Changes in socioeconomic inequalities in the use of dental care following major healthcare reform in Chile, 2004-2009.
The study examines changes in the distribution and socioeconomic inequalities of dental care utilization among adults after the major healthcare reform in Chile, 2004-2009. We evaluated the proportion of people who visited the dentist at least once in the previous two years, and the mean number of visits. These outcome variables were stratified by sex, age (20-39, 40-59, 60-63; ≥64 years), educational level (primary, secondary, higher), type of health insurance (public, private, uninsured), and socioeconomic status (quintiles of an asset-index). We also used the concentration index (CIndex) to assess the extent of socioeconomic inequalities in the use of dental care, stratified by age and sex as a proxy for dental care needs. The use of dental care significantly increased between 2004 and 2009, especially in those with public health insurance, with lower educational level and lower socioeconomic status. The CIndex for the total population significantly decreased both for the proportion who used dental care, and also the mean number of visits. Findings suggest that the use of dental care increased and socioeconomic-related inequalities in the utilization of dental care declined after a Major Health Reform, which included universal coverage for some dental cares in Chile. However, efforts to ameliorate these inequalities require an approach that moves beyond a sole focus on rectifying health coverage.
Faculty of Dentistry, University of Chile, 943 Sergio Livingstone Pohlhammer, Independencia, Santiago de Chile 8380000, Chile. mcornejo@odontologia.uchile.cl.
Marco
M
Cornejo-Ovalle
Business School, Adolfo Ibañez University, 12138 Av. Las Torres , Santiago de Chile 7910000, Chile. guillermo.paraje@uai.cl.
Guillermo
G
Paraje
School of Economics and Business, Universidad del Desarrollo, 456 Ainavillo, Concepción 4030000, Chile. fvlavin@gmail.com.|Department of Economics, University of Concepción, 471 Victoria, Concepción 4030000, Chile. fvlavin@gmail.com.
Felipe
F
Vásquez-Lavín
Service of Health Information Systems, Public Health Agency of Barcelona (ASPB), Barcelona 08023, Spain. gperez@aspb.cat.|Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), 3-5 Melchor Fernández Almagro, Madrid 28029, Spain. gperez@aspb.cat.|Biomedical Research Institute Sant Pau (IIB Sant Pau), 167 Sant Antoni Maria Claret, Barcelona 08025, Spain. gperez@aspb.cat.
Glòria
G
Pérez
Service of Health Information Systems, Public Health Agency of Barcelona (ASPB), Barcelona 08023, Spain. lpalenci@aspb.cat.|Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), 3-5 Melchor Fernández Almagro, Madrid 28029, Spain. lpalenci@aspb.cat.|Biomedical Research Institute Sant Pau (IIB Sant Pau), 167 Sant Antoni Maria Claret, Barcelona 08025, Spain. lpalenci@aspb.cat.
Laia
L
Palència
Service of Health Information Systems, Public Health Agency of Barcelona (ASPB), Barcelona 08023, Spain. cborrell@aspb.cat.|Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), 3-5 Melchor Fernández Almagro, Madrid 28029, Spain. cborrell@aspb.cat.|Biomedical Research Institute Sant Pau (IIB Sant Pau), 167 Sant Antoni Maria Claret, Barcelona 08025, Spain. cborrell@aspb.cat.
Carme
C
Borrell
D000328:Adult; D002677:Chile; D003729:Dental Care / Q000191:economics* / Q000379:methods* / Q000592:standards; D005260:Female; D018166:Health Care Reform / Q000191:economics* / Q000592:standards*; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008875:Middle Aged; D012923:Social Class; D012959:Socioeconomic Factors