INCOME RELATED INEQUITY IN DENTAL CARE USE AND ORAL HEALTH IN GREECE
Author(s)
Athanasios Chantzaras, PhD1, Ioannis John Yfantopoulos, II, DPhil2.
1Economics, University Peloponnese, Korinthos, Greece, 2Professor of Health Economics, University of Athens, Ekali, Greece.
1Economics, University Peloponnese, Korinthos, Greece, 2Professor of Health Economics, University of Athens, Ekali, Greece.
OBJECTIVES: Greece has the EU's highest dentist density, yet dental attendance is below the EU average. This study assessed this discrepancy by comparing Greece with EU countries and quantifying income-related inequality and need-standardised inequity in dental use and oral health.
METHODS: Cross-national indicators came from Eurostat EHIS 2019, GBD 2019 oral-disorders prevalence, and dentist-density data. Within-country analyses used ELSTAT HIS 2019 adult microdata. We estimated Erreygers concentration indices, a need-standardised horizontal inequity index for dental use, and logistic regressions (adjusted odds ratios, ORs).
RESULTS: Greece had the EU's highest dentist density in 2023 (13.8 per 10,000), yet only 50.0% of adults reported a dental visit within the previous year, below the EU-27 average (60.5%) and ranking 21st of 27 countries. Age-standardised oral-disorders prevalence was mid-ranked (47.8%; EU mean 48.0%). Dental use was pro-rich (Erreygers CI=+0.203; p<0.001), while poor oral health was concentrated among lower-income adults (Erreygers CI=−0.046; p<0.001), showing a double inequity pattern. Need standardisation barely changed the pro-rich concentration of use (standard CI 0.102; horizontal inequity index 0.094; p<0.001), indicating horizontal inequity rather than need-driven variation. Logistic models confirmed higher use among high-education (OR=2.58) and high-income adults (OR=1.67), but lower use among those aged ≥75 (OR=0.27), reporting cost barriers (OR=0.45), or poor oral health (OR=0.57), despite greater apparent need. Poor oral health increased sharply with age (≥75: OR=29.38) and was lower where no financial barrier was reported (OR=0.21).
CONCLUSIONS: Greece combines abundant dentist supply with below-average attendance and a double inequity: oral-health burden is concentrated among lower-income adults, while use favours higher-income groups even after accounting for need. The paradox reflects a failure to convert available capacity into need-based use rather than a workforce shortage; strengthening public coverage and financial protection is central to equitable realised access.
METHODS: Cross-national indicators came from Eurostat EHIS 2019, GBD 2019 oral-disorders prevalence, and dentist-density data. Within-country analyses used ELSTAT HIS 2019 adult microdata. We estimated Erreygers concentration indices, a need-standardised horizontal inequity index for dental use, and logistic regressions (adjusted odds ratios, ORs).
RESULTS: Greece had the EU's highest dentist density in 2023 (13.8 per 10,000), yet only 50.0% of adults reported a dental visit within the previous year, below the EU-27 average (60.5%) and ranking 21st of 27 countries. Age-standardised oral-disorders prevalence was mid-ranked (47.8%; EU mean 48.0%). Dental use was pro-rich (Erreygers CI=+0.203; p<0.001), while poor oral health was concentrated among lower-income adults (Erreygers CI=−0.046; p<0.001), showing a double inequity pattern. Need standardisation barely changed the pro-rich concentration of use (standard CI 0.102; horizontal inequity index 0.094; p<0.001), indicating horizontal inequity rather than need-driven variation. Logistic models confirmed higher use among high-education (OR=2.58) and high-income adults (OR=1.67), but lower use among those aged ≥75 (OR=0.27), reporting cost barriers (OR=0.45), or poor oral health (OR=0.57), despite greater apparent need. Poor oral health increased sharply with age (≥75: OR=29.38) and was lower where no financial barrier was reported (OR=0.21).
CONCLUSIONS: Greece combines abundant dentist supply with below-average attendance and a double inequity: oral-health burden is concentrated among lower-income adults, while use favours higher-income groups even after accounting for need. The paradox reflects a failure to convert available capacity into need-based use rather than a workforce shortage; strengthening public coverage and financial protection is central to equitable realised access.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR203
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care, Methodological & Statistical Research
Topic Subcategory
Health Disparities & Equity
Disease
No Additional Disease & Conditions/Specialized Treatment Areas