Dental utilisation by young adults before and after subsidisation reform in Finland

Dental care was never fully integrated into the welfare state in Finland, but in 1986 it was decided to improve access to both publicly and privately provided dental care by reducing the price paid by patients. Since this would have been rather expensive to do for the whole population, it was decided to introduce it gradually, starting with the young adult population (those under 21 already had free publicly provided dental care). The so-called “Subsidisation Reform” (SR) was based on the assumption that the seeking of care would increase, as would the amount of care actually provided, and this increase would be spread across both the public and the private sectors. This study investigates the short-term effects of this reform. The seeking of care did increase, but the amount of care actually provided decreased and the changes were not evenly spread between the two sectors. The reasons for these changes are explored, and some of the inherent difficulties in evaluating health care reforms are set out, since they are likely to be of wider significance than this particular reform in Finland.reform, dental care

The choice of dental care sector by young adults before and after subsidisation reform in Finland

This work is a part of a project, which aims at studying the utilisation of dental care by young adults and the effects of subsidisation reform (SR) on it. SR was introduced in 1986 for the Finnish population born after 1960 and comprised a decrease of about 50% in the out-of-pocket price for dental care both in the public and private sector. The copayments are paid by the National Health Insurance in the private and municipalities through taxation in the public sector. In this work, the choice of dental care sector (private or public) before and after the reform and the effect of the reform on the choice are examined. The choice was measured by revealed preference; i.e. by actual choice in a period of two years before and after the reform. A random sample was drawn at the end of 1985 (before) and 1987 (after) from the population of 19-26/27 years of age in four towns, in which the conditions of supply of dental services differed essentially (n = 2250 at both occasions). The data were gathered by using a self-administered questionnaire. The method of analysis was discrete logit analysis and applied Chow-test. The changes in choices between 1985 and 1987 were counted by estimated model by using means of independent variables. The change in the choice of sector caused by the subsidisation reform was marginal. The probability of choosing public sector increased 3%-points in the target group of the reform (19-25 aged), but the relative importance of different factors explaining the choice did not change. However, changes in the relative importance of explanatory factors took place in the first age group left outside the reform, but no clear picture was obtained about a possible change in the probability of choosing public sector in this group.dental utilisation health economics health service research dental care subsidisation reform