title: High educational attainment moderates the association between dental health-care supply and utilization in Europe.
abstract: In line with the theory of supplier-induced demand, an increased physician density often goes along with a higher utilization of medical services, including dental services. This study aimed to assess whether dentist density and self-employment are related to dental care use, and whether these relationships are moderated by patients' educational attainment. We used data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) from over 20,000 respondents, 50 + yr of age, in 13 countries. We conducted multilevel logistic regressions with probability and type of dental treatment on individual education, country-specific dentist density, and dentist remuneration, and their cross-level interaction. Patients with a high educational level were more likely to report a dentist visit (OR = 2.1, 95% CI: 1.912-2.305) and to receive preventive care (OR = 1.9, 95% CI: 1.697-2.043) than those with a low educational level (reference category). Cross-level interaction effects indicated that high dentist density decreases dental care utilization differences between patients with high (OR = 0.996, 95% CI: 0.993-0.999), medium (OR = 0.995, 95% CI: 0.991-0.999), and low education levels. This was also true for prevention use (OR = 0.996, 95% CI: 0.992-0.999 for patients with a high education level, and OR = 0.996, 95% CI: 0.993-1.000 for patients with a medium education level). The findings suggest that although dentist density is positively associated with dental care utilization, patients have differing susceptibilities to dental care supply.
authors.affiliation: Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.
authors.forename: Maike
authors.initials: M
authors.lastname: Schulz
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.affiliation: School of Humanities and Social Sciences, Jacobs University Bremen, Bremen, Germany.
authors.forename: Hilke
authors.initials: H
authors.lastname: Brockmann
mesh_terms: D003729:Dental Care; D003815:Dentists; D004651:Employment; D005060:Europe; D006801:Humans; D008875:Middle Aged; D009909:Oral Health
keywords: Europe; SHARE; dental care; educational level; elderly