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Lien Nguyen and Unto Häkkinen Choices and Utilization in Dental Care : Public vs . Private Dental Sectors , and the Impacts of a Two-Channel Financed Health Care System

CHESS undertakes high-quality health economics research into health-policy relevant issues. CHESS aims to promote interaction between researchers in Finland and abroad and to increase the impact of health economics research. CHESS focuses on three research areas: 1) quality and efficiency of health services, 2) quality and efficiency of elderly care services, and 3) financing and provision of health services. The CHESS Discussion Papers intends to make research available quickly to the academic community, health policy makers and health professionals both in Finland and internationally. Material published in Discussion Papers ranges from work in progress to papers submitted for journal publication. Comments and suggestions on Discussion Papers are encouraged and should be sent directly to the authors. Choices and utilization in dental care: public vs. private dental sectors, and the impacts of a two-channel financed health care system STAKES. Discussion Papers 1/2005 3 Summary The aim of this paper is to examine the determinants of the utilization of dentists' services, especially the factors affecting the choice between public and private sectors among adults entitled to age-based subsidized dental care, using the data from the Finnish Health Care Survey of 1996 (n=2010). The decision to contact a dentist and the choice of a public or private dentist are sequentially modeled by two single logit equations, while the positive number of visits to each chosen dentist is modeled by a zero-truncated Negative Binomial model. The choice between sectors is measured by the observed choice made by the public and private users. Seeking care is mainly determined by pain and dentist's recall, but is deterred by both the perceived expense of private care and the insufficient availability of public services. The choice of a private dentist tends to be made by people who are older, who perceive the public availability as insufficient, or who receive a recall. Income positively affects both access to care and the number of private dental visits. The ratio of dentists to population also increases the number of private dental visits. The findings suggest that lowering co-payments and user fees and increasing the public supply of dental care, accompanied by an efficient recall system might improve access to dental care and better steer the choice between sectors. Choices and utilization in dental care: public vs. private dental sectors, and the impacts of a two-channel financed health care system