Universal access to oral health care for Australian children: comparison of travel times to public dental services at consecutive census dates as an indicator of progressive realisation

Abstract

Progressive realisation of equitable access to health services is a fundamental measure of a state’s resolve to achieve universal health coverage. The World Health Organization has reprioritised the importance of oral health services as an integral element of the roadmap towards health equity. This study sought to determine whether there is an indication of progressive realisation of equitable spatial access to public dental services for Australians <18 years of age through a comparison of travel times to the nearest public dental clinic at successive census dates. The distribution of children classified by rural remoteness and level of socioeconomic disadvantage, as well as the location of public dental clinics at the 2011 and 2016 Australian Bureau of Statistics censuses, was mapped using geographic imaging software. OpenRouteService software was used to calculate the travel time by car between each statistical census district and the nearest public dental clinic. There has been an improvement in the percentage of the population <18 years of age living within a reasonable travel time of a public dental clinic. The most socioeconomically disadvantaged groups in more densely populated areas have better spatial access to publicly funded dental services than less disadvantaged groups. Children living in very remote areas continue to experience lengthy travel times to access fixed oral health services.

Inequality in dental services: a scoping review on the role of access toward achieving universal health coverage in oral health

“…Dental visit waiting-time [ 41 ] and applying virtual services and telehealth [ 38 , 42 ] may affect the availability of services and, consequently, access dental services in different ways. Geographical access, travelling time [ 43 ] and public transportation utilisation [ 44 ] are other determinants of physical access.…”

The application of spatial measures to analyse health service accessibility in Australia: a systematic review and recommendations for future practice

“…Twenty-two articles, published between 2010 to 2022, focused on accessibility to public and private dental practices, dental hospitals, and distribution of the dental workforce [ 29 , 30 , 41 , 48 , 52 , 57 – 61 , 65 , 71 , 80 , 86 – 90 , 96 , 101 , 106 , 107 ]. Articles focused on specific target populations, including paediatric [ 30 , 59 ], > 65 years [ 61 , 86 ], economically disadvantaged [ 41 ], and rural, regional, or remote [ 48 , 60 , 87 , 96 ]. One article analysed dental services for people living with a disability and used the National Survey of Disability, Ageing and Carers to model the prevalence of disability [ 71 ].…”

“…One article analysed dental services for people living with a disability and used the National Survey of Disability, Ageing and Carers to model the prevalence of disability [ 71 ]. Sixteen articles accounted for socio-economic status (SES), seven used the ABS Socio-Economic Indexes for Areas (SEIFA) [ 30 , 80 , 88 – 90 , 96 , 106 ], and nine articles further specified the index used; for example, the Index of Relative Socio-economic Disadvantage (IRSD) [ 29 , 52 , 57 – 59 , 61 , 65 , 86 , 87 ]. Five articles used standardised geographic classification systems to define remoteness areas, including ARIA + [ 57 – 60 ] and the ABS ASGS-RA [ 48 ].…”

“…Area-based measures include the number of practices per defined area [ 52 , 61 , 65 , 71 , 86 , 87 , 96 , 106 ] and PPR [ 57 , 58 , 60 , 101 ]. Distance-based measures include Euclidean distance or multiple ring buffer [ 29 , 30 , 41 , 65 , 71 , 80 , 86 – 90 , 96 , 106 , 107 ], travel time using road networks [ 48 , 59 ], and public transport networks [ 86 , 90 ]. Definition of spatial methods are summarised in the supplementary materials (see Supplementary File 3 ).…”

Travel Time for Dental Care Services Based on Patient Preference in South Korea

“…Jean et al [ 57 ], who studied the travel time for dental care in socioeconomically disadvantaged groups living in remote communities, and Cao et al [ 58 ], who reported the travel time for access to preventive dental care, showed that the lower the group, the greater the travel time. Seo et al [ 59 ] reported that the NHI dental policy benefited the out-of-pocket spending of low-income households and the elderly.…”