title: An analysis examining socio-economic variations in the provision of NHS general dental practitioner care under a fee for service contract among adolescents: Northern Ireland Longitudinal Study.
abstract: OBJECTIVE
  To examine socio-economic variations in the use of publicly funded general dental practitioner care by adolescents under a fee for service arrangement.
  
  
  METHODS
  Publicly funded general practitioner reimbursement data were linked to census and vital statistics data within the Northern Ireland Longitudinal Study. Data relate to 12,846 adolescents aged 11 or 12 in April 2003 included within the Northern Ireland Longitudinal Study (28% of the population). The main outcome measure was consumption of dental care between 2003/2004 and 2007/2008 by socio-economic status (as measured by National Statistics Socio-economic Classification of occupation and highest educational attainment of household reference person).
  
  
  RESULTS
  In multivariate analysis, socio-economic status was a significant determinant of dental care consumed. Those of the lowest socio-economic status, according to both occupation and highest educational attainment of household reference person, were less likely to have consumed orthodontics OR 0.76 (0.62, 0.95) and OR 0.79 (0.69, 0.91), respectively. Those of lower socio-economic status were, however, more likely to have undergone an extraction and restorative treatment and also consumed on average more treatment than those of higher socio-economic status.
  
  
  CONCLUSIONS
  A demand-led service, in which practitioners are reimbursed in part on a fee for service basis, may create incentives that contribute to different patterns of utilization between social groups. Such a system may not be providing equal access for equal need and may widen existing socio-economic disparities in oral health among adolescents.
authors.affiliation: Peninsula School of Medicine and Dentistry, University of Exeter, UK. claire.telford@pcmd.ac.uk
authors.forename: Claire
authors.initials: C
authors.lastname: Telford
authors.forename: Liam
authors.initials: L
authors.lastname: Murray
authors.forename: Michael
authors.initials: M
authors.lastname: Donaldson
authors.forename: Ciaran
authors.initials: C
authors.lastname: O'Neill
mesh_terms: D000293:Adolescent; D002648:Child; D003729:Dental Care / Q000191:economics*; D018588:Fee-for-Service Plans / Q000191:economics*; D005260:Female; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009660:Northern Ireland; D012959:Socioeconomic Factors; D013222:State Medicine / Q000191:economics* / Q000706:statistics & numerical data