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Inequity in a market-based health system: evidence from Canada's dental sector

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  • Michel Grignon

    ()
    (Department of Economics, Centre for Health Economics and Policy Analysis, Department of Health, Aging and Society, McMaster University)

  • Jeremiah Hurley

    ()
    (Department of Economics, Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University)

  • Li Wang

    ()
    (Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University)

  • Sara Allin

    ()
    (London School of Economics and Political Science, European Observatory on Health Systems and Policies)

Abstract

We study the extent and drivers of income-related inequity in utilization of dental services in Canada using the concentration-index approach that has been widely applied to study equity in physician and hospital services. Because dental care is almost wholly privately financed in Canada, our estimates provide a benchmark for income-related inequity of utilization in private health systems. Although a number of studies document a link between income and utilization, our study is one of the few measuring income-related inequity in dental care utilization. A unique feature of our study is that we analyze separately equity in total dental visits and in preventive visits. This is important because the case for equity is much clearer for preventive dental care. We also examine the impact of controlling for need using a wider variety of need indicators than previous analyses. We confirm that most oral health indicators perform poorly as need adjustors because they reflect past dental care use: individuals with higher levels of utilization also are in better oral health. Our most important finding is that access to preventive care is the most pro-rich type of dental care utilization and that income-related inequity in preventive dental care utilization is three times larger than what is measured for specialist services utilization in Canada.

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File URL: http://chepa.org/docs/working-papers/chepa-wp-08-0584DC0C887FF2.pdf
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Bibliographic Info

Paper provided by Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada in its series Centre for Health Economics and Policy Analysis Working Paper Series with number 2008-05.

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Date of creation: 2008
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Handle: RePEc:hpa:wpaper:200805

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Keywords: Canada; Equity; Dental care; Prevention;

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  1. Windmeijer, F A G & Silva, J M C Santos, 1997. "Endogeneity in Count Data Models: An Application to Demand for Health Care," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 12(3), pages 281-94, May-June.
  2. Eddy van Doorslaer & Cristina Masseria, 2004. "Income-Related Inequality in the Use of Medical Care in 21 OECD Countries," OECD Health Working Papers 14, OECD Publishing.
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Cited by:
  1. Law, Michael R. & Daw, Jamie R. & Cheng, Lucy & Morgan, Steven G., 2013. "Growth in private payments for health care by Canadian households," Health Policy, Elsevier, vol. 110(2), pages 141-146.
  2. Mazzanti, Giovanni Maria & Fiorentini, Gianluca, 2012. "Proposte per una revisione del finanziamento e dell’offerta dei servizi odontoiatrici in Italia. L’intervento pubblico e i fondi integrativi," AICCON Working Papers 100-2012, Associazione Italiana per la Cultura della Cooperazione e del Non Profit.

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