Sari Helminen

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.

Income-related inequality in perceived oral health among adult Finns before and after a major dental subsidization reform

Abstract Objectives In Finland, a dental subsidization reform, implemented in 2001–2002, abolished age restrictions on subsidized dental care. The aim of this study was to investigate income-related inequality in the perceived oral health and its determinants among adult Finns before and after the reform. Materials and methods Three identical cross-sectional nationally representative postal surveys, concerning perceived oral health and the use of dental services among people born before 1971, were conducted in 2001 (n = 2157), in 2004 (n = 1814) and in 2007 (n = 1671). Three measures of perceived oral health were used: toothache or oral discomfort during the past 12 months, current need for dental care and self-reported oral health status. Concentration index was used to analyse the income-related inequalities. Its decomposition was used to study factors related to the inequalities. Results The proportion of respondents reporting need for dental care decreased from 2001 to 2007, while no changes were seen in reports of toothache or self-reported oral health status. Income-related inequalities in reports of toothache and perceived need for care widened, while the inequality in self-reported oral health remained stable. Most of the inequalities were related to income itself, perceived general health and the time since the last visit to dental care. Conclusions It seems that the income-related inequalities in perceived oral health remained or even widened after the reform.

Education-related inequality in restorative dental treatment need over 11 years in two areas of Finland

OBJECTIVES This study aimed to analyse education-related inequality in restorative dental treatment need among adults aged 30 years and older living in Northern and Southern Finland in 2000 and 2011. METHODS Data were taken from the Health 2000 and 2011 population-based follow-up surveys, including information gathered by interviews and clinical dental examination. Final effective sample sizes were 2423 people in 2000 and 1192 people in 2011. Restorative dental treatment need was measured with number of decayed and/or fractured teeth (DT + FrT). Education-related inequality in number of DT + FrT and factors explaining it were analysed using the Poisson regression analysis, relative index of inequality and slope index of inequality. RESULTS Average number of DT + FrT decreased from 2000 to 2011. Absolute and relative education-related inequalities in them decreased approximately 50% and 25% from 2000 to 2011, respectively. Tooth brushing frequency and time since last dental visit explained approximately 30%-40% of the education-related inequality. The contribution of time since last dental visit to the education-related inequality was smaller in 2011 than in 2000. CONCLUSIONS It seems that, from 2000 to 2011, the need for restorative dental treatment decreased simultaneously with the education-related inequality in it among adults aged 30 years and older living in Northern and Southern Finland.