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Inequities in unmet oral care needs after a Swedish subsidization reform: an intersectional analysis
Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0001-9321-6174
Institute of Dentistry, University of Eastern Finland, Kuopio, Finland; Oral and Maxillofacial Teaching Unit, Kuopio University Hospital, Kuopio, Finland.
Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
Umeå University, Faculty of Medicine, Department of Odontology.ORCID iD: 0000-0002-2779-5865
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2024 (English)In: JDR Clinical & Translational Research, ISSN 2380-0844Article in journal (Refereed) Epub ahead of print
Abstract [en]

Introduction: The main strategy to achieve equal provision of oral care in Sweden has been to offer partial subsidies for the adult population. However, their effects on unmet oral care needs (UOCNs) have not been extensively assessed.

Objective: This study used an intersectionality framework to examine 1) the overall frequency of UOCNs, 2) single-indicator inequities, and 3) intersectional inequities in total UOCNs and financial-related UOCNs (FUOCNs) in Sweden before and after implementation of a partial subsidization reform in 2008.

Methods: Data from 12 national surveys conducted over 2004 to 2018 were divided into 3 periods: prereform (2004 to 2007), early postreform (2008 to 2011), and late postreform (2012 to 2018). The analytic sample consisted of 98,177 respondents aged 24 to 84 y. Changes in the prevalence of UOCNs were estimated by inferential statistics. Single-indicator and intersectional inequities were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy, across 48 strata defined by gender, age, educational level, income, and immigrant status. Results: The prevalence of total UOCNs and FUOCNs decreased significantly early after the reform, followed by a slight rebound. Relative inequities increased by education, income, and immigrant status after the reform and decreased for age. The discriminatory accuracy for both types of UOCNs was moderate and improved marginally but significantly with the inclusion of the intersectional strata. Most intersectional strata showed greater FUOCN inequities after the reform.

Conclusions: Contrary to expected, larger inequities in FUOCNs were identified in most intersectional strata after the reform. The moderate discriminatory accuracy suggested that Sweden could benefit from future strategies to foster equity that are universal but proportionately more intense among the intersectional strata with greater inequities (proportionate universalism). Knowledge Transference Statement: This analysis highlighted the benefit of adopting the principle of proportionate universalism as a strategy to reduce unmet oral care needs in Sweden. This would mean implementing universal strategies and specific support measures for the most vulnerable social groups as a future oral care policy change in Sweden.

Place, publisher, year, edition, pages
Sage Publications, 2024.
Keywords [en]
dental public health, dental care, health care inequities, universal health insurance, health care reform, intersectional framework
National Category
Public Health, Global Health and Social Medicine
Identifiers
URN: urn:nbn:se:umu:diva-233430DOI: 10.1177/23800844241305109ISI: 001380103500001PubMedID: 39698837Scopus ID: 2-s2.0-85212705297OAI: oai:DiVA.org:umu-233430DiVA, id: diva2:1924323
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, STY-2024/0005Umeå University, FS2.1.6-339-20Available from: 2025-01-03 Created: 2025-01-03 Last updated: 2025-02-20

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Anticona Huaynate, CynthiaLif Holgerson, PernillaGustafsson, Per E

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