Inequity in Dental Care Utilization: Evidence from Indonesia

Indonesian Household Health Survey 2004 indicated dental caries as one of the highest infection disease in Indonesia. But why was the use of dental health care services still low?

Objectives: To predict contributing variables of dental care utilization and to analyze inequity in dental care utilization in Indonesia.

Methods: This research used secondary cross sectional data of 2004 Indonesian National Socio-Economy Survey. In addition, tertiary data from Statistics-Indonesia, Indonesian Ministry of Health and Indonesian Medical Council were used. Samples were respondents from 30provinces in Indonesia, aged 15years above, who reported having dental problems in the last 1month (N=20718). This study examined the association between self reported need for dental care and utilization of dental care services. Logistic regression analysis were performed to determine the contributions of variables to dental care utilization. Need standardized concentration index, horizontal inequity index and concentration curve were applied to determine the degree of inequality and inequity in the use of dental care services. Then it was decomposed into its causes.

Results: Averages of unmet need were high in people who were living in rural area outside Java Island, uninsured, unemployed and poor. Variables which were contributing significantly to dental care utilization were insurance, region of residence, education, household expenditure and dentist availability. Being insured had the biggest odd ratio of using dental care services. There were significant inequality and inequity in use of dental care regarding to demographic characteristics and socio economic status. Utilization of dental care was more concentrated in richest (CI=0.064). Dental health care system favored the better off (HI 0.068). The decomposition point out that insurance coverage was the biggest contribution to inequality in utilization of dental care.

Conclusions: Unmet needs for dental care were concentrated in poor. Inequity in dental care utilization in Indonesia with respect to household expenditure, insurance, employment status, region and education were observed. Insurance, specially targeted for poor, will encourage the poor to contact dentist more often and provide an opportunity in reducing inequality and inequity in dental care utilization.