Equity in children's utilization of dental services: effect of a children's dental care programme

Abstract

Objectives: To evaluate the long term impact on fairness of children's dental care programmes. Methods: Data were taken from the Health Module of the Spanish Disability Interview Survey in 1999 (n=8,049). The probability of visit to a dentist and the number of visits are estimated with binary logistic models and count data models in order to compare the regions with consolidated dental care programmes, PADI regions, with the rest of Spanish regions. The effects of family income, residential status and living in small village settings on dental care access for both regions are investigated and compared. Results: The scope of the dental care programme (PADI) makes a very significant difference. Regions with consolidated PADI are by far more equitable than the rest. Once the other explanatory factors have been controlled, the percentage of users is by far larger in PADI regions, odds ratio 3.47 (95% CI 2.38 to 5.07). In PADI regions family income doesn't have any significance in the probability of visits to the dentist, odds ratio 1.9 (95% confidence interval 0.92 to 1.81). In non PADI regions poorer families have less probability of visiting a dentist, odds ratio 1.68 (95% CI 1.50 to 1.88). In addition, in each region, inequalities discriminating against those children that live in small villages cannot be found in PADI regions. Conclusions: PADI regions have more equity in access to dental care. The PADI programme managed to drop any income base discrimination in access and succeeded in equalizing access in small villages and in urban areas. The use of dental services is very unequal among the population. Public dental care programmes for children equalize utilization and strongly contribute to improving children's oral health.