title: Income-related inequality and inequity in the use of dental services in Finland after a major subsidization reform.
abstract: OBJECTIVE
  In Finland, a major oral healthcare reform (OHCR), implemented during 2001-2002, opened the public dental services (PDS) and extended subsidies for private dental services to entire adult population. Before the reform, adults born earlier than 1956 were not entitled to use PDS nor did they receive any reimbursements for their private dental costs. We aimed to examine changes in the income-related inequality and inequity in the use of dental services among the adult Finns after the reform.
  
  
  METHODS
  Representative data from Finnish adults born in 1970 or earlier were gathered from three identical postal surveys concerning the use of dental services and subjective perceptions of oral health. Those surveys were conducted before the OHCR in 2001 (n = 1907) and after the OHCR in 2004 (n = 1629) and 2007 (n = 1509). We used concentration index and its decomposition to analyse income-related inequality and inequity in the use of dental services and factors associated with them.
  
  
  RESULTS
  Results showed that pro-rich inequality and inequity in the overall use of dental services narrowed from 2001 to 2004. However, between 2004 and 2007, pro-rich inequality and inequity widened, so it returned to a rather similar level in 2007 as it had been in 2001. Most of the pro-rich inequality and inequity were related to regular dental visiting habit and income level. While there was pro-poor inequality and inequity in the use of PDS, there was pro-rich inequality and inequity in the use of private dental services throughout the study years.
  
  
  CONCLUSIONS
  It seems that income-related inequality and inequity in the use of dental services narrowed only temporarily after the reform.
authors: University of Eastern Finland, Kuopio, Finland.
authors: Eero
authors: E
authors: Raittio
authors: Urpo
authors: U
authors: Kiiskinen
authors: Sari
authors: S
authors: Helminen
authors: Arpo
authors: A
authors: Aromaa
authors: Anna Liisa
authors: AL
authors: Suominen
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003729:Dental Care / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland / Q000453:epidemiology; D018166:Health Care Reform / Q000191:economics / Q000379:methods*; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D015995:Prevalence; D012959:Socioeconomic Factors; D016388:Tooth Loss / Q000191:economics / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: access; dental services; disparities; public health policy