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

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  • Grignon, Michel
  • Hurley, Jeremiah
  • Wang, Li
  • Allin, Sara

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 inequity 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 inequity 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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  • Grignon, Michel & Hurley, Jeremiah & Wang, Li & Allin, Sara, 2010. "Inequity in a market-based health system: Evidence from Canada's dental sector," Health Policy, Elsevier, vol. 98(1), pages 81-90, November.
    • Handle: RePEc:eee:hepoli:v:98:y:2010:i:1:p:81-90
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    1. Pulok, Mohammad Habibullah & van Gool, Kees & Hall, Jane, 2020. "Horizontal inequity in the utilisation of healthcare services in Australia," Health Policy, Elsevier, vol. 124(11), pages 1263-1271.
    2. Denzil G. Fiebig & Kees van Gool & Jane Hall & Chunzhou Mu, 2021. "Health care use in response to health shocks: Does socio‐economic status matter?," Health Economics, John Wiley & Sons, Ltd., vol. 30(12), pages 3032-3050, December.
    3. Giovanni Maria Mazzanti & Gianluca Fiorentini, 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.
    4. Xiaomin Qu & Xiang Qi & Bei Wu, 2020. "Disparities in Dental Service Utilization among Adults in Chinese Megacities: Do Health Insurance and City of Residence Matter?," IJERPH, MDPI, vol. 17(18), pages 1-13, September.
    5. Marion Devaux, 2015. "Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 21-33, January.
    6. 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.
    7. Bartram, Mary & Stewart, Jennifer M., 2019. "Income-based inequities in access to psychotherapy and other mental health services in Canada and Australia," Health Policy, Elsevier, vol. 123(1), pages 45-50.
    8. Pulok, Mohammad Habibullah & Hajizadeh, Mohammad, 2022. "Equity in the use of physician services in Canada's universal health system: A longitudinal analysis of older adults," Social Science & Medicine, Elsevier, vol. 307(C).
    9. Laura Hirello & Mohammad Habibullah Pulok & Mohammad Hajizadeh, 2022. "Equity in healthcare utilization in Canada’s publicly funded health system: 2000–2014," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(9), pages 1519-1533, December.

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