Leake J L, Birch S
Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, ON, Canada.
Community Dent Oral Epidemiol. 2008 Aug;36(4):287-95. doi: 10.1111/j.1600-0528.2008.00438.x.
Social inequality in access to oral health care is a feature of countries with predominantly privately funded markets for dental services. Private markets for health care have inherent inefficiencies whereby sick and poor people have restricted access compared to their healthy and more affluent compatriots. In the future, access to dental care may worsen as trends in demography, disease and development come to bear on national oral healthcare systems. However, increasing public subsidies for the poor may not increase their access unless availability issues are resolved. Further, increasing public funding runs counter to policies that feature less government involvement in the economy, tax policy on private insurance premiums, tax reductions and, in some instances, free-trade agreements. We discuss these issues and provide international examples to illustrate the consequences of the differing public policies in oral health care. Subsidization of the poor by inclusion of dental care in social health insurance models appears to offer the most potential for equitable access. We further suggest that nations need to develop national systems capable of the surveillance of disease and human resources, and of the monitoring of appropriateness and efficiency of their oral healthcare delivery systems.
在以私人资助为主的牙科服务市场的国家中，获得口腔医疗保健方面的社会不平等是一个特征。医疗保健的私人市场存在内在的低效率，与健康且较为富裕的同胞相比，患病和贫困的人群获得医疗服务的机会受到限制。未来，随着人口统计学、疾病和发展趋势对国家口腔医疗保健系统产生影响，获得牙科护理的机会可能会恶化。然而，除非解决了可及性问题，否则增加对穷人的公共补贴可能不会增加他们获得医疗服务的机会。此外，增加公共资金与减少政府对经济的干预、对私人保险费的税收政策、减税以及在某些情况下的自由贸易协定等政策背道而驰。我们讨论这些问题，并提供国际实例来说明口腔医疗保健中不同公共政策的后果。通过将牙科护理纳入社会医疗保险模式来补贴穷人似乎为公平获得医疗服务提供了最大潜力。我们进一步建议，各国需要建立能够对疾病和人力资源进行监测，并对其口腔医疗服务提供系统的适宜性和效率进行监测的国家体系。
