Oral Health Care Reform in Finland – aiming to reduce inequity incare provision (original) (raw)
Related papers
Income-Related Inequality in the Use of Dental Services in Finland
Applied Health Economics and Health Policy, 2004
concentration and horizontal inequity indices and the decomposition method to decompose observed inequalities into sources. The data are from the Finnish Health Care Survey of 1996. We examine three measures of utilisation: (a) the total number of visits; (b) the probability of visiting a dentist; and (c) the conditional number of positive visits for (i) visits to all dentists, (ii) those to public dentists and (iii) those to private dentists. The results for the whole sample show pro-poor inequities in all three measures of utilisation in public care, whereas in the first two measures there are pro-rich inequities nationwide and in private care. Among those entitled to age-based subsidised dental care, we find equality and equity in all three measures of utilisation nationwide. The two main factors related to pro-rich distributions of use are income and dentist's recall. To enhance equity in dental care across income groups, attention should be focused on supply factors and other incentives to encourage the poor to contact dentists more often. Nguyen & Häkkinen Table I. Main features of the Finnish dental care system in 1996 Features Public dental system Private dental system Patient group Age 0-18 years Free of charge, priority to receive care 60% NHI subsidy a (0% for orthodontics and prosthetics), in effect 35-40% reimbursement Age 19-40 years Eligible for subsidised care Age 40+ years Subsidised dental care in some small municipalities All dental fees paid World War II veterans Subsidised dental care 60-100% NHI subsidy a People with certain diseases Subsidised dental care 60% NHI subsidy a for some selected treatments Attribute of dental care Cost Cheaper than private dental care, low user fees Always more expensive than public dental care, high co-payments Availability Restricted capacity, yet good in some rural areas Good in urban areas and highly populated centres Dentist's payment system Monthly salary Fixed fee-for-service basis Dentist's recall To those aged under 18 years To adult clients a According to the NHI's own fixed tariffs for treatments and procedures provided by private dentists. Some private dental services are not compensated at all.
Dental utilisation by young adults before and after subsidisation reform in Finland
1996
Dental care was never fully integrated into the welfare state in Finland, but in 1986 it was decided to improve access to both publicly and privately provided dental care by reducing the price paid by patients. Since this would have been rather expensive to do for the whole population, it was decided to introduce it gradually, starting with the young adult population (those under 21 already had free publicly provided dental care). The so-called "Subsidisation Reform" (SR) was based on the assumption that the seeking of care would increase, as would the amount of care actually provided, and this increase would be spread across both the public and the private sectors. This study investigates the short-term effects of this reform. The seeking of care did increase, but the amount of care actually provided, decreased and the changes were not evenly spread between the two sectors. The reasons for these changes are explored, and some of the inherent difficulties in evaluating health care reforms are set out, since they are likely to be of wider significance than this particular reform in Finland.
Community Dentistry and Oral Epidemiology, 1997
Honkala E, Kuusela S, Ritnpelii A, Rimpela M, ,)okela ,1: Dental services utilization between 1977 and 1995 by Finnish adolescents of diffet-ent socioeeonotnie levels. Cotntnunity Dent Oral Epidemiol 1997; 25: 385-90, © Munksgaard, 1997 Abstract -Equal distribution of health cat-e services has long been a major goal ot health policy in the Nordic countries. According to these guidelines, every ehild is expected to have an examination and tt-eattnent at least every second year. The aim of this study was to analyze the trends and, in particulat-, the socioeeonomie diflerenees in dental visits between 1977 and 1995. The data wet-e eolleeted as part of a nationwide research progt-am, the Adolescent Health and Lifestyle Survey, which began in 1977, Every second year a self-adtninistet-ed questionnaire was mailed to a representative sample of 14-, 16-and 18-yeat--old Finns. The sample sizes in the surveys varied from 2422 to 9556, making a total of 56 605 subjects in the whole study. The t-esponse rates in diffet-ent years varied from 77% to 88%, The pet-centage of adolescents visiting a dentist inct-eased between 1977 and 1981 and thet-eafter t-etnained stable. Dental visits seemed to con-elate with the occupational and educational status of the pat-ents up to 1983, but not after that. The Finnish primary oral health cat-e policy seetns to have gained a major objective by eliminating social inequality in dental service utilization among adolescents.
BMC Oral Health, 2017
Background: During the 2000s, two major legislative reforms concerning oral health care have been implemented in Finland. One entitled the whole population to subsidized care and the other regulated the timeframes of access to care. Our aim was, in a cross-sectional setting, to assess changes in and determinants of use of oral health care services before the first reform in 2000 and after both reforms in 2011. Methods: The data were part of the nationally representative Health 2000 and 2011 Surveys of adults aged ≥ 30 years and were gathered by interviews and questionnaires. The outcome was the use of oral health care services during the previous year. Determinants of use among the dentate were grouped according to Andersen's model: predisposing (sex, age group), enabling (education, recall, dental fear, habitual use of services, household income, barriers of access to care), and need (perceived need, self-rated oral health, denture status). Chi square tests and logistic regression analyses were used for statistical evaluation. Results: No major changes or only a minor increase in overall use of oral health care services was seen between the study years. An exception were those belonging to oldest age group who clearly increased their use of services. Also, a significant increase in visiting a public sector dentist was observed, particularly in the age groups that became entitled to subsidized care in 2000. In the private sector, use of services decreased in younger age groups. Determinants for visiting a dentist, regardless of the service sector, remained relatively stable. Being a regular dental visitor was the most significant determinant for having visited a dentist during the previous year. Enabling factors, both organizational and individual, were emphasized. They seemed to enable service utilization particularly in the private sector. Conclusions: Overall changes in the use of oral health care services were relatively small, but in line with the goals set for the reform. Older persons increased use of services in both sectors, implying growing need. Differences between public and private sectors persisted, and recall, costs of care and socioeconomic factors steered choices between the sectors, sustaining inequity in access to care.
Some issues on provision and access to dental services in Norway
The organisation and financing of the Norwegian oral health care differ compared to general health care. The public responsibility for general health care includes the whole population, and the scope is universal coverage involving public finance, and historically public provision as well. Concerning oral health care, there seems to be less emphasis on providing the same level of service to all citizens. The limited public responsibility for providing oral health care leaves Norwegian dentistry dominated by private providers, and most adults faced with paying all costs themselves when they seek dental services. These aspects have potential distributional consequences, which are only explored to some extent in the research literature. On a general level, the research problems focused in this thesis concern different issues on provision and access to dental services in Norway. The present thesis is a collection of four separate papers. The introduction outlines theoretical and empiric...
BMC Oral Health, 2021
BackgroundImproving access to health services is a way towards achieving universal health coverage (UHC) in oral health. The purpose of this review was to map the determinants of access to dental services within a UHC framework.MethodScoping review methods were adopted for the review. PUBMED, Scopus, ISI Web of Science and ProQuest were searched for academic literature on determinants of access to dental services in OCED countries. Articles published in the last 20 years were included. No restriction was placed on study methods; only articles in English language were included. Qualitative synthesis was conducted, along with a trend analysis and mapping exercise.ResultA total of 4320 articles were identified in the initial search; 57 articles were included in the qualitative synthesis. The results indicate 7 main themes as the determinants of access to dental services: family condition, cultural factors, health demands, affordability of services, availability of services, socio-envir...
HRB Open Research, 2022
Background: Oral diseases have the highest global prevalence rate among all diseases, with dental caries being one of the most common conditions in childhood. A low political priority coupled with a failure to incorporate oral health within broader health systems has contributed to its neglect in previous decades. In response, calls are emerging for the inclusion of oral health within the universal healthcare domain (UHC). This protocol outlines the methodology for a cross-country comparative analysis of publicly funded oral health systems for children across six European countries, reporting on oral health status in line with the indicators for UHC. Methods: This study will follow Yin’s multiple case study approach and employ two strands of data collection, analysis, and triangulation: a systematic documentary analysis and semi-structured interviews with elite participants local to each country. The countries chosen for comparison and providing a representative sample of European d...
Technical and cost efficiency of oral health care provision in Finnish health centres
Social Science & Medicine, 2003
In this study we measured the productive efficiency of public dental health provision across Finland. The analysis was based on data envelopment analysis (DEA) using linear programming. In addition, we investigated various factors explaining the technical and cost efficiency of public dental care using a parametric Tobit model.