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Han DH, Kang HY, Ryu JI. The role of income and frequency of dental visits in the relationship between dental sealant use and resin fillings after extended coverage: a retrospective cohort study. BMC Oral Health 2023; 23:807. [PMID: 37891584 PMCID: PMC10612205 DOI: 10.1186/s12903-023-03387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Prevention and treatment services use is closely associated with socioeconomic factors, such as income. This study aimed to investigate the relationship between implementing the sealant program and resin fillings restoration and to explore the role of income and frequency of dental visits in this relationship. METHODS This retrospective cohort study used the cohort database from the National Health Information Database of the National Health Insurance Service. The study population comprised 494,731 children born in 2007. A logistic regression model for the experience of resin fillings and a linear regression model for weighted utilization of them were used to identify the independent effects of dental sealants, income, and frequency of dental visits. All analyses were conducted using the SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA). RESULTS The ratio based on income level was almost proportional in all groups except the medical aid group, which had a rate as high as that of the wealthier group. Children without sealants were 1.05 times more likely to have resin fillings than others after adjusting for income level and frequency of visiting dental clinics in the final model. However, an opposite relationship between sealant experiences and resin fillings was observed in the previous model without dental visits. The gap in the weighted resin filling scores according to socioeconomic variables showed a similar tendency. CONCLUSIONS Income and frequency of dental visits might be confounding factors for the relationship between dental sealant and resin fillings. It is necessary to consider the complex relationship between socioeconomic indicators and service use while studying oral health inequality.
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Affiliation(s)
- Dong-Hun Han
- Department of Preventive and Social Dentistry, Seoul National University School of Dentistry, Seoul, Republic of Korea
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hee-Yeon Kang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Jae-In Ryu
- Department of Preventive and Social Dentistry, Kyung Hee University College of Dentistry, Seoul, Republic of Korea.
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2
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Socioeconomic Disparities in Iranians’ Preferences toward Dental Care Services: A Population-Based Survey. Int J Dent 2022; 2022:5652011. [PMID: 36338392 PMCID: PMC9629957 DOI: 10.1155/2022/5652011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background and Aims Patients' perspectives and preferences are considered an essential influencing factor for healthcare utilization. This study is one of the first to investigate patient preference for dental services across socioeconomic and demographic indicators in Iran. Materials and Methods This cross-sectional study was conducted through telephone interviews with adult residents in Mashhad and Kerman cities. A representative sample was selected by stratified random sampling. A valid structured questionnaire was used for data collection, including people's preference toward dental care services in terms of dental settings, choosing a general or specialist dentist, prevention or treatment, and the preferable gender of the dentist. Factors potentially associated with preferences included gender, age, educational level, job, monthly income, house size, family number, insurance coverage, dental insurance, type of insurance, and social class in the city were investigated. Results 1475 individuals participated in the study [response rate 63%]. Our findings showed higher preferences for private offices (50.6%), specialist dentists (76.2%), treatment services (40.8%), and no specific gender preference for the dentist (60.6%). Their preferences were significantly influenced by age range, social class, insurance status, dental insurance, and type of insurance. Income, household size, level of education, and job were not statistically significant with none of the preferences. Conclusions Socioeconomic and demographic factors' correlation with people's preferences was observed. Efforts are needed to promote preventive care demand in deprived regions. Moreover, increasing financial resources allocated to preventive care and covering preventive dental services in insurance plans are recommended.
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Saadatfar N, Jadidfard MP. Parents' preferences for preventive and curative dental services: A comparison between fissure sealant and composite filling using willingness-to-pay method. Int J Paediatr Dent 2021; 31:792-800. [PMID: 33548081 DOI: 10.1111/ipd.12778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 01/23/2021] [Accepted: 01/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The early years of life play a significant role in the lifelong health of humans and parents have an important role in healthcare decision making. Thus, it seems necessary for policymakers and clinicians to be aware of how parents value pediatric health services. Willingness to pay (WTP) is a recommended method for measuring the stated utility of health services/goods or health states. AIM This study aimed to elicit and compare parents' WTP for health services such as fissure sealant and composite filling. DESIGN An originally developed questionnaire was used to guide interviews with a sample of 290 parents attending a public pediatric healthcare center. Related-samples Wilcoxon signed-rank test was performed for comparing the difference in absolute WTP amounts between the two services, and linear regression was used to assess the association between WTP and relevant variables using SPSS version 21. RESULTS Mean WTP for fissure sealant and filling was 269 724 and 555 327 Tomans, respectively, and the difference between them was statistically significant (P < .001). Higher WTP amounts found in both services were associated with income levels of 4 and 5 (P < .05). CONCLUSIONS Respondents highly valued the considered services and stated a significantly higher relative preference for filling. Public awareness should be promoted about the importance of prevention of oral health diseases and the attributes of the oral healthcare system services.
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Affiliation(s)
- Navid Saadatfar
- Department of Community Oral Health, School of Dentistry, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Pooyan Jadidfard
- Department of Community Oral Health, School of Dentistry, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
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4
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Parents' Willingness to Invest in Primary Oral Health Prevention for Their Preschool Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111437. [PMID: 34769953 PMCID: PMC8582652 DOI: 10.3390/ijerph182111437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
There is growing evidence for the beneficial effects of starting oral health prevention early in life. Preventing dental caries in very young children requires considerable investment from parents. Therefore, this cross-sectional study aimed to explore parents' willingness to pay (WTP) and willingness to invest in time (WTIT) for primary oral health prevention in preschool children and describe whether these are related to the parents' demographic, socio-economic and behavioural characteristics. In a convenience sample of parents of preschool children aged six months to four years (n = 142), data were collected with questionnaires. On average, parents were willing to pay EUR15.84 per month, invest time for 1.9 dental visits per year, and spend 2.4 min per day brushing their child's teeth. A higher education level of the mother and having a child older than two were associated with a higher WTIT in brushing minutes per day (p = 0.03). In addition, parents who brushed their child's teeth more frequently were also more willing to invest in brushing minutes (p < 0.01) and money (p < 0.01). Findings emphasise the importance of early oral health interventions and the need to increase awareness of primary prevention's importance in maintaining healthy teeth and reducing possibly oral health inequalities.
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5
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Prevalence of Missing Values and Protest Zeros in Contingent Valuation in Dental Medicine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147219. [PMID: 34299670 PMCID: PMC8307611 DOI: 10.3390/ijerph18147219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 12/26/2022]
Abstract
Background: The number of contingent valuation (CV) studies in dental medicine using willingness-to-pay (WTP) methodology has substantially increased in recent years. Missing values due to absent information (i.e., missingness) or false information (i.e., protest zeros) are a common problem in WTP studies. The objective of this study is to evaluate the prevalence of missing values in CV studies in dental medicine, to assess how these have been dealt with, and to suggest recommendations for future research. Methods: We systematically searched electronic databases (MEDLINE, Web of Science, Cochrane Library, PROSPERO) on 8 June 2021, and hand-searched references of selected reviews. CV studies in clinical dentistry using WTP for valuing a good or service were included. Results: We included 49 WTP studies in our review. Out of these, 19 (38.8%) reported missing values due to absent information, and 28 (57.1%) reported zero values (i.e., WTP valued at zero). Zero values were further classified into true zeros (i.e., representing the underlying preference of the respondent) or protest zeros (i.e., false information as a protest behavior) in only 9 studies. Most studies used a complete case analysis to address missingness while only one study used multiple imputation. Conclusions: There is uncertainty in the dental literature on how to address missing values and zero values in CV studies. Zero values need to be classified as true zeros versus protest zeros with follow-up questions after the WTP elicitation procedure, and then need to be handled differently. Advanced statistical methods are available to address both missing values due to missingness and due to protest zeros but these are currently underused in dental medicine. Failing to appropriately address missing values in CV studies may lead to biased WTP estimates of dental interventions.
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Abstract
Despite the recognized need to change the emphasis of health services by
shifting the balance from treatment to prevention, limited progress
has been made in many settings. This is true in oral health, where
evidence for preventive interventions that work has not been
systematically exploited in oral health services. While reorienting
health services is complex and context specific, economics can bring a
helpful perspective in understanding and predicting the impact of
changes in resource allocation, provider remuneration systems, and
patient payments. There is an increasing literature on the economics
of different prevention approaches. However, much of this literature
focuses on the costs and potential savings of alternative approaches
and fails to take into account benefits. Even where benefits are taken
into account, these tend to be narrowly focused on clinical outcomes
using cost-effectiveness analysis, which may be of little relevance to
the policy maker, patient, and the public. Some commonly used economic
approaches (such as quality-adjusted life years and incremental
cost-effectiveness ratios) may also not be appropriate to oral health.
Using alternative techniques, including wider measures of benefit and
employing priority setting and resource allocation tools, may provide
more comprehensive information on economic impact to decision makers
and stakeholders. In addition, it is important to consider the effects
of provider remuneration in reorienting services. While there is some
evidence about traditional models of remuneration (fee for service and
capitation), less is known about pay for performance and blended
systems. This article outlines areas in which economics can offer an
insight into reorientation of health systems toward prevention,
highlighting areas for further research and consideration.
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Affiliation(s)
- C R Vernazza
- School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - S Birch
- Centre for the Business and Economics of Health, University of Queensland, Saint Lucia, Queensland, Australia.,Centre for Health Economics, University of Manchester, Manchester, UK
| | - N B Pitts
- Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, London, UK
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7
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Saadatfar N, Jadidfard MP. An overview of the methodological aspects and policy implications of willingness-to-pay studies in oral health: a scoping review of existing literature. BMC Oral Health 2020; 20:323. [PMID: 33183293 PMCID: PMC7664028 DOI: 10.1186/s12903-020-01303-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022] Open
Abstract
Background Demands for dental services seem to be beyond the capacities of most healthcare systems these days. Patient preferences have been increasingly emphasized to be considered in the joint decision-making process. Willingness-to-pay (WTP) is a recommended method for measuring the utility of health services; increasingly being used in recent decades. Taking these points into consideration, this article aims to provide an overview of the methodological aspects and policy implications of WTP studies in the field of oral health. Methods The research was conducted in ISPOR, PubMed and Google Scholar databases. In addition, reference lists of included articles were checked to identify the relevant studies. All studies published were included that were in the English language and reported using WTP for oral health-related goods and services. A data-charting form was developed by a focus group discussion panel of seven experts to derive the main methodological aspects of WTP. Also, Core policy suggestions were categorized through thematic content analysis of the included papers. Results The search strategy yielded 389 studies of which 52 were included. WTP studies in oral health show an increasing trend in global publications. The UK and Canada have a greater share in published material than in any other country. The dominant field of these researches is in restorative and prosthetic dentistry, and a wide range of different methodological aspects was documented. Policy suggestions were categorized in three main themes: (A) setting new tariffs or subsidizing the item, (B) provision of the item due to population preferences, and (C) improving literacy regarding the item. Conclusions An urgent need for a common framework regarding the design of WTP studies in dentistry seems paramount. Some policy suggestions seem not to be applicable, perhaps due to insufficient familiarity of the researchers with the complexities of the public policymaking process.
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Affiliation(s)
- Navid Saadatfar
- Department of Community Oral Health, School of Dentistry, Shahid-Beheshti University of Medical Sciences, Shahid-Chamran Avenue, Evin, Tehran, 19839, Iran
| | - Mohammad Pooyan Jadidfard
- Department of Community Oral Health, School of Dentistry, Shahid-Beheshti University of Medical Sciences, Shahid-Chamran Avenue, Evin, Tehran, 19839, Iran.
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8
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Re D, Ceci C, Cerutti F, Fabbro MD, Corbella S, Taschieri S. Natural tooth preservation versus extraction and implant placement: patient preferences and analysis of the willingness to pay. Br Dent J 2018; 222:467-471. [PMID: 28337015 DOI: 10.1038/sj.bdj.2017.271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 12/19/2022]
Abstract
Objectives The aim of this study was to evaluate the patients' willingness to pay (WTP) values and preference for the treatment of a tooth with very poor prognosis, among two options: root canal therapy and crown positioning or tooth extraction, implant insertion and crown positioning.Methods A total of 103 patients were recruited from a private dental clinic and interviewed. A questionnaire measured individuals' preferences among the two alternative treatments for a tooth with poor prognosis and the maximum amount of money they would be willing to pay for their choice with a starting bid of [euro]2,000 in [euro]100 increment/decrement. Demographic data, patient choice, median values and WTP association with socio-demographic factors (Student ttest and one-way ANOVA) and correlation between variables (Pearson chi-square test) were revealed.Results Seventy-six percent of patients expressed a preference for root canal therapy, while the remaining 24% chose the dental surgery. A fair agreement between previous experience and current therapeutic choice was found (P = 0.0001). The WTP median value was [euro]2,000 and 46% of participants would pay an additional sum of money for the therapy (median: [euro]300). The preferred treatment was influenced by previous experience, but no association was found between WTP values and socio-demographic factors.Conclusion Patients tend to prefer a conservative approach for the treatment of a tooth with poor prognosis and are willing to pay an additional fee to receive their treatment choice.
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Affiliation(s)
- D Re
- Division of Oral Rehabilitation, Istituto Stomatologico Italiano, University of Milan, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - C Ceci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,IRCC Istituto Ortopedico Galeazzi, Milan, Italy
| | - F Cerutti
- Division of Oral Rehabilitation, Istituto Stomatologico Italiano, University of Milan, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - M Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,IRCC Istituto Ortopedico Galeazzi, Milan, Italy
| | - S Corbella
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,IRCC Istituto Ortopedico Galeazzi, Milan, Italy
| | - S Taschieri
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,IRCC Istituto Ortopedico Galeazzi, Milan, Italy
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9
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Vernazza C, Anderson L, Ian Hunter A, Leck HC, O'Connor SD, Smith GR, Stokes RJ, Rolland S. The value of orthodontics: Do parents' willingness to pay values reflect the IOTN? JDR Clin Trans Res 2018; 3:141-149. [PMID: 29556552 DOI: 10.1177/2380084418756039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Given the limited evidence about the benefits of orthodontic treatment, many health care systems have rationed access to orthodontic care with the Index of Orthodontic Treatment Need (IOTN) being one tool used to attempt to allocate resources based on need. However, it is not clear whether patient and public valuations of different levels of need (as described by the IOTN) reflect the resource allocation decisions. The aim of this project was therefore to determine the values parents placed on correction of malocclusions at different IOTN levels using the willingness to pay (WTP) technique. Method 401 parents of children attending hospital-based orthodontic clinics in the North of England were recruited to complete a questionnaire eliciting WTP for the correction of seven malocclusions with different IOTN scores. In addition demographic and orthodontic history characteristics were collected. Results were analysed with appropriate pairwise significance tests and regression. Results A significant difference in WTP was noted between all the possible pairs of malocclusions with the exception of overjets with moderate versus great need of treatments. At moderate levels, correction of crowding was valued less than overjet but this was reversed at great need levels. Very little of the variance in WTP was explained by the variables collected. When looking at factors affecting percentage difference between values for different pairs of malocclusions, in general, no factors predicted the magnitude of difference. Conclusion Median valuations for correction of malocclusions vary significantly for different levels of need (as judged by IOTN), with increasing levels of need generating higher values. However, there was a limited effect of demographic or orthodontic characteristics on the magnitude of percentage difference in values for correcting malocclusions different levels of need.
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Affiliation(s)
- Christopher Vernazza
- NIHR Clinician Scientist, Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, UK. NE2 4BW, +44 (0)191 2088396
| | - Lauren Anderson
- Specialist Orthodontist, Milngavie Orthodontics, 13 Main Street, Milngavie, Scotland, G62 6BJ
| | - Andrew Ian Hunter
- Specialist Orthodontist, Dentalign Orthodontics, 55 Burscough Street, Ormskirk, Near Liverpool, UK. L39 2EL
| | - Helen Christine Leck
- Specialist Orthodontist, Windmill Orthodontics, 37 Heaton Road, Newcastle upon Tyne, UK. NE6 1SB
| | - Stephen Daniel O'Connor
- Post-CCST Orthodontist, Birmingham Dental Hospital, Mill Pool Way, Birmingham, United Kingdom. B5 7EG
| | - Gillian Rose Smith
- Post-CCST in Orthodontics, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, UK, S10 2SZ
| | - Richard Joseph Stokes
- Specialist Orthodontist, Dungarvan Orthodontic Practice, Priory House, Main St., Dungarvan, Co. Waterford, Ireland
| | - Sarah Rolland
- Clinical Senior Lecturer in Orthodontics, Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, UK. NE2 4BW
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10
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Tan SHX, Vernazza CR, Nair R. Critical review of willingness to pay for clinical oral health interventions. J Dent 2017; 64:1-12. [PMID: 28662842 PMCID: PMC5558873 DOI: 10.1016/j.jdent.2017.06.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This critical review aimed to identify, consolidate and evaluate the quality of Willingness to Pay (WTP) studies applied to clinical contexts in the field of dentistry. METHODS PubMed and Web of Science databases were systematically searched for relevant publications. Screening and data extraction was then performed. Primary literature in English-language were included to assess the WTP for oral health interventions, when the valuations were applied to a clinical measure. Twenty-six publications met the inclusion criteria. RESULTS WTP was elicited mainly via face-to-face interviews (13 publications) and questionnaires (12 publications). The majority (24) of publications selected an out-of-pocket payment vehicle. Eleven publications adopted a bidding method, nine publications adopted an open-ended format, and the remaining six studies adopted a payment card or choice method. Pre-testing was reported in only nine publications, and few studies accounted for starting point bias. Eight of 11 publications found that higher incomes were associated with higher WTP values. The female gender, a younger age and higher education levels were associated with a higher WTP in select studies. CONCLUSIONS Only a small minority of the studies used strategies to avoid well documented biases related to WTP elicitation. Cost versus benefit of many clinical scenarios remain uninvestigated. CLINICAL SIGNIFICANCE WTP studies in dentistry may benefit from pre-testing and the inclusion of a script to minimise hypothetical bias. They may also be better conducted face-to-face and via a shuffled payment card method. Income levels, and potentially education levels, gender and age, should be assessed for their influence on WTP values.
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Affiliation(s)
- Sharon Hui Xuan Tan
- Ministry of Health Holdings, Singapore 1 Maritime Square, 099253, Singapore.
| | - Christopher R Vernazza
- Centre for Oral Health Research, Newcastle University Framlington Place, Newcastle Upon Tyne, NE2 4BW, United Kingdom.
| | - Rahul Nair
- University of Adelaide, ARCPOH, Adelaide Dental School, Level 9, AHMS Building, Adelaide, SA 5005, Australia.
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11
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Berendsen J, Bonifacio C, van Gemert-Schriks M, van Loveren C, Verrips E, Duijster D. Parents' willingness to invest in their children's oral health. J Public Health Dent 2017; 78:69-77. [PMID: 28749530 DOI: 10.1111/jphd.12242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/30/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to evaluate parents' Willingness to Invest (WTI) in their children's oral health in terms of money, visits to a dental practice, and brushing minutes. Objectives were to assess the association between parents' WTI and a) children's dental caries experience, b) children's oral hygiene behavior (OHB), and c) maternal education level and ethnic background. METHODS A sample of 630 five to six-year-old-children was recruited from pediatric dental centers in the Netherlands. Children's dmft scores were extracted from personal dental records. Parental questionnaires were used to collect data on parents' WTI, children's OHB, maternal education level and ethnicity. RESULTS On average, parents were willing to spend a maximum of €37 per month, 3.0 dental visits per year, and 4.5 brushing minutes per day to maintain good oral health for their child. The mean dmft was significantly higher in children whose parents were willing to pay more money and visit the dentist more often (P = 0.028 and P = 0.002, respectively), while the mean dmft was significantly lower in children of parents who were willing to invest more brushing minutes (P < 0.001). Parental WTI in terms of money and brushing minutes was higher in native and higher-educated parents, and was associated with more favorable OHB of children. CONCLUSIONS Parents' WTI in their children's oral health is related to children's dental caries status and reported OHB. Results suggest that children are better off when parents are willing to invest in self-care, rather than in money or dental visits.
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Affiliation(s)
- Jannetje Berendsen
- Department of Cariology, Endodontology and Pedodontology, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Clarissa Bonifacio
- Department of Cariology, Endodontology and Pedodontology, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Martine van Gemert-Schriks
- Department of Cariology, Endodontology and Pedodontology, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Cor van Loveren
- Department of Cariology, Endodontology and Pedodontology, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Erik Verrips
- Lifestyle, TNO, Netherlands Organisation for Applied Scientific Research, Leiden, Netherlands
| | - Denise Duijster
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
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12
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Re D, Del Fabbro M, Karanxha L, Augusti G, Augusti D, Fessi S, Taschieri S. Minimally-invasive dental anesthesia: Patients' preferences and analysis of the willingness-to-pay index. ACTA ACUST UNITED AC 2017; 9. [PMID: 28544653 DOI: 10.1111/jicd.12275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/29/2017] [Indexed: 12/31/2022]
Abstract
AIM The aim of the present prospective study was to evaluate the impact of a computer-controlled anesthesia on patients' comfort and to investigate, through the willingness-to-pay (WTP) index, and patients' acceptance of this new technology. METHODS Fifty patients undergoing a class I or II restorative procedure were enrolled. A computer-controlled device for anesthetic delivery was utilized, and a questionnaire on the level of discomfort and WTP was given to all patients. RESULTS A total of 86% of participants declared less discomfort than that perceived during their last traditional procedure for pain control; 58% of patients were willing to pay an additional fee for a modern anesthesia technique, with a median WTP value of 20$. CONCLUSIONS Computer-controlled systems for local anesthesia represent a relevant tool for reducing patients' discomfort during dental treatment. The WTP index helps to quantify its relevance.
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Affiliation(s)
- Dino Re
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Institue Stomatologico, Milan, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Lorena Karanxha
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | | | | | - Sabrine Fessi
- Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
| | - Silvio Taschieri
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milan, Italy
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13
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Nair R, Yee R. Differences in willingness to pay for an extraction, a filling, and cleaning teeth at various levels of oral health-related quality of life, as measured by oral impacts on daily performance, among older adults in Singapore. ACTA ACUST UNITED AC 2016; 37:2-8. [PMID: 27916251 DOI: 10.1016/j.sdj.2016.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/19/2016] [Accepted: 10/24/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the differences in Willingness to pay (WTP) for an extraction, a filling, and cleaning of teeth among older adults with varying levels of Oral Health-related Quality of Life (OHQoL). BACKGROUND OHQoL has been used extensively to measure utilities as reported by individuals of interest. Currently there are no reports that examine the WTP of individuals at various levels of OHQoL. METHODS A convenience sample of adults 60 years or older were recruited. Besides other domains, questionnaires were used to assess WTP (extraction, filling, and cleaning of teeth), OHQoL (using Oral Impacts on Daily Performance-OIDP), McArthur scale, and access to care. RESULTS Tamil ethnicity was related to higher WTP for an extraction (mean ratio, 1.63-3.98; 95% Confidence Interval [CI]), increase of age in years was related to lower WTP for extraction (mean ratio, 0.96-1.00 [95%CI]) and increasing OIDP score was related to lower WTP for extractions (mean ratio, 0.80-0.99 [95%CI]). Tamil ethnicity was associated with higher WTP for fillings (mean ratio, 2.69-6.44 [95%CI]); higher age in years was associated with lower WTP for fillings (mean ratio, 0.94-0.99 [95%CI]), and higher OIDP scores was trending to be associated to lower WTP for filling (mean ratio, 0.80-1.00 [95%CI]). Tamil Ethnicity was also associated with higher WTP for cleaning (mean ratio, 2.14-7.19 [95%CI]), higher age in years was also associated with cleaning (mean ratio, 0.94-0.99 [95%CI]). CONCLUSION Individuals with higher OIDP scores tended to have lower WTP for extraction, filling and cleaning; with significant differences reported for extraction.
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Affiliation(s)
- Rahul Nair
- Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore.
| | - Robert Yee
- Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore.
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Factors affecting patient valuations of caries prevention: Using and validating the willingness to pay method. J Dent 2015; 43:981-8. [PMID: 26054234 DOI: 10.1016/j.jdent.2015.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Determining the value of, or strength of preference for health care interventions is useful for policy makers in planning health care services. Willingness to pay (WTP) is an established economic technique to determine the strength of preferences for interventions by eliciting monetary valuations from individuals in hypothetical situations. The objective of this study was to elicit WTP values for a dental preventive intervention and to analyze the factors affecting these as well as investigating the validity of the WTP method. METHODS Patients aged 40 years plus attending dental practices in the UK and Germany were recruited on a consecutive basis over one month. Participants received information about a novel root caries prevention intervention. They then completed a questionnaire including a WTP task. Where the coating was indicated, patients were offered this for a payment and acceptance was recorded. Analysis included econometric modelling and comparison of expected (based on stated WTP) versus actual behaviour. RESULTS The mean WTP for the coating was £96.41 (standard deviation 60.61). Econometric models showed that no demographic or dental history factors were significant predictors of WTP. 63% of the sample behaved as expected when using stated WTP to predict whether they would buy the coating. The remainder were split almost equally between those expected to pay but who did not and those who were expected to refuse but paid. CONCLUSIONS Values for a caries preventive intervention had a large and unpredictable variance. In comparing hypothetical versus real preferences both under- and over-valuation occurs. CLINICAL SIGNIFICANCE Wide and unpredictable variation in valuations for prevention may mean that there are difficult policy questions around what resource should be allocated to dental prevention and how to target this resource.
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Meertens RM, Van de Gaar VMJ, Spronken M, de Vries NK. Prevention praised, cure preferred: results of between-subjects experimental studies comparing (monetary) appreciation for preventive and curative interventions. BMC Med Inform Decis Mak 2013; 13:136. [PMID: 24344779 PMCID: PMC3878324 DOI: 10.1186/1472-6947-13-136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/04/2013] [Indexed: 12/02/2022] Open
Abstract
Background 'An ounce of prevention is worth a pound of cure’ is a common saying, and indeed, most health economic studies conclude that people are more willing to pay for preventive measures than for treatment activities. This may be because most health economic studies ask respondents to compare preventive measures with treatment, and thus prompt respondents to consider other uses of resources. However, psychological theorizing suggests that, when methods do not challenge subjects to consider other uses of resources, curative treatment is favored over prevention. Could it be that while prevention is praised, cure is preferred? Methods In two experimental studies, we investigated, from a psychological perspective and using a between-subjects design, whether prevention or treatment is preferred and why. In both studies, participants first read a lung cancer prevention or treatment intervention scenario that varied on the prevention-treatment dimension, but that were the same on factors like 'costs per saved life’ and kind of disease. Then participants completed a survey measuring appreciation (general and monetary) as well as a number of potential mediating variables. Results Both studies clearly demonstrated that, when the design was between-subjects, participants had greater (general and monetary) appreciation for treatment interventions than for preventive interventions with perceived urgency of the intervention quite consistently mediating this effect. Differences in appreciation of treatment over preventive treatment were shown to be .59 (Study 1) and .45 (Study 2) on a 5-point scale. Furthermore, participants thought that health insurance should compensate more for the treatment than for preventive measures, differences of 16% (Study 1), and 22% (Study 2). When participants were asked to directly compare both interventions on the basis of a short description, they preferred the preventive intervention. Conclusion It appears that people claim to prefer prevention when they are asked to consider other use of resources, but otherwise they prefer treatment. This preference is related to perceived urgency. The preference for treatment may be related to the prevention-treatment dimension itself, but also to variations on other dimensions that are inherently linked to prevention and treatment (like different efficacy rates and costs per treatment).
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Affiliation(s)
- Ree M Meertens
- Department of Health Education and Promotion, Maastricht University, P,O, Box 616, 6200, MD Maastricht, The Netherlands.
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Augusti D, Augusti G, Re D. Prosthetic restoration in the single-tooth gap: patient preferences and analysis of the WTP index. Clin Oral Implants Res 2013; 25:1257-1264. [PMID: 24021020 DOI: 10.1111/clr.12264] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the preference of a patients' population, according to the index of willingness to pay (WTP), against two treatments to restore a single-tooth gap: the implant-supported crown (ISC) and the 3-unit fixed partial denture prosthesis (FPDP) on natural teeth. MATERIALS AND METHODS Willingness to pay values were recorded on 107 subjects by asking the WTP from a starting bid of €2000 modifiable through monetary increases or decreases (€100). Data were collected through an individually delivered questionnaire. The characteristics of the population and choices made, the median values and WTP associations with socio-demographic parameters (Mann-Whitney and Kruskal-Wallis tests), correlations between variables (chi-square test in contingency tables) and significant parameters for predicting WTP values obtained in a multiple linear regression model were revealed. RESULTS The 64% of patients expressed a preference for ISC, while the remaining 36% of the population chose the FPDP. The current therapeutic choice and those carried out in the past were generally in agreement (>70% of cases, P = 0.0001); a relationship was discovered between the anterior and posterior area to the same method of rehabilitation (101 of 107 cases, 94.4%). The WTP median values for ISC were of €3000 and of €2500 in the anterior and posterior areas, respectively. The smallest amount of money has been allocated for FPDP in posterior region (median of €1500). The "importance of oral care" for the patient was a significant predictor, in the regression model analysis, for the estimation of both anterior (P = 0.0003) and posterior (P < 0.0001) WTP values. The "previous therapy" variable reached and was just close to significance in anterior (P = 0.0367) and posterior (P = 0.0511) analyses, respectively. CONCLUSIONS Within the limitations of this study, most of the population (64%) surveyed indicated the ISC as a therapeutic solution for the replacement of a single missing tooth, showing a higher WTP index in the anterior area. Among investigated socio-demographic variables, the importance assigned by the patient to oral care appeared to influence WTP values of the rehabilitation, regardless the location of the single gap in the mouth.
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Affiliation(s)
- Davide Augusti
- Division of Oral Rehabilitation, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
| | - Gabriele Augusti
- Division of Oral Rehabilitation, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
| | - Dino Re
- Division of Oral Rehabilitation, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
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Vermaire JH, van Exel NJA, van Loveren C, Brouwer WBF. Putting your money where your mouth is: parents' valuation of good oral health of their children. Soc Sci Med 2012; 75:2200-6. [PMID: 22995665 DOI: 10.1016/j.socscimed.2012.08.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 08/13/2012] [Accepted: 08/17/2012] [Indexed: 10/27/2022]
Abstract
The aim of this study was to investigate the parental willingness to invest in good oral health for their child in terms of money and time and to relate this to oral health related knowledge and behavioral aspects. 290 parents of 6-year-old children, participating in a RCT on caries preventive strategies in The Netherlands were asked to provide information on education, oral health habits, dietary habits, knowledge on dental topics, willingness to pay and perceived resistance against investing in preventive oral health actions for their children. Despite the fact that parents overall valued oral health for their child highly, still 12% of the parents were unwilling to spend any money, nor to invest any time by brushing their children's teeth to maintain good oral health for their child. Additionally, they indicated that they were unwilling to visit the dentist for preventive measures more than once a year. These children may certainly be considered at higher risk of developing oral diseases because worse oral hygiene habits and dietary habits were found in this group. Given the results, it may be necessary to differentiate in allocating caries prevention programmes to target parents or (school-based) children directly.
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Affiliation(s)
- J H Vermaire
- Academic Centre for Dentistry Amsterdam (ACTA), Department of Social Dentistry and Behavioural Sciences, Gustav Mahlerlaan 3004, 1181 LA Amsterdam, The Netherlands.
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Tianviwat S, Chongsuvivatwong V, Birch S. Optimizing the mix of basic dental services for Southern Thai schoolchildren based on resource consumption, service needs and parental preference. Community Dent Oral Epidemiol 2009; 37:372-80. [DOI: 10.1111/j.1600-0528.2009.00481.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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