An Evaluation of the Socioeconomic Viability of a Dental Health Care Reform in Norway : A Willingness to Pay Approach

Abstract

Abstract Background: Criticisms can be found in the media, and (false) promises can be found in politics; but what does the population really want? Is the current system defendable? Or are there reasons to reconsider dental health care as part of the Norwegian health care system? Objective: The purpose of this thesis was to attempt to determine whether it can be considered socioeconomically viable to replace the current private and public dental health care system in Norway with a wholly publicly financed dental health care scheme. Approach: In order to determine the socioeconomic viability of introducing a publicly financed dental health care system, three central aspects were considered. First, the status of the current system was evaluated, especially with regards to inspecting for existence of socioeconomic and geographical inequalities. Second, the population desirability of a dental health care reform was assessed from a theoretical standpoint based on arguments for the rise of nonmarket institutions. Finally this was complemented by measuring willingness-to-pay among a sample population; the elicited willingness-to-pay amounts were further compared with the estimated costs of a publicly financed dental health care scheme with the purpose of evaluating economic feasibility. Method: A contingent valuation method, via face-to-face and telephone interviews was used to assess willingness-to-pay. The collected data were further analyzed using binary logistic regression. To describe the extent of inequalities in the market, data from a cross-sectional living survey from 2008 undertaken by Statistics Norway was used as a foundation. These data were also analyzed using binary logistic regression. Results: The population is willing-to-pay for a publicly financed dental health care system. The amount’s individuals are willing-to-pay are varied, however, the average aggregate willingness-to-pay of 1930 NOK, was found to be sufficient to cover the predicted costs of a publicly financed scheme. These results are however bounded by the limitations of the study and analyses. Socioeconomic inequalities are prevalent in the current system, and these provide further evidence that implementation of a scheme could be advantageous. Conclusions: A universal publicly financed dental health care scheme is socioeconomically viable according to the findings in this thesis, but due to the limitations of the study especially with regards to generalizability, and further, to the organizational challenges of initiating a public scheme, additional research would be necessary prior to establishing any firm conclusions on implementation.