[go: up one dir, main page]
IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v98y2010i1p81-90.html
   My bibliography  Save this article

Inequity in a market-based health system: Evidence from Canada's dental sector

Author

Listed:
  • Grignon, Michel
  • Hurley, Jeremiah
  • Wang, Li
  • Allin, Sara
Abstract
We study the extent and drivers of income-related inequity in utilization of dental services in Canada using the concentration-index approach that has been widely applied to study inequity in physician and hospital services. Because dental care is almost wholly privately financed in Canada, our estimates provide a benchmark for income-related inequity of utilization in private health systems. Although a number of studies document a link between income and utilization, our study is one of the few measuring income-related inequity in dental care utilization. A unique feature of our study is that we analyze separately inequity in total dental visits and in preventive visits. This is important because the case for equity is much clearer for preventive dental care. We also examine the impact of controlling for need using a wider variety of need indicators than previous analyses. We confirm that most oral health indicators perform poorly as need adjustors because they reflect past dental care use: individuals with higher levels of utilization also are in better oral health. Our most important finding is that access to preventive care is the most "pro-rich" type of dental care utilization and that income-related inequity in preventive dental care utilization is three times larger than what is measured for specialist services utilization in Canada.

Suggested Citation

  • Grignon, Michel & Hurley, Jeremiah & Wang, Li & Allin, Sara, 2010. "Inequity in a market-based health system: Evidence from Canada's dental sector," Health Policy, Elsevier, vol. 98(1), pages 81-90, November.
    • Handle: RePEc:eee:hepoli:v:98:y:2010:i:1:p:81-90
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168-8510(10)00158-2
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Windmeijer, F A G & Silva, J M C Santos, 1997. "Endogeneity in Count Data Models: An Application to Demand for Health Care," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 12(3), pages 281-294, May-June.
    2. Eddy van Doorslaer & Cristina Masseria, 2004. "Income-Related Inequality in the Use of Medical Care in 21 OECD Countries," OECD Health Working Papers 14, OECD Publishing.
    3. Andrew M. Jones, 2012. "health econometrics," The New Palgrave Dictionary of Economics,, Palgrave Macmillan.
    4. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862, Elsevier.
    5. Sintonen, Harri & Tuominen, Risto, 1989. "Exploring the determinants of periodontal treatment costs: A special focus on cigarette smoking," Social Science & Medicine, Elsevier, vol. 29(7), pages 835-844, January.
    6. Sintonen, Harri & Linnosmaa, Ismo, 2000. "Economics of dental services," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 24, pages 1251-1296, Elsevier.
    7. Sergi Jiménez‐Martín & José M. Labeaga & Maite Martínez‐Granado, 2002. "Latent class versus two‐part models in the demand for physician services across the European Union," Health Economics, John Wiley & Sons, Ltd., vol. 11(4), pages 301-321, June.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Marion Devaux, 2015. "Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 21-33, January.
    2. Bartram, Mary & Stewart, Jennifer M., 2019. "Income-based inequities in access to psychotherapy and other mental health services in Canada and Australia," Health Policy, Elsevier, vol. 123(1), pages 45-50.
    3. Pulok, Mohammad Habibullah & Hajizadeh, Mohammad, 2022. "Equity in the use of physician services in Canada's universal health system: A longitudinal analysis of older adults," Social Science & Medicine, Elsevier, vol. 307(C).
    4. Laura Hirello & Mohammad Habibullah Pulok & Mohammad Hajizadeh, 2022. "Equity in healthcare utilization in Canada’s publicly funded health system: 2000–2014," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(9), pages 1519-1533, December.
    5. Pulok, Mohammad Habibullah & van Gool, Kees & Hall, Jane, 2020. "Horizontal inequity in the utilisation of healthcare services in Australia," Health Policy, Elsevier, vol. 124(11), pages 1263-1271.
    6. Mazzanti, Giovanni Maria & Fiorentini, Gianluca, 2012. "Proposte per una revisione del finanziamento e dell’offerta dei servizi odontoiatrici in Italia. L’intervento pubblico e i fondi integrativi," AICCON Working Papers 100-2012, Associazione Italiana per la Cultura della Cooperazione e del Non Profit.
    7. Xiaomin Qu & Xiang Qi & Bei Wu, 2020. "Disparities in Dental Service Utilization among Adults in Chinese Megacities: Do Health Insurance and City of Residence Matter?," IJERPH, MDPI, vol. 17(18), pages 1-13, September.
    8. Law, Michael R. & Daw, Jamie R. & Cheng, Lucy & Morgan, Steven G., 2013. "Growth in private payments for health care by Canadian households," Health Policy, Elsevier, vol. 110(2), pages 141-146.
    9. Denzil G. Fiebig & Kees van Gool & Jane Hall & Chunzhou Mu, 2021. "Health care use in response to health shocks: Does socio‐economic status matter?," Health Economics, John Wiley & Sons, Ltd., vol. 30(12), pages 3032-3050, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Hudson, Eibhlin & Nolan, Anne, 2015. "Public healthcare eligibility and the utilisation of GP services by older people in Ireland," The Journal of the Economics of Ageing, Elsevier, vol. 6(C), pages 24-43.
    2. Bago d'Uva, Teresa & Jones, Andrew M., 2009. "Health care utilisation in Europe: New evidence from the ECHP," Journal of Health Economics, Elsevier, vol. 28(2), pages 265-279, March.
    3. McLeod, Logan, 2011. "A nonparametric vs. latent class model of general practitioner utilization: Evidence from Canada," Journal of Health Economics, Elsevier, vol. 30(6), pages 1261-1279.
    4. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income‐related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647, July.
    5. Tom Van Ourti, 2004. "Measuring horizontal inequity in Belgian health care using a Gaussian random effects two part count data model," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 705-724, July.
    6. Erik Schokkaert & Tom Van Ourti & Diana De Graeve & Ann Lecluyse & Carine Van de Voorde, 2010. "Supplemental health insurance and equality of access in Belgium," Health Economics, John Wiley & Sons, Ltd., vol. 19(4), pages 377-395, April.
    7. Jiménez Rubio, Dolores, 2008. "Equity in the Use of Health Care Services by Immigrants in the Spanish National Health Care System," Estudios de Economia Aplicada, Estudios de Economia Aplicada, vol. 26, pages 211-230, Septiembr.
    8. Majo, M.C. & van Soest, A.H.O., 2011. "The Fixed-Effects Zero-Inflated Poisson Model with an Application to Health Care Utilization," Other publications TiSEM 68cf0f9b-fc68-4017-97a9-a, Tilburg University, School of Economics and Management.
    9. Bago d'Uva, Teresa & Jones, Andrew M. & van Doorslaer, Eddy, 2009. "Measurement of horizontal inequity in health care utilisation using European panel data," Journal of Health Economics, Elsevier, vol. 28(2), pages 280-289, March.
    10. Winkelmann, Rainer, 2006. "Reforming health care: Evidence from quantile regressions for counts," Journal of Health Economics, Elsevier, vol. 25(1), pages 131-145, January.
    11. Antonio Abatemarco & Sergio Beraldo & Francesca Stroffolini, 2020. "Equality of opportunity in health care: access and equal access revisited," International Review of Economics, Springer;Happiness Economics and Interpersonal Relations (HEIRS), vol. 67(1), pages 13-29, March.
    12. Marisol Rodríguez & Alexandrina Stoyanova, 2004. "The effect of private insurance access on the choice of GP/specialist and public/private provider in Spain," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 689-703, July.
    13. Sisira Sarma & Wayne Simpson, 2006. "A microeconometric analysis of Canadian health care utilization," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 219-239, March.
    14. Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores, 2009. "A comparison of the health status and health care utilization patterns between foreigners and the national population in Spain: New evidence from the Spanish National Health Survey," Social Science & Medicine, Elsevier, vol. 69(3), pages 370-378, August.
    15. Hai Zhong, 2007. "Equity in Pharmaceutical Utilization in Ontario: A Cross-Section and Over Time Analysis," Canadian Public Policy, University of Toronto Press, vol. 33(4), pages 487-508, December.
    16. José-Ignacio Antón & Rafael Muñoz de Bustillo, 2010. "Health care utilisation and immigration in Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(5), pages 487-498, October.
    17. Daniele Fabbri & Chiara Monfardini, 2003. "Public vs. Private Health Care Services Demand in Italy," Giornale degli Economisti, GDE (Giornale degli Economisti e Annali di Economia), Bocconi University, vol. 62(1), pages 93-123, April.
    18. Barros, Pedro Pita & Machado, Matilde P. & Sanz-de-Galdeano, Anna, 2008. "Moral hazard and the demand for health services: A matching estimator approach," Journal of Health Economics, Elsevier, vol. 27(4), pages 1006-1025, July.
    19. Jonas Fooken & Varinder Jeet, 2022. "Using Australian panel data to account for unobserved factors in measuring inequities for different channels of healthcare utilization," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(4), pages 717-728, June.
    20. Hendrik Schmitz, 2012. "More health care utilization with more insurance coverage? Evidence from a latent class model with German data," Applied Economics, Taylor & Francis Journals, vol. 44(34), pages 4455-4468, December.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:98:y:2010:i:1:p:81-90. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.