illustrated inequality by calculating the concentration index of actual dental care utilization (C M ).…”

“…To adjust for size and age structures of households, total household consumption was divided by the adult-equivalence scale. Consistent with previous studies (Deaton 1997;Somkotra and Detsomboonrat 2008), it was defined as e h = (A h + α K h ) θ , where A h is the number of adults in household h and K h is the number of children (0-14 years). Children typically consume less than adults, so counting children as adults may overestimate the living standards of households with children.…”

“…Indirect standardization using a nonlinear logistic regression was applied to standardize dental care needs (ŷ i IS ). The aim of standardization was to determine what the distribution of dental care utilization would look like in the absence of differences in the distribution of certain standardized need determinants, here age and gender (Van Doorslaer et al 2000;Ohkusa and Honda 2003;Somkotra and Detsomboonrat 2008). The age and gender combination used can be seen in Table 1.…”

“…The value of ŷ i was obtained by regressing y i on a set of need and non-need determinants (x k ). These determinants w ere selected based on previous empirical analysis of dental care utilization (Nguyen and Häkkinen 2004;Somkotra and Detsomboonrat 2008). Variables such as age and gender were used as proxies for need .…”

“…The age and gender combination used can be seen in Table 1. The non-need determinants are defined as other explanatory variables that correlate with dental care utilization (Somkotra and Detsomboonrat 2008). Based on Indonesia's demographic characteristics and guidance from other empirical work (Nguyen and Häkkinen 2004), several non-need variables were included: (1) living standards in quintiles; (2) educational attainment, distinguished by no formal education, primary, secondary and higher education; (3) work status, categorized as agriculture/fishery, selfemployed, employee, and other; (4) health insurance entitlement in Indonesia, which is composed of Askes (government employees), Jamsostek (private sector employees), Kartu Sehat (insurance for the poor), other insurance, and uninsured; (5) marital status, distinguished as not married, married, and divorced/widowed; (6) area of residence, categorized as outside Java Island rural, outside Java urban, in Java rural, and in Java urban; (7) and dentist availability, categorized as less or more than 1 dentist available per 30,000 persons.…”