Abstract
OBJECTIVES: From the perspective of Universal Health Coverage (UHC) to reduce health inequalities, health insurance plays a crucial role. This study examined the mediating effect of health insurance on the economic and educational inequalities in dental utilisation patterns among Indonesian adults. METHODS: This cross-sectional study analysed self-reported data from participants (n = 26 351) of the Indonesian Family Life Survey-5 (IFLS-5) conducted during the transition of Indonesia's health financing system in 2014-2015. Economic and educational inequalities in dental utilisation were measured and examined using the relative concentration index (RCI). A multinomial logistic regression, adjusted for confounders (sex, age, ethnicity, religion, marital status, household size and residency based on province and rural-urban), examined the association of economic status (quintiles of adjusted monthly household expenditure) and educational status (unschooled to higher education) with dental utilisation patterns (never/irregular/regular). The extent to which the association was explained by health insurance ownership (public and private insurance) was assessed using the Karlson-Holm-Breen mediation method. RESULTS: Among participants, 12.9% of individuals utilise dental visits irregularly and 1.4% regularly, with the utilisation concentrated among those with higher economic status (RCI: 0.30, standard error [SE]: 0.01) and educational status (RCI: 0.34, SE: 0.01). Compared to those with the lowest economic quintile, the highest economic quintile showed higher odds of irregular utilisation (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.89-2.48) and regular utilisation (OR: 4.28; 95% CI: 2.50-7.34). People with higher education were more likely to utilise dental care, with higher odds ratios of irregular utilisation (OR: 6.80; 95% CI: 5.04-9.18) and regular utilisation (OR: 7.34; 95% CI: 2.24-24.04) compared to unschooled individuals. Private insurance partly mediated the association with regular dental utilisation: stronger indirect effects were observed at the highest economic level (proportion mediated [PM]: 10.6%) and highest educational level (PM: 9.2%). In contrast, the mediation effects of public insurance were less remarkable. CONCLUSION: Education and economic status play a significant role in determining dental utilisation patterns, with limited mediating effects for public insurance on these associations. To ensure equitable access to quality dental utilisation across socioeconomic groups, it is crucial to strengthen public insurance programmes that effectively address the needs of disadvantaged populations.