The choice of dental care sector by young adults before and after subsidization reform in Finland.

This work is a part of a project, which aims at studying the utilization of dental care by young adults and the effects of subsidization reform (SR) on it. SR was introduced in 1986 for the Finnish population born after 1960 and comprised a decrease of about 50% in the out-of-pocket price for dental care both in the public and private sector. The copayments are paid by the National Health Insurance in the private and municipalities through taxation in the public sector. In this work, the choice of dental care sector (private or public) before and after the reform and the effect of the reform on the choice are examined. The choice was measured by revealed preference; i.e. by actual choice in a period of two years before and after the reform. A random sample was drawn at the end of 1985 (before) and 1987 (after) from the population of 19-26/27 years of age in four towns, in which the conditions of supply of dental services differed essentially (n = 2250 at both occasions). The data were gathered by using a self-administered questionnaire. The method of analysis was discrete logit analysis and applied Chow-test. The changes in choices between 1985 and 1987 were counted by estimated model by using means of independent variables. The change in the choice of sector caused by the subsidization reform was marginal. The probability of choosing public sector increased 3%-points in the target group of the reform (19-25 aged), but the relative importance of different factors explaining the choice did not change. However, changes in the relative importance of explanatory factors took place in the first age group left outside the reform, but no clear picture was obtained about a possible change in the probability of choosing public sector in this group.

Health-related quality of life in type 1 diabetes without or with symptoms of long-term complications.

OBJECTIVE: To measure subjective health-related quality of life (HRQoL) of patients with type 1 diabetes and describe the influence of symptoms of diabetes-related long-term complications on HRQoL. METHODS: The 15-D health-related quality of life measure (15D) was used to measure HRQoL of a representative sample of Finnish insulin-treated patients expected to have type 1 diabetes. Background data were gathered with a separate questionnaire. A tobit (censored regression) model was constructed to estimate the effects of symptoms of complications on HRQoL and to separate these effects from those of other health problems and aging. RESULTS: The 15D scores declined markedly with increasing age, and the prevalence of symptoms of long-term complications increased. The tobit regression model showed that these symptoms have a significant negative influence on HRQoL. The model explained over 50% of the variation in the 15D scores. CONCLUSIONS: High prevalence of symptoms of long-term complications combined with their significant negative influence on HRQoL causes substantial losses in terms of quality of life and utility from both individual and societal perspectives. Thus, the importance of secondary prevention, i.e., prevention of complications by better metabolic control, and also the so-far theoretic possibility to prevent type 1 diabetes itself is emphasized.