Does subsidized orthodontic treatment reduce inequalities in access? Evidence from Norway based on population register data

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Community dentistry and oral epidemiology Pub Date : 2023-10-30 DOI:10.1111/cdoe.12918

Nan Jiang, Jonas Minet Kinge, Irene Skau, Jostein Grytten

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Abstract

Objective

An important part of Norwegian welfare policy is to provide subsidized orthodontic treatment for children and adolescents. The objective of this policy is that dental services should be allocated according to children's need for treatment, and not according to parents' ability to pay. The probability of receiving orthodontic treatment independent of parent's household income was examined.

Methods

The study population encompassed children and adolescents aged 10–18 years in 2019 (n = 354 439). Information about whether they had started orthodontic treatment was obtained from the Norwegian Health Economics Administration. The key independent variable was net equalized household income. Inequalities were measured using concentration indices, which were estimated according to the severity of the malocclusion (very great need, great need, obvious need and no need). Two indices were used to measure relative inequality: the unstandardized concentration index and the partial concentration index. Absolute inequality was measured using the corrected concentration index. Relevant control variables were included in some of the analyses.

Results

The unstandardized indices were in the range 0.04 (very great need) to 0.05 (obvious need). For all three groups of severity, the 95% confidence intervals overlapped. The values of the partial indices were significantly lower than the values of the unstandardized indices. The partial indices were in the range 0.008 (very great need) to 0.03 (obvious need). The 95% confidence intervals for the partial indices did not overlap with the 95% confidence intervals of the unstandardized indices. For all three groups of severity, the indices that measured absolute inequality were close to zero.

Conclusions

It is possible to achieve the egalitarian aim of equality in service provision by subsidizing orthodontic treatment. This is possible within a system where the cost of orthodontic treatment is reimbursed according to the criteria of need. These criteria function in such a way that patients with the greatest need for orthodontic treatment are given the highest priority.

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有补贴的正畸治疗是否减少了获得治疗的不平等？挪威根据人口登记数据提供的证据。

目的：挪威福利政策的一个重要部分是为儿童和青少年提供有补贴的正畸治疗。这项政策的目标是，牙科服务的分配应根据儿童的治疗需求，而不是根据父母的支付能力。研究了独立于父母家庭收入接受正畸治疗的可能性。方法：研究人群包括10-18岁的儿童和青少年 2019年（n = 354 439）。关于他们是否已经开始正畸治疗的信息是从挪威卫生经济管理局获得的。关键的自变量是净均衡家庭收入。使用浓度指数来测量不平等，浓度指数是根据错牙合的严重程度（非常需要、非常需要、明显需要和不需要）来估计的。使用两个指数来衡量相对不平等：非标准浓度指数和部分浓度指数。使用校正后的浓度指数测量绝对不平等。相关的控制变量包括在一些分析中。结果：非标准化指标在0.04（非常需要）到0.05（明显需要）之间。对于所有三组严重程度，95%置信区间重叠。部分指数的值显著低于非标准化指数的值。部分指数在0.008（非常需要）到0.03（明显需要）之间。部分指数的95%置信区间与非标准化指数的95%可信区间不重叠。对于所有三组严重程度，衡量绝对不平等的指数都接近于零。结论：通过资助正畸治疗，可以实现平等服务的目的。在一个根据需要标准报销正畸治疗费用的系统中，这是可能的。这些标准的作用是，最需要正畸治疗的患者被给予最高的优先权。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Community dentistry and oral epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

4.40

自引率

8.70%

发文量

审稿时长

6 months

期刊介绍： The aim of Community Dentistry and Oral Epidemiology is to serve as a forum for scientifically based information in community dentistry, with the intention of continually expanding the knowledge base in the field. The scope is therefore broad, ranging from original studies in epidemiology, behavioral sciences related to dentistry, and health services research through to methodological reports in program planning, implementation and evaluation. Reports dealing with people of all age groups are welcome. The journal encourages manuscripts which present methodologically detailed scientific research findings from original data collection or analysis of existing databases. Preference is given to new findings. Confirmations of previous findings can be of value, but the journal seeks to avoid needless repetition. It also encourages thoughtful, provocative commentaries on subjects ranging from research methods to public policies. Purely descriptive reports are not encouraged, nor are behavioral science reports with only marginal application to dentistry. The journal is published bimonthly.