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Coverage of public oral health services for young children in Finland
A Milén1, T Laaksonen, P Halonen
1Centre for Training and Development, University of Kuopio, Finland.
Insights
Many children lack true choice in public oral health care due to barriers like parental education, work difficulties, dental fear, and missed invitations. These factors highlight systemic issues in ensuring equitable access to essential dental services for all children.
Area of Science:
- Public Health
- Pediatric Dentistry
- Health Services Research
Background:
- The Finnish public oral health care program offers free services to all preschool children, achieving high coverage.
- Despite universal eligibility, the extent to which nonparticipants have genuine choice in opting out requires investigation.
Purpose of the Study:
- To assess the equality of choice for nonparticipating children in public oral health care.
- To identify specific barriers contributing to nonutilization of these services.
Main Methods:
- A study in Lahti, Finland, analyzed 4- to 6-year-old nonparticipants and matched controls from 1981 administrative data.
- Multiple logistic regression analysis was employed to examine 36 potential factors influencing nonutilization.
Main Results:
- Administrative data misclassification indicated higher national program coverage than reported, suggesting improvements for statistical reliability.
- Key barriers to oral health care utilization included single-parent families with low parental education and work constraints, dental fear, and failure to receive examination invitations.
- These identified barriers disproportionately affected certain child demographics, limiting their effective choice to participate.
Conclusions:
- Systemic barriers, rather than individual choice, significantly impact participation in public oral health care.
- The public oral health care system can implement strategies to mitigate these barriers and enhance equitable access for all children.
Abstract:
In the Finnish programme of public oral health care for preschool children, every child is eligible for free care. The coverage of the programme has been high, about 85%. The aim of this study was to determine, whether the nonparticipants of the programme actually do have equality in making the choice to participate. The barriers to care were identified. All 4- to 6-year-old children who were registered administratively as nonparticipants in oral health care in 1981 and their randomly selected controls were studied in the city of Lahti. Detailed analysis of nonparticipation showed that some children had been misclassified as nonparticipants in the administrative statistics, indicating the national coverage of the programme to be higher than reported. Based on this finding, suggestions are made for increasing reliability of official statistics. Multiple logistic regression analysis for 36 factors resulted in three main barriers to utilization. Children of single-parent families in which the parent had a low level of education and difficulties to take time off work had the highest risk of nonutilization and thus had little choice to participate. Children with fear to dental care, regardless of any characteristic of the family or parents, were at increased risk of nonparticipation. Not having received the invitation to an examination also increased nonutilization, regardless of any factors related to family, parents or child. It was concluded, however, that these barriers to utilization could be manipulated by the system of public oral health care.