Inequality in Dental Care Utilization among Thais Exits despite Universal Coverage

Methods: This study conducted from the national representative Health and Welfare Survey (HWS) of Thailand, in 2003 and 2011. The survey consisted of a face-to-face interview divided into household and individual questionnaires. Both HWS2003 and HWS2011 comprise data of 38951 and 41402 Thai adults (aged 20-59 years), respectively. Descriptive analyses performed the distribution of dental care utilization among Thais. Furthermore, the summary of distribution of outcome variables relative to household-asset index was obtained by concentration index (CI). Multivariate-Logistic regression was employed to determine factors associated with inequality, if any, in dental care utilization.

Results: The findings of both HWS2003 and HWS2011 reveal consistent figures as there were gradients in dental care utilization among Thai adults. That is, those of the higher socioeconomic-status utilized dental care more than do the less well-off. Dental care utilization, for instance, among Thai adults in the HWS2011 range from 4.89% by the 1^st quintile to 16.15% by the 5^thquintile. The CI values corroborated pro-rich inequality in dental care, as indicated by its value (CI = 0.294) of HWS2011. However, those of lower socioeconomic-status were more likely to obtain dental care from primary health care facility, i.e. community hospitals or health center. Multivariate-logistic regression analysis demonstrates that demographic-, socioeconomic-, and geographic characteristics were particularly associated with poor-rich differences in dental care utilization among Thais.

Conclusions: Although inequality in dental care utilization among Thais exists, the pro-poor utilization at public facilities particularly primary care facilities substantiates the concert effort to reducing such inequality. Alleviating that inequality for the less well-off through strengthening primary health care system deserves particular.