Capitation registration and social deprivation in England. An inverse 'dental' care law?
OBJECTIVE
To examine associations between NHS child dental registration data and area deprivation scores of English Health Authorities (N= 100) in 1996/97 and 1997/98.


METHODS
The Department of the Environment index of local conditions and the Jarman Underpriviledge Area Score from the 1991 census were used to measure deprivation. Prior to September 1997, children got free dental treatment under a capitation scheme with an NHS dentist. If they did not attend within 24 months their registration lapsed on the last day of December of the second registration year and they were deleted from the capitation list. After September 1997 the registration period was reduced to 15 months.


RESULTS
Curve-linear regression of the Health Authority (HA) percentage of children registered, lapses in capitation registrations and deprivation scores.


RESULTS
In England 68% of children were registered in December 1996. The percentage registered in each Health Authority was associated with deprivation (DoE, r2=0.33, Jarman, r2=0.27 p<0.01). In January 1997, 17.8% (1,345,142) of children registered lapsed (HA range 12.8% to 30.3%) and this was also significantly associated with deprivation (DoE r2=0.66, Jarman, r2=0.51 p<0.01). Similar results were found in 1997/98.


CONCLUSIONS
Registration and lapse rates were significantly associated with social deprivation confirming that there is an inverse 'dental' care law for children in England. NHS capitation may widen dental health inequalities.
Consultant in Dental Public Health, Highland Health Board, Assynt House, Inverness.
C M
CM
Jones
D000293:Adolescent; D002204:Capitation Fee / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019140:Dental Care for Children / Q000706:statistics & numerical data*; D003731:Dental Caries / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D006801:Humans; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011204:Poverty Areas; D012044:Regression Analysis; D012189:Retrospective Studies; D012923:Social Class; D013218:State Dentistry / Q000191:economics / Q000706:statistics & numerical data*