Utilisation of dental services in Tanzania before and after the introduction of cost-sharing

Objective: The objective of this study was to evaluate the effect of cost-sharing, introduced in July 1994, on the utilisation of dental services in Tanzania. Methods: The study compared dental attendance, demand for dental services and treatment pattern of patients in 17 out of 20 regions of mainland Tanzania in 1993 and 1995, a year before and after the introduction of user fees. Outcomes measures: Dental attendance and demand for treatment. Results: Results revealed a 33.2 per cent overall reduction in dental attendance but no effect on either the demand for treatment or treatment pattern. The exceptions were increases in referral cases by 14.5 times and prosthetic work by 3.9 times, and a reduction in surgical cases by 18.8 per cent. Conclusions: In order to improve attendance and decrease referrals it is necessary to enforce the first line of oral primary health care to meet the simple treatment demands. Furthermore, the revenue generated by cost-sharing should be used to improve services.