Broadbent J M, Theodore R F, Te Morenga L, Thomson W M, Brunton P A
N Z Dent J. 2016 Jun;112(2):55-61.
Health services should be targeted toward those most in need of health care. Poor oral health disproportionately affects Māori, Pacific Island, and socioeconomically deprived New Zealanders of all ages, and oral health care services should be prioritised to such groups. In New Zealand, free oral health care is available for all children up to the age of 17. On the other hand, adult dental services are provided on a user-pays basis, except for a limited range of basic services for some adults, access to which varies regionally. This study investigated the extent of dental treatment inequalities among patients at New Zealand's only School of Dentistry.
Data were audited for all treatments provided at the University of Otago Faculty of Dentistry from 2006 to 2011 for patients born prior to 1990. Ethnic and socioeconomic inequalities in the provision of dental extractions, endodontic treatment, crowns, and preventive care were investigated. Differences were expressed as the odds of having received one or more treatments of that type during the six-year period 2006 to 2011.
Data were analysed for 23,799 individuals, of whom 11,945 (50.2%) were female, 1,285 (5.4%) were Māori and 479 (2.0%) were Pacific, 4,040 (17.0%) were of low socioeconomic status (SES), and 2,681 (11.3%) were beneficiaries or unemployed. After controlling for SES, age, and sex, Māori had 1.8 times greater odds of having had a tooth extracted than NZ European patients, while Pacific Islanders had 2.1 times the odds. Furthermore, after controlling for ethnicity, age, and sex, low-SES patients had 2.4 times greater odds of having had a tooth extracted than high-SES patients, and beneficiaries had 2.9 times the odds. Conversely, these groups were less likely to have had a tooth treated with a crown or endodontics or receive preventive care.
Existing policies call for the reduction of inequalities. There is a need for a strategy to monitor changes in treatment inequality over time which includes improving equity in service care provision. The observed treatment inequalities are likely to be an underestimate of those occurring in private dental practice in New Zealand.
卫生服务应面向最需要医疗保健的人群。口腔健康状况不佳对毛利人、太平洋岛民以及新西兰所有年龄段社会经济贫困人群的影响尤为严重，口腔保健服务应优先提供给这些群体。在新西兰，17岁以下的儿童可享受免费口腔保健服务。另一方面，成人牙科服务实行收费制，不过针对部分成年人有有限范围的基本服务，且不同地区的获取情况有所差异。本研究调查了新西兰唯一一所牙科学院患者中牙科治疗不平等的程度。
对奥塔哥大学牙科学院2006年至2011年为1990年以前出生的患者提供的所有治疗数据进行审核。调查了在拔牙、牙髓治疗、牙冠修复和预防保健方面的种族和社会经济不平等情况。差异以2006年至2011年六年期间接受过一种或多种该类型治疗的几率来表示。
对23799名个体的数据进行了分析，其中11945名（50.2%）为女性，1285名（5.4%）为毛利人，479名（2.0%）为太平洋岛民，4040名（17.0%）社会经济地位较低，2681名（11.3%）是受益人或失业者。在控制了社会经济地位、年龄和性别因素后，毛利人拔牙的几率是新西兰欧洲裔患者的1.8倍，而太平洋岛民的几率是2.1倍。此外，在控制了种族、年龄和性别因素后，社会经济地位低的患者拔牙的几率是社会经济地位高的患者的2.4倍，受益人的几率是2.9倍。相反，这些群体接受牙冠修复或牙髓治疗或接受预防保健的可能性较小。
现有政策要求减少不平等现象。需要制定一项战略来监测治疗不平等随时间的变化，其中包括提高服务提供的公平性。观察到的治疗不平等情况可能低估了新西兰私人牙科诊所中存在的不平等情况。
