Dental care utilization among Thais after universal coverage policy implementation

Objectives: To investigate and quantify the extent of inequality in dental care utilizations among Thais after the implementation of the Universal Coverage (UC) policy in 2002. Methods: The data to perform analyses were taken from the nationally representative Health and Welfare Survey 2003, 2007, and 2009 in Thailand which consisted of data of 68433, 69679, and 73087 Thais, respectively. Descriptive analyses were performed to reveal the features of dental care utilization among Thais, in addition to the use of concentration index (CI) to measure the extent of socioeconomic-related inequality in dental care utilization. Results: Generally, the unequivocal gradients in dental care utilization among Thais in 2003, 2007, and 2009 were manifest, and the socioeconomic-related inequality in dental care utilization were more concentrated among the better-off in each age- group (i.e. children aged younger than 15 year, adult aged 15-59 years, and elderly aged 60 years and over), also in each wave of survey. These are corroborated by the positive value of CI indicating the pro-rich inequality in such care. However, the poor Thais were more likely to access and utilize dental care at public facilities particularly the primary care facilities (i.e. district facilities), and this trend is increased from 2003 to 2009. In addition, types of insurance entitlement and geographic difference are particularly associated with poor-rich differences in dental care among Thais. Conclusion: After the implementation of UC policy in Thailand- a middle income developing country, although there is the persistence of socioeconomic-related inequality in dental care utilization among Thais, the pro-poor dental care utilization particularly at primary care facilities substantiate the concerted effort to reducing inequality in dental care. This is the impressive experience of its oral health care system as the lesson for other developing countries.