title: Changes in problem-based and routine-based healthcare attendance: a comparison of three national dental health surveys.
abstract: BACKGROUND
  Healthcare utilization either may be guided by a preventive orientation leading to regular visits to the doctor, or it may be triggered by impaired health. Using data from three German national surveys, we wanted to examine whether the effects of income on the utilization of dental health services increased over time owing to the considerable decrease in insurance coverage over the years and the increase in higher out-of-pocket costs from patients.
  
  
  METHODS
  Data from three national dental health surveys (1989, 1997 and 2005) were used. The data of all respondents aged between 35 and 44 years were available, and the number of caries-free and unrestored healthy teeth was used as outcome.
  
  
  RESULTS
  Over the years, the proportion of routine attenders increased considerably, and the dental health measure used indicates the improvement. The least educated respondents and those with the lowest income profited less than other groups. In spite of higher copayments, the effects of income on the utilization of dental care did not increase over time. Regarding the results of education, a significant effect was only found in the study from 2005. No clear differences between routine- and problem-oriented attenders emerged with respect to the dental health measure chosen.
  
  
  CONCLUSIONS
  Material conditions and education had effects on utilization behaviour. Contrary to expectation, increasing copayments did not yield higher effects of income on healthcare utilization.
authors.affiliation: Medical Sociology Unit, Hannover Medical School, Hannover, Germany. geyer.siegfried@mh-hannover.de
authors.forename: Siegfried
authors.initials: S
authors.lastname: Geyer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Micheelis
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003729:Dental Care / Q000706:statistics & numerical data*; D003753:Dental Health Surveys; D004522:Educational Status; D005260:Female; D005858:Germany; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D016018:Least-Squares Analysis; D016015:Logistic Models; D008297:Male; D009909:Oral Health; D018709:Statistics, Nonparametric