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


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


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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    References listed on IDEAS

    1. Sintonen, Harri & Tuominen, Risto, 1989. "Exploring the determinants of periodontal treatment costs: A special focus on cigarette smoking," Social Science & Medicine, Elsevier, vol. 29(7), pages 835-844, January.
    2. Sintonen, Harri & Linnosmaa, Ismo, 2000. "Economics of dental services," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 24, pages 1251-1296 Elsevier.
    3. 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 281-294, May-June.
    4. 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.
    5. Andrew M. Jones, 2012. "health econometrics," The New Palgrave Dictionary of Economics, Palgrave Macmillan.
    6. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862 Elsevier.
    7. Sergi Jiménez-Martín & José M. Labeaga & Maite Martínez-Granado, 2002. "Latent class versus two-part models in the demand for physician services across the European Union," Health Economics, John Wiley & Sons, Ltd., vol. 11(4), pages 301-321.
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    Cited by:

    1. 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.
    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.
    3. 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.


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