Equity impacts of a system of social assistance for the public subsidisation of the costs of dental care for low income adults

Universal Health Coverage (UHC) has been defined as all people receiving quality health services that meets their needs without being exposed to financial hardship in paying for them [WHO, 2013]. The WHO identifies reducing payment of out-of-pocket expenses as a key way to achieve this [WHO, 2014].

Dental care is an area of healthcare which often involves out-of-pocket expenses and requires patients to pay for some, if not all of their care. Various countries have designed safety net health policies for people unable to pay for dental care but we know relatively little about how effective they are in reducing health inequalities. It is possible that the way some of the systems are implemented can esacerbate the experience of poverty-related stress, shame and stigma in unequal societies [Inglis et al 2019]. In the UK for example, incorrect completion of forms to claim back the cost of dental treatment are levied a £100 fine, with a further £50 fine for late payment as well as the cost of treatment [4]. This PhD involves examining health policies relating to social assistance for dental care for low income adults. It will look at the variety of systems which exist and sets out to learn lessons on whether these effectively reduce barriers to dental care for people on low incomes. It is likely to be able to inform health policy in this area.

The first piece of work will involve a review of the literature and policies relating to social assistance for dental care. Then using nationally available data the student will investigate differences in utilisation of NHS dental services across England, looking particularly at the uptake by adults on low income. Since NHS dental services have been disrupted by the COVID pandemic (closed completely between March and June 2020, and now operating at much reduced capacity), the investigation will explore whether differences in uptake have changed over time, especially while the capacity of services to take on patients was reduced. Another piece of work will involve using interviews to explore the experiences of people who are eligible to use the social assistance system supporting dental care costs, and the experience and perspectives of dental teams providing care for patients funded in this way. There is some flexibility in the component parts of the PhD, since later work will be informed by findings of initial work as they emerge.

This area of research will sit alongside a wider programme of research concerning inequalities in dental visiting employing several research assistants, including a lay researcher with extensive connections with community groups and the public in disadvantaged areas of Liverpool. There are also wider global connections.

This PhD provides health services and policy research experience. Applicants do not need to have a dental background. Applicants with a wide range of backgrounds such as in economics are welcomed.

It is expected the successful applicant (s) must commence on or before 1st February 2021.

For any enquiries please contact Professor Rebecca Harris on [Email Address Removed]

If you wish to apply, please send a covering letter, full CV together with names and contact details of two academic referees, stating the research proposal/s of interest to you and why you think you are suitable. Please send to Professor Rebecca Harris on [Email Address Removed] and Dr Mathur on [Email Address Removed]