Abstract
OBJECTIVES: To compare physician and dentist visits nationally and at the provincial/territorial level and to assess the extent of the “inverse care law” in dental care among different age groups in the same way.
METHODS: Publicly available data from the 2007 to 2008 Canadian Community Health Survey were utilized to investigate physician and dentist visits in the past 12 months in relation to self-perceived general and oral health by performing descriptive statistics and binary logistic regression, controlling for age, sex, education, income, and physician/dentist population ratios. Analysis was conducted for all participants and stratified by age groups - children (12–17 years), adults (18–64 years) and seniors (65 years and over).
RESULTS: Nationally and provincially/territorially, it appears that the “inverse care law” persists for dental care but is not present for physician care. Specifically, when comparing to those with excellent general/oral health, individuals with poor general health were 2.71 (95% confidence interval [CI]: 2.70–2.72) times more likely to visit physicians, and individuals with poor oral health were 2.16 (95% CI: 2.16–2.17) times less likely to visit dentists. Stratified analyses by age showed more variability in the extent of the ‘inverse care law” in children and seniors compared to adults.
CONCLUSIONS: The “inverse care law” in dental care exists both nationally and provincially/territorially among different age groups. Given this, it is important to assess the government’s role in improving access to, and utilization of, dental care in Canada.
Key Words: Dental health services, health services, health care utilization, oral health
Résumé
OBJECTIFS: Comparer les visites chez le médecin et chez le dentiste à l’échelle nationale et à l’échelle provinciale/territoriale et évaluer de la même façon l’ampleur de la „loi inverse des soins” dans les soins dentaires selon différents groupes d’âge.
MÉTHODE: Nous avons utilisé les données publiquement disponibles de l’Enquête sur la santé dans les collectivités canadiennes de 2007 à 2008 pour étudier les visites chez le médecin et chez le dentiste au cours des 12 mois antérieurs par rapport à la santé générale et à la santé buccodentaire autoperçues, à l’aide de statistiques descriptives et d’une analyse de régression logistique binaire, après avoir apporté des ajustements pour tenir compte des effets de l’âge, du sexe, de l’instruction, du revenu et du nombre de médecins ou dentistes par habitant. Cette analyse a été effectuée pour tous les participants et stratifiée par groupe d’âge: enfants (12–17 ans), adultes (18–64 ans) et aînés (65 ans et plus).
RÉSULTATS: À l’échelle nationale et à l’échelle provinciale/territoriale, il semble que la „loi inverse des soins” joue encore dans les soins dentaires, mais pas dans les soins médicaux. Plus précisément, comparativement aux personnes dont la santé générale ou la santé buccodentaire est excellente, les personnes en mauvaise santé générale étaient 2,71 fois (intervalle de confiance de 95 % [IC]: 2,70–2,72) plus susceptibles d’aller chez le médecin, et les personnes en mauvaise santé buccodentaire étaient 2,16 fois (IC de 95 %: 2,16–2,17) moins susceptibles d’aller chez le dentiste. Les analyses stratifiées selon l’âge indiquent une plus grande variabilité dans l’ampleur de la „loi inverse des soins” chez les enfants et les aînés que chez les adultes.
CONCLUSIONS: La „loi inverse des soins” dans les soins dentaires existe à la fois à l’échelle nationale et à l’échelle provinciale/territoriale dans différents groupes d’âge. Il est donc important d’évaluer le rôle du gouvernement pour améliorer l’accès et le recours aux soins dentaires au Canada.
Mots Clés: services de santé buccodentaire, services de santé, utilisation des soins de santé, santé buccodentaire
Footnotes
Conflict of Interest: None to declare.
References
- 1.Birch S, Eyles J, Newbold KB. Equitable access to health care: Methodological extensions to the analysis of physician utilization in Canada. Health Econ. 1993;2(2):87–101. doi: 10.1002/hec.4730020203. [DOI] [PubMed] [Google Scholar]
- 2.Quinonez C W w d c e f C m. Network for Canadian Oral Health Research Working Papers Series. 2013;1(1):1–5. [Google Scholar]
- 3.Government of Canada. Health Care-Refugees. 2016. [Google Scholar]
- 4.Government of Canada. Veterans Affairs Canada. 2016. [Google Scholar]
- 5.Parkin D, Devlin N. Measuring efficiency in dental care. In: Scott A, Maynard A, Elliott R, editors. Advances in Health Economics. London, UK: John Wiley & Sons Ltd.; 2003. pp. 143–66. [Google Scholar]
- 6.Sabbah W, Leake JL. Comparing characteristics of Canadians who visited dentists and physicians during 1993/94: A secondary analysis. J Can Dent Assoc. 2000;66(2):90–95. [PubMed] [Google Scholar]
- 7.Quinonez CR, Locker D, Sherret L, Grootendorst P, Azarpazhooh A, Figueiredo R. An Environmental Scan of Provincial and Territorial Public Dental Programs in Canada. Toronto, ON: Community Dental Health Services Research Unit, University of Toronto; 2006. [Google Scholar]
- 8.Bhatti T, Rana Z, Grootendorst P. Dental insurance, income and the use of dental care in Canada. J Can Dent Assoc. 2007;73(1):57. [PubMed] [Google Scholar]
- 9.Government of Canada. Public Health Agency of Canada. 2016. [Google Scholar]
- 10.Millar WJ, Locker D. Dental insurance and use of dental services. Health Rep. 1999;11(1):55–67. [PubMed] [Google Scholar]
- 11.Locker D, Maggirias J, Quinonez C. Income, dental insurance coverage, and financial barriers to dental care among Canadian adults. J Public Health Dent. 2011;71(4):327–34. doi: 10.1111/j.1752-7325.2011.00277.x. [DOI] [PubMed] [Google Scholar]
- 12.Grignon M, Hurley J, Wang L, Allin S. Inequity in a market-based health system: Evidence from Canada’s dental sector. Health Policy. 2010;98(1):81–90. doi: 10.1016/j.healthpol.2010.05.018. [DOI] [PubMed] [Google Scholar]
- 13.Thompson B. Cost Barriers to Dental Care in Canada. Toronto, ON: University of Toronto; 2012. [Google Scholar]
- 14.Statistics Canada. Statistics Canada, Health Statistics Division . Canadian Community Health Surveys, Annual Component, 2007–2008. Ottawa, ON: Data Liberation Initiative; 2009. [Google Scholar]
- 15.Ramraj C. Dental Treatment Needs in the Canadian Population. Toronto, ON: University of Toronto; 2012. [Google Scholar]
- 16.Statistics Canada. Annual Estimates of Population for Canada, Provinces and Territories, from July 1971 to July 2014. Ottawa, ON: Statistics Canada; 2014. [Google Scholar]
- 17.Canadian Institute for Health Information. Canada’s Health Care Providers, 2000-2009: A Reference Guide. Ottawa, ON: CIHI; 2011. [Google Scholar]
- 18.Canadian Medical Association. Physicians per 100,000 Population by Province/Territory, 1986-2014. 2015. [Google Scholar]
- 19.Vecchio N, Chung R-M, Johnson NW. The Association between State Funding and Utilization of Dental Services: A Case for a Universal Dental Scheme. 2015. [Google Scholar]
- 20.Ramraj C, Weitzner E, Figueiredo R, Quinonez C. A macroeconomic review of dentistry in Canada in the 2000s. J Can Dent Assoc. 2014;80:e55. [PubMed] [Google Scholar]
- 21.Sullivan GM, Feinn R. Using effect size - or why the P value is not enough. J Grad Med Educ. 2012;4(3):279–82. doi: 10.4300/JGME-D-12-00156.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Statistics Canada. Statistics Canada, Health Statistics Division . Canadian Community Health Survey, Cycle 2.1, 2003. Ottawa, ON: Data Liberation Initiative; 2005. [Google Scholar]
- 23.Locker D, Leake JL. Inequities in health: Dental insurance coverage and use of dental services among older Ontario adults. Can J Public Health. 1993;84(2):139–40. [PubMed] [Google Scholar]
- 24.Pitiphat W, Garcia RI, Douglass CW, Joshipura KJ. Validation of self-reported oral health measures. J Public Health Dent. 2002;62(2):122–28. doi: 10.1111/j.1752-7325.2002.tb03432.x. [DOI] [PubMed] [Google Scholar]