The role of healthcare system in dental check-ups in 27 European countries: Multilevel analysis

Objective: To examine whether public expenditure on health and Euro Health Consumer Index (EHCI) are associated with dental check-ups in European countries. Methods: Individual data were from Eurobarometer 72.3, 2009 a cross-national survey of 27 European countries. Eligible participants were those aged 18 years and older in 27 European countries. Dental check-ups reflected dental visits for oral examination and getting advice on oral health in the last 12 months. Individual factors included age, gender, marital status, urbanisation, education, subjective social status, and difficulty in paying bills. Public expenditure on health as a percentage of gross domestic product (GDP) and EHCI were used as contextual factors. A set of multilevel logistic regression models was used to examine the relationship between dental check-ups and each of healthcare expenditure and EHCI adjusting for demographic factors, GDP per capita and socioeconomic indicators. Results: Total number included in the analysis was 23,842. Participants in countries with greater healthcare expenditure and higher score of EHCI were significantly 1.17 (95% CI: 1.03, 1.32) and 1.30 times (95% CI: 1.04, 1.64) more likely to report dental check-ups within the past 12 months after accounting for demographic characteristics, GDP per capita, and all socioeconomic indicators. Conclusion: The findings suggest that greater governmental support for the healthcare and better characteristics of healthcare system are positively associated with routine dental attendance.