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      Providing dental insurance can positively impact oral health outcomes in Ontario

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          Abstract

          Background

          Universal coverage for dental care is a topical policy debate across Canada, but the impact of dental insurance on improving oral health-related outcomes remains empirically unexplored in this population.

          Methods

          We used data on individuals 12 years of age and older from the Canadian Community Health Survey 2013–2014 to estimate the marginal effects (ME) of having dental insurance in Ontario, Canada’s most populated province ( n = 42,553 representing 11,682,112 Ontarians). ME were derived from multi-variable logistic regression models for dental visiting behaviour and oral health status outcomes. We also investigated the ME of insurance across income, education and age subgroups.

          Results

          Having dental insurance increased the proportion of participants who visited the dentist in the past year (56.6 to 79.4%, ME: 22.8, 95% confidence interval (CI): 20.9–24.7) and who reported very good or excellent oral health (48.3 to 57.9%, ME: 9.6, 95%CI: 7.6–11.5). Compared to the highest income group, having dental insurance had a greater ME for the lowest income groups for dental visiting behaviour: dental visit in the past 12 months (ME highest: 17.9; 95% CI: 15.9–19.8 vs. ME lowest: 27.2; 95% CI: 25.0–29.3) and visiting a dentist only for emergencies (ME highest: -11.5; 95% CI: − 13.2 to − 9.9 vs. ME lowest: -27.2; 95% CI: − 29.5 to − 24.8).

          Conclusions

          Findings suggest that dental insurance is associated with improved dental visiting behaviours and oral health status outcomes. Policymakers could consider universal dental coverage as a means to support financially vulnerable populations and to reduce oral health disparities between the rich and the poor.

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          Most cited references37

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          Towards health equity: a framework for the application of proportionate universalism

          Introduction The finding that there is a social gradient in health has prompted considerable interest in public health circles. Recent influential works describing health inequities and their causes do not always argue cogently for a policy framework that would drive the most appropriate solutions differentially across the social gradient This paper aims to develop a practice heuristic for proportionate universalism. Methods Through a review the proposed heuristic integrates evidence from welfare state and policy research, the literature on universal and targeted policy frameworks, and a multi-level governance approach that adopts the principle of subsidiarity. Results The proposed heuristic provides a more-grained analysis of different policy approaches, integral for operationalizing the concept of proportionate universalism. Conclusion The proposed framework would allow governments at all levels, social policy developers and bureaucrats, public health professionals and activists to consider the appropriateness of distinctive policy objectives across distinctive population needs within universal welfare state principles.
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            Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries.

            A key policy objective in OECD countries is to achieve adequate access to health care for all people on the basis of need. Previous studies have shown that there are inequities in health care services utilisation (HCSU) in the OECD area. In recent years, measures have been taken to enhance health care access. This paper re-examines income-related inequities in doctor visits among 18 selected OECD countries, updating previous results for 12 countries with 2006-2009 data, and including six new countries. Inequalities in preventive care services are also considered for the first time. The indirect standardisation procedure is used to estimate the need-adjusted HCSU and concentration indexes are derived to gauge inequalities and inequities. Overall, inequities in HCSU remain present in OECD countries. In most countries, for the same health care needs, people with higher incomes are more likely to consult a doctor than those with lower incomes. Pro-rich inequalities in dental visits and cancer screening uptake are also found in nearly all countries, although the magnitude of these varies among countries. These findings suggest that further monitoring of inequalities is essential in order to assess whether country policy objectives are achieved on a regular basis.
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              Income, dental insurance coverage, and financial barriers to dental care among Canadian adults.

              To explore the issue of affordability in dental care by assessing associations between income, dental insurance, and financial barriers to dental care in Canadian adults. Data were collection from a national sample of adults 18 years and over using a telephone interview survey based on random digit dialing. Questions were asked about household income and dental insurance coverage along with three questions concerning cost barriers to accessing dental care. These were: "In the past three years...has the cost of dental care been a financial burden to you?...have you delayed or avoided going to a dentist because of the cost?...have you been unable to have all of the treatment recommended by your dentist because of the cost?" The survey was completed by 2,027 people, over half of which (56.0%) were covered by private dental insurance and 4.9 percent by public dental programs. The remainder, 39.1 percent, paid for dental care out-of-pocket. Only 19.3 percent of the lowest income group had private coverage compared with 80.5 percent of the highest income group (P < 0.001). Half (48.2%) responded positively to at least one of the three questions concerning cost barriers, and 14.8 percent responded positively to all three. Low income subjects (P < 0.001) and those without dental insurance (P < 0.001) were most likely to report financial barriers to care. While private dental insurance reduced financial barriers to dental care, it did not entirely eliminate it, particularly for those with low incomes. Those reporting such barriers visited the dentist less frequently and had poorer oral health outcomes after controlling for the effects of income and insurance coverage. Canadian adults report financial barriers to dental care, especially those of low income. These barriers appear to have negative effects with respect to dental visiting and oral health outcomes. For policy, appropriateness will be key, as clarity needs to be established in terms of what constitutes actual need, and thus which dental services can then be considered a public health response to affordability. © 2011 American Association of Public Health Dentistry.
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                Author and article information

                Contributors
                nevena.zivkovic@mail.utoronto.ca
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                17 February 2020
                17 February 2020
                2020
                : 20
                : 124
                Affiliations
                [1 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Dental Public Health, Faculty of Dentistry, , University of Toronto, ; Toronto, Canada
                [2 ]ISNI 0000 0004 1936 7486, GRID grid.6572.6, School of Dentistry, , University of Birmingham, ; Birmingham, England
                Author information
                http://orcid.org/0000-0002-7214-3137
                Article
                4967
                10.1186/s12913-020-4967-3
                7027064
                32066434
                324be005-5ce2-468c-8752-6fb119287825
                © The Author(s). 2020

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 5 September 2019
                : 6 February 2020
                Funding
                Funded by: Canadian Institute of Health Research (CIHR)
                Award ID: 402507
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Health & Social care
                dental care,oral health,insurance,dental insurance,dental utilization,dental visits,dental outcomes,privately financed care,canada

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