Does Universal Coverage achieve equity in oral health care utilization?

Objectives: To assess equality and horizontal equity in oral health care utilization of Thai adults after Universal Coverage policy implemented nationwide, and to decompose sources of inequality in utilization.

Methods: This study employs concentration index (CI) and horizontal inequity index (HI) to measure equality and equity in oral health care utilization, respectively. Further, decomposition method based on two-part model estimation is used to identify sources of inequality comprising of effect of income, need, non-need determinants and residual term. The data of 32748 Thai adults aged over 15 years with self-response to interviewer, from national representative Health&Welfare survey and Socio-Eeconomic survey in 2006 are used.

Results: Significantly positive values of CI of oral health care utilization (=0.199) and number of visits (=0.083) indicate pro-rich inequalities. After need-standardization, pro-rich inequities persist as demonstrated by significantly positive values of HI. Disaggregation of utilizations by various types of facilities reveals substantial divergent pattern that the poor are more likely to access and utilize services at subsidized public facility particularly community hospital, as oppose to the better-off who have better access and utilize services at private faciity. Income and non-need determinants (working status, educational level attainment, type of insurance entitled, geographic characteristics) principally contribute to pro-poor in public sector utilization, unlike pro-rich in private sector utilization. Need factors (self-assessed oral health, demographic characteristics) account for most of pro-poor utilization.

Conclusion: This study provides important evidences for Thailand and other countries. Despite, implementation of Universal Coverage made impressive strides toward the improvement of welfare coverage and increasing of accessibility of health services. However, inequality and inequity in oral health care utilization persist even after the country achieved Universal Coverage. Decomposition analyses demonstrate the association of each determinant to inequality in utilization which provides information for policy amendment to achieve the goal of equity in oral health care system.