1
|
Bammert P, Schüttig W, Novelli A, Iashchenko I, Spallek J, Blume M, Diehl K, Moor I, Dragano N, Sundmacher L. The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review. Int J Equity Health 2024; 23:37. [PMID: 38395914 PMCID: PMC10885500 DOI: 10.1186/s12939-024-02122-6] [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: 03/06/2023] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Besides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use. METHODS We used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)' recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered. RESULTS Of the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies. CONCLUSIONS Socioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.
Collapse
Affiliation(s)
- Philip Bammert
- Chair of Health Economics, Technical University of Munich, Munich, Germany.
| | - Wiebke Schüttig
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Anna Novelli
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Iryna Iashchenko
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
- Lausitz Center for Digital Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Miriam Blume
- Department of Epidemiology and Health Monitoring, Robert-Koch-Institute, Berlin, Germany
| | - Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Irene Moor
- Institute of Medical Sociology, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| |
Collapse
|
2
|
Che X, Sohn M, Moon S, Park HJ. Relationship between Precarious Employment and Unmet Dental Care Needs among Korean Workers: A Longitudinal Panel Study. Medicina (B Aires) 2022; 58:medicina58111547. [PMID: 36363503 PMCID: PMC9697259 DOI: 10.3390/medicina58111547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background and Objectives: Precarious workers experience certain conditions, such as low income, instability in employment, and lack of social security. Precarious employment has increased barriers to the use of dental care services, resulting in more unmet dental care needs. The aim of this study was to identify unmet dental care needs among precarious workers in Korea's labor market, using data from the Korea Health Panel Survey (2011-2017). Materials and Methods: Based on job and income security criteria, four groups were formed: Group A (individuals with job and income security), Group B (individuals reporting job security with income insecurity), Group C (individuals reporting job insecurity with income security), and Group D (individuals with job and income insecurity). We measured self-reported unmet dental need or the inability to receive necessary dental care owing to the past economic burdens. Panel logistic regression analyses were performed to determine the effect of precarious employment on unmet dental care needs for all participants. Results: Approximately 16% of the respondents reported having unmet dental care needs. Unmet dental care needs owing to economic reasons were higher among male workers in groups C and D than among male workers in Group A. In particular, male workers aged 50 years and above in Group B were 3.36 times more likely to have unmet dental care needs than those in Group A. In Group D, female workers showed a high probability of having dental care needs owing to economic reasons. Moreover, female workers aged 18-49 years witnessed an increase in unmet dental care needs. Conclusions: Korean workers with unstable employment and/or income are at a higher risk of having unmet dental care needs owing to financial factors. The findings suggest an urgent need to implement robust national health insurance policies to improve efforts aimed at reducing unmet dental care needs that potentially decreases the disparity in oral health among precariously employed workers. Furthermore, it is necessary to implement comprehensive labor market policies such as sickness benefits for those in precarious employment.
Collapse
Affiliation(s)
- Xianhua Che
- Department of Health Policy Research, Daejeon Metropolitan City Public Health Policy Institute, Daejeon 35015, Korea
| | - Minsung Sohn
- Division of Health and Medical Sciences, The Cyber University of Korea, Seoul 03051, Korea
| | - Sungje Moon
- Research Institute for Healthcare Policy, Korean Medical Association, Seoul 04373, Korea
| | - Hee-Jung Park
- Department of Dental Hygiene, Kangwon National University, Samcheok 25945, Korea
- Correspondence: ; Tel.: +82-33-540-3395
| |
Collapse
|
3
|
Cho HA, Kim BR, Shin H. Travel Time for Dental Care Services Based on Patient Preference in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042051. [PMID: 35206239 PMCID: PMC8872074 DOI: 10.3390/ijerph19042051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/10/2022]
Abstract
This study analyzed patient preferences using travel time from residence to dental institution when selecting dental care services. We used data from the Korean Health Panel from 2008 to 2017 and analyzed each dental service episode. Since the distribution of travel time was skewed to the left, median travel time was analyzed. The association of travel time with services was analyzed via the population-averaged generalized estimating equation (GEE) with the Poisson family. The median of the average travel time per episode was longer for non-National Health Insurance (NHI)-covered services and shorter for NHI-covered services. The first quintile of low-income subjects traveled the longest for all services and utilized dental care the most. In the GEE analysis, travel time was approximately three times longer for implant treatment and gold inlay/resin fillings and >2 times longer for orthodontic care than for NHI-covered services. Patients residing in rural counties traveled for longer than residents of large cities. Income was statistically significant; however, the coefficient was close to zero. Travel time was related to the type of service and reflected patient preference. This was more prominent for expensive non-NHI-covered services than for NHI-covered services. The findings suggest patients’ subjective preferences for dental clinic selection are expressed as rational deliberation considering each individual’s situation.
Collapse
Affiliation(s)
- Han-A Cho
- Department of Dental Hygiene, Shinhan University, 95, Hoam-ro, Uijeongbu-si 11644, Korea;
| | - Bo-Ra Kim
- Department of Dental Hygiene, Namseoul University, 91, Cheonan-si 31020, Korea;
| | - Hosung Shin
- Department of Social and Humanity in Dentistry, Wonkwang University School of Dentistry, 460, Iksan-daero, Iksan-si 54538, Korea
- Correspondence: ; Tel.: +82-63-850-6915; Fax: +82-63-850-6934
| |
Collapse
|
4
|
Kazemi-Karyani A, Yahyavi Dizaj J, Khoramrooz M, Soltani S, Soofi M, Irandoust K, Ramezani-Doroh V. Socio-economic inequality in reported dental self-care behavior among Iranian households: a national pooled study. Int J Dent Hyg 2022; 20:689-699. [PMID: 35080140 DOI: 10.1111/idh.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/27/2021] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Setting out effective prevention strategies in dental diseases needs recognition related factors of the prevention behaviors and targeting the most disadvantaged groups in the term of dental hygiene. This study aimed to investigate socio-economic inequality in the dental self-care status (DSS) of Iranian households and decompose the measured inequality into its contributors. METHOD In this cross-sectional study pooled data was extracted from Households Income and Expenditure Surveys (HIESs) conducted in Iran from 2012 to 2017. The index of socioeconomic status (SES) for each household was constructed using principal components analysis (PCA). We used Wagstaff normalized concentration index as a measure of socioeconomic inequality in dental self-care. Decomposition analysis was applied to determine the main factors contributed to the measured inequality. RESULTS The prevalence of dental self-care in the whole population was 40.56%. The total concentration index was 0.271 (CI: 0.266, 0.275). The results of decomposition analysis for the measured inequality showed that SES, was the highest positive contributors (90.19 %) followed by sex of household's head (12.15 %), place of residence (11.79 %), and education level of household's head (11.71 %). Furthermore, the province of residence had the highest negative contribution (-11.37) to the inequality. CONCLUSION The findings of this study showed that a huge portion of the observed inequality was explained by SES that might give us a policy recommendation: There is room for improving dental health and reducing inequality in dental self-care by paying more attention to SES-disadvantaged households.
Collapse
Affiliation(s)
- Ali Kazemi-Karyani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jafar Yahyavi Dizaj
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Khoramrooz
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Moslem Soofi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kamran Irandoust
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Vajihe Ramezani-Doroh
- Department of Health Management and Economics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
5
|
Zhou N, Wong HM, McGrath C. Dental visit experience and dental care barriers among Hong Kong preschool children with special education needs. Int J Paediatr Dent 2021; 31:699-707. [PMID: 33314353 DOI: 10.1111/ipd.12770] [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: 06/17/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Children with special education needs (SEN) require additional supports in education settings, as well as extra supports in healthcare services. AIM To investigate dental visit experience and dental care barriers among Hong Kong preschoolers with SEN. DESIGN This was designed as a cross-sectional study. A structured questionnaire was employed to investigate dental attendance and dental care barriers among Hong Kong preschoolers with SEN. Binary logistic regression and multi-factor ANOVA were performed to identify factors associated with children's dental visit experience. RESULTS A total of 383 children were included in the final analysis. The average age of the recruited children was 3.87 ± 0.95 years. 72.5% parents reported that dental visits were a challenging task for their children. Among children with caries, 70.7% had never visited a dentist. Regression models indicated that (a) children over 3 years or children whose parents received tertiary education were more likely to visit a dentist; (b) the existence of dental care barriers was associated with children's primary diagnosis, practical skills, conceptual skills, and parents' education attainment; and (c) children with low conceptual skills (95%CI:0.71 to 2.40, P < .001), or children from low-income families (95%CI:1.21 to -0.06, P = .031) had more dental care barriers than their counterparts. CONCLUSION Unmet dental treatment needs and dental care barriers existed among pre-schoolers with SEN. Dental care barriers were associated with children's developmental profile, parents' education attainment, and household income.
Collapse
Affiliation(s)
- Ni Zhou
- Paediatric Dentistry & Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Paediatric & Preventive Dentistry, The Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
| | - Hai Ming Wong
- Paediatric Dentistry & Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Colman McGrath
- Periodontology and Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
6
|
Impact of Long Working Hours and Shift Work on Perceived Unmet Dental Need: A Panel Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062939. [PMID: 33805606 PMCID: PMC8001453 DOI: 10.3390/ijerph18062939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022]
Abstract
This study investigates whether workers with long working hours as well as shift workers perceive higher unmet dental care needs, and whether there is a gender difference in the associations. We used the Korea Health Panel (2009, 2011–2014) involving 20,451 person-wave observations from 5567 individuals. Perceived unmet dental care needs was defined when the participants reported that they perceived a need for dental treatment or check-up but had failed to receive dental care services during the past year. Fixed effects logit models were applied to examine how changes in weekly working hours or shift work status were linked to changes in perceived unmet dental needs within each individual. Among participants, 15.9–24.7% reported perceived unmet dental needs and the most common reason was time scarcity. We found that long working hours (>52 h/week) was significantly associated with perceived unmet dental needs due to time scarcity in both men (OR = 1.42, 95% CI 1.13–1.78) and women (OR = 1.35, 95% CI 1.03–1.79) compared workers working 40–52 h per week. Shift work was also a significant risk factor, but only in women (OR = 1.57, 95% CI 1.06–2.32). These findings provide evidence for labor policies to reduce working hours in order to improve access to dental care services.
Collapse
|
7
|
Unmet Dental Care Needs among Korean National Health Insurance Beneficiaries Based on Income Inequalities: Results from Five Waves of a Population-Based Panel Study. Healthcare (Basel) 2020; 8:healthcare8020124. [PMID: 32380767 PMCID: PMC7349312 DOI: 10.3390/healthcare8020124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 02/03/2023] Open
Abstract
This study investigates whether self-employed beneficiaries experience greater difficulties in accessing dental care than insured employees based on their income level. This analysis uses 2011–2015 data from the Korea Health Panel, a population-based and nationally representative sample, covering 7083 participants aged 18 years and older. We measured barriers to dental access based on unmet needs or the inability to receive necessary dental care owing to the past year’s economic burdens. The type of health insurance and household income are considered independent variables. We applied multiple panel logistic regressions and two-panel logistic regression models with a fixed-effects approach to analyze the data. Self-employed beneficiaries were 1.16 times (95% confidence interval (CI) = 1.08–1.24) more likely to experience unmet dental needs than were insured employees. Insured employees and self-employed beneficiaries belonging to the lowest income bracket were 1.76 times (95% CI = 1.53–2.03) and 2.33 times (95% CI = 1.89–2.87) more likely to have unmet needs than those in the highest income bracket. Self-employed beneficiaries were 1.31 times (95% CI = 1.21–1.43) more likely to experience unmet dental needs caused by economic burdens than are insured employees. Insured employees of the lowest income quintile were 4.15 times (95% CI = 3.41–5.05) more likely to experience unmet needs caused by economic burdens, while the odds ratio for self-employed beneficiaries was 5.47 (95% CI = 4.05–7.39). Our findings indicate gaps in unmet dental needs between self-employed beneficiaries and insured employees. The government should adopt strategies to reduce unmet needs among marginalized groups and redefine the role of national health insurance.
Collapse
|
8
|
Kim ES, Kim BI, Jung HI. Does the national dental scaling policy reduce inequalities in dental scaling usage? A population-based quasi-experimental study. BMC Oral Health 2019; 19:185. [PMID: 31412821 PMCID: PMC6694626 DOI: 10.1186/s12903-019-0881-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/07/2019] [Indexed: 12/01/2022] Open
Abstract
Background In 2013, the national dental scaling insurance policy was introduced in South Korea. The purpose of this study is to determine the impact of the policy on inequalities in dental scaling usage. Methods Data of a nationally representative sample of 1,517,097 people over the age of 20 were obtained from the 2010–2016 Community Health Survey. Respondents who reported that they had not received dental scaling in the past year were defined as dental scaling non-users. The excess prevalence and relative prevalence ratio of dental scaling non-users were calculated for the pre-policy (2010–2012) and post-policy periods (2014–2016) using monthly household income levels. Additionally, trends of dental scaling inequalities were shown as concentration indexes. Results The prevalence of dental scaling non-users declined from 58.0 to 48.7% in the highest income group and from 86.3 to 78.8% in the lowest income group. However, the adjusted excess prevalence for the lowest income group compared with the highest had increased from 11.9 (95% CI: 11.9–11.9) to 15.5 (95% CI: 15.5–15.5)%, and the adjusted prevalence ratio increased from 1.19 (95% CI: 1.19–1.20) to 1.29 (95% CI: 1.29–1.30). Absolute and relative concentration indexes of dental scaling non-users increased after policy implementation. Conclusions The national dental scaling insurance policy has increased socioeconomic inequalities in dental scaling usage. Because dental care access generally requires high individual agency, expanded dental coverage may have had limited effects in attenuating inequalities and inadvertently widened the gap. To reduce dental care inequalities, universal access with universal dental coverage should be considered. Electronic supplementary material The online version of this article (10.1186/s12903-019-0881-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eun-Soo Kim
- Department of Preventive Dentistry & Public Oral Health, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Baek-Il Kim
- Department of Preventive Dentistry & Public Oral Health, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hoi In Jung
- Department of Preventive Dentistry & Public Oral Health, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|