Influence of dental insurance coverage on access to preventive periodontal care in middle-aged and elderly populations: analysis of representative Korean Community Health Survey Data (2011–2015)

Effect of the oral examinations in the national health screening program on preventive oral health care and treatments: a 19-year follow-up study

OBJECTIVES

The national health screening (NHS) program in Korea serves as primary prevention by detecting oral diseases early for easier management. Dental scaling helps prevent oral disease and treat early periodontal disease. This study evaluated the effects of national oral examinations (NOE) in NHS on preventive oral hygiene care and dental treatments for a 19-year follow-up study.

METHODS

We conducted a longitudinal observation of Korean adults ≥ 19 years between 2002 and 2003 from the Korean National Health Insurance Service (n = 4,669,107; men = 2,518,704; women = 2,150,403). The independent variable involved tracking the number of people who underwent the NOE recruited between 2002 and 2003 from 2002 to 2013. The dependent variables pertained to the number of dental scaling and the presence or absence of periodontal and dental caries treatments from 2014 to 2020.

RESULTS

Individuals receiving 6 to 7 dental scaling during the follow-up exhibited an adjusted odds ratio (AOR) of 2.91 in the NOE-middle (3-4 times) and 3.30 in the NOE-high (5-6 times) (p < 0.001). The adjusted rate ratios were 1.69 in the NOE-middle and 1.77 in the NOE-high (p < 0.001). The AOR for periodontal treatment was 1.23 in the NOE-middle and NOE-high (p < 0.001).

CONCLUSION

Frequent NOEs lead to undergoing dental scaling and dental treatment, highlighting the importance of encouraging NOE attendance to improve population oral health. Expanding the scope of dental coverage for preventive intervention combined with NOE could help encourage greater participation and promote preventive oral healthcare.

Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study

The 2021 Resolution on Oral Health by the 74th World Health Assembly supports an important health policy direction: inclusion of oral health in universal health coverage. Many healthcare systems worldwide have not yet addressed oral diseases effectively. The adoption of value-based healthcare (VBHC) reorients health services towards outcomes. Evidence indicates that VBHC initiatives are improving health outcomes, client experiences of healthcare, and reducing costs to healthcare systems. No comprehensive VBHC approach has been applied to the oral health context. Dental Health Services Victoria (DHSV), an Australian state government entity, commenced a VBHC agenda in 2016 and is continuing its efforts in oral healthcare reform. This paper explores a VBHC case study showing promise for achieving universal health coverage that includes oral health. DHSV applied the VBHC due to its flexibility in scope, consideration of a health workforce with a mix of skills, and alternative funding models other than fee-for-service.

Relationship between the Social Development Index and Self-Reported Periodontal Conditions

Inequalities in oral health are influenced by the social strata of the population. Few studies have focused on the multitude of factors related to social development as indicators of living conditions and periodontal health status. The aim of this study is to evaluate the association between self-reported periodontal conditions and the Social Development Index (SDI). A cross-sectional validated questionnaire was carried out among 1294 Mexican adults. Descriptive statistics and multivariate logistic regression models were used to identify the best predictors of self-reported periodontal conditions. Bone loss reporting was used as a proxy for the presence of periodontal disease. We found that higher global scores on the SDI and quality and available space in the home (QASH) increase the probability of having bone loss. Global SDI (OR = 7.27) and higher QASH (OR = 3.66) were indeed the leading societal factors related to periodontal disease. These results have pointed out how SDI and its indicators, in particular QASH, can be used to further explore inequities related to privileged access to dental care in the context of periodontal diseases.

An Investigation of the Association between Health Screening and Dental Scaling in Korea

Dental disease is one of the most prevalent chronic diseases worldwide, and its expenditure is continuously increasing. Periodontal disease is increasing as a chronic non-communicable disease in adults and older people. Health screening has been shown to be cost-effective and improves the quality of life through the early detection of diseases. This study aimed to analyze the relationship between national health screening and dental scaling as a preventive service for periodontal disease. The study used sample cohort data from 2002 to 2015 provided by the National Health Insurance Sharing Service in South Korea. A logistic regression analysis of the utilization of dental scaling was performed to identify the independent effects of national health screening. People who underwent health screening showed a higher tendency to undergo dental scaling. Additionally, disparities in utilization according to socioeconomic status were reduced among those who underwent screening. The intervention to extend dental coverage could be more beneficial when combined with health screening, encouraging more people to participate and reducing inequalities in utilization.

Trends in Self-Rated Poor Oral Health Among all Age Populations in Korea from 2007 to 2015: Monitoring Expansion of Dental Insurance

OBJECTIVES

This study explored trends in self-rated poor oral health (SRPOH) from 2007 to 2015 among all age groups to monitor changes after the expansion of dental insurance.

METHODS

Repeated cross-sectional data from 2007 to 2015 Korea National Health and Nutrition Examination Surveys were collected and analysed. The respondents (n = 20,199) were categorised into four age groups: 0-19, 20-44, 45-64, and ≥65 years. The outcome variable was SRPOH, with independent variables being socioeconomic factors, sex, household income, and education. The age-sex standardised prevalence rate was calculated to determine trends, and complex samples logistic regression analysis was performed to confirm the factors affecting SRPOH.

RESULTS

Self-rated poor oral health prevalence decreased significantly from 2007 to 2009 (25%) to 2013 to 2015 (14%) in the age groups of 0-19 and 20-44 years (P < 0.05), whereas the SRPOH prevalence in the age groups of 45-64 and ≥65 years did not undergo any significant changes. Although the prevalence decreased by 6% among older adults, over 40% older women still experienced SRPOH. A sex gap increased with age but did not change over time. SRPOH was strongly associated with sex, income, and education across all age groups; the association did not notably change from 2007 to 2015.

CONCLUSIONS

Self-rated poor oral health improved among younger people in Korea. The gender gap in the prevalence increased with age and persisted over time. However, income was the strongest determinant of SRPOH among all age groups, regardless of dental insurance expansion. Further studies should aim to draw causal inferences to explore the policy impact of dental insurance benefits.

Has the Health Insurance Coverage of Scaling Contributed Positively to Periodontal Health in Korea?

This study aimed to evaluate the effectiveness of the health insurance coverage of dental scaling (introduced in 2013) using the Community Periodontal Index of Treatment Needs parameter among Korean adults aged 20 years or older. We used the Korea National Health and Nutrition Examination Survey data from before and after 2013 to analyze the statistical significance and associations of the covariates with the prevalence of healthy periodontal tissues, prevalence of people in need of scaling, and prevalence of periodontal diseases. The results showed that the prevalence of healthy periodontal tissues increased by 4.9% (from 34.2% to 39.1%), the number of people in need of scaling decreased by 5% (from 65.9% to 60.9%), and the prevalence of periodontal diseases increased by 7.2% (from 23.4% to 30.6%). Moreover, after the scaling coverage policy, the odds ratio of the prevalence of healthy periodontal tissues was 1.10 times higher, the prevalence of the need for scaling was 1.5 times higher, and the prevalence of periodontal diseases was 0.90 times lower. Therefore, the state should formulate policies that provide dental biofilm management through a disclosing agent, impart education about oral hygiene, and develop a health management system that enables the concurrent management of periodontal diseases and systemic diseases.

Did expanded access to denture services improve chewing ability in the Korean older population? Results of a regression discontinuity analysis

The Korean National Health Insurance expanded the dental insurance in 2012 to cover denture services for older adults. We analyzed whether the new policy improved of chewing ability in the eligible population. We used regression discontinuity (RD), a quasi-experimental design, to analyze the effects of the expanded dental insurance. We analyzed data from the Korea National Health and Nutrition Examination Survey conducted in 2010 and 2015. The study population consisted of two groups: the treatment group, aged 65 and above who were eligible; and the control group, under 65 years of age who were not eligible for the dental insurance benefit. The main outcome evaluated was self-reported chewing difficulty. The RD analysis showed that in 2015, the chewing difficulty in aged above 65 was 2.2% lower than in those aged under 65. However, the difference was not statistically significant (P = 0.76). The results from the falsification testing of predetermined covariates, placebo cut-offs, and bandwidths validated our main conclusion. The expansion of dental insurance benefits to include dentures for the older adults did not improve the chewing ability in the eligible population. Future studies should evaluate long-term outcomes of oral health as well as the social impacts on the elderly.

Did Expanded Dental Insurance Improve Chewing Ability in the Older Korean Population? Results of an Interrupted Time-series Analysis

Background

In 2012, the Korean National Health Insurance extended its coverage to include denture services for older adults. We examined whether the new policy resulted in improved chewing ability in the eligible population.

Methods

We used interrupted time-series (ITS) analysis, a quasi-experimental design, to analyze the effect of the policy. We used data from the Korea National Health and Nutrition Examination Survey conducted from 2007 to 2016–2018. The study population consisted of two groups: the treatment group, aged 65 years or older and eligible for the dental insurance benefit; and the control group, those younger than 65 years and ineligible. The main evaluated outcome was self-reported chewing difficulty.

Results

The ITS analysis showed that chewing difficulty decreased annually by 0.93% (95% CI, −1.30 to −0.55%) and 0.38% (95% CI, −0.59 to −0.16%) after the policy extension in the older than 65 and younger than 65 groups, respectively. However, we could not conclude that the insurance extension affected chewing difficulty because there was a decrease in the control group as well.

Conclusion

Chewing ability improved in both older and younger adults regardless of dental insurance coverage for older adults. Other exogenous factors probably led to the improvements in chewing ability as well as dental insurance benefits.

Did the Expansion of Insurance Coverage for Oral Health Reduce Self-reported Oral Health Inequalities in Korea? Results of Repeated Cross-Sectional Analysis, 2007-2015

BACKGROUND

In 2009, the South Korean government expanded universal health insurance to include oral health services. In the present study, we sought to examine whether improved access resulted in a reduction in income-based self-reported oral health inequalities.

METHODS

We analyzed repeated cross-sectional data from the Korea National Health and Nutrition Examination Survey (KNHANES) waves IV through VI (2007-2015). We analyzed self-reported oral health status among 68,431 subjects. Changes in oral health inequalities across four income levels (low, middle-low, middle-high, and high) were assessed with the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII).

RESULTS

The average oral health status of children and adolescents improved the most over the observation period. The absolute magnitude of oral health inequalities (measured by the SII) improved for most groups, with the notable exception of young male adults. By contrast, the ratio of poor oral health between high- and low-income groups (measured by the RII) changed little over time, indicating that relative inequalities remained resistant to change.

CONCLUSIONS

The expansion of dental health insurance may not be sufficient to move the needle on self-reported oral health inequalities among adults.