Income-Related Inequalities in Access to Dental Care Services in Japan

Patterns, barriers, and utilization of oral healthcare provided at primary health centers (PHCs) and its association with oral health status among rural population in Rohtak district, Haryana: A household cross-sectional study

Introduction

Access to oral healthcare is limited in rural areas, resulting in disparities in oral health services. Primary health centers (PHCs) are essential for providing integrated oral healthcare to rural populations. This study examines the patterns, barriers, and utilization of oral healthcare at PHCs in Rohtak district, Haryana.

Materials and Methods

In this 6-month household cross-sectional study, data were collected from a sample of 600 participants residing in rural areas under the jurisdiction of three randomly selected PHCs in Rohtak district. The study employed multistage cluster systematic random sampling procedures. Data collection included structured questionnaires and clinical oral examinations following the type-III ADA classification. Participants' oral health status was evaluated using the WHO oral health assessment form for adults (2013). Descriptive and analytical statistics were used for data analysis.

Results and Discussion

Dental caries and periodontal diseases were more common in older age groups. Barriers to oral healthcare among the elderly include fear of dental procedures and low dental literacy. Proximity to PHCs influenced dental service utilization, with higher rates among participants living near a PHC, that is, within 5 km of a PHC.

Conclusion

Age, gender, proximity to PHCs, household size, and socioeconomic status play crucial roles in the utilization of oral health services among the rural population. Addressing these factors is essential for improving oral healthcare and overcoming barriers. It is crucial to enhance the accessibility, affordability, and availability of oral health services at PHCs to promote better oral health and overall well-being in rural areas.

Association between dental visit behavior and mortality: a nationwide longitudinal cohort study from NHANES

OBJECTIVES

The benefits of professional dental treatment for oral diseases have been widely investigated. However, it is unclear whether professional dental treatment provides additional benefits for improving general health.

MATERIALS AND METHODS

Data were obtained from the US National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 and 2011 to 2018 cycles. A total of 36,174 participants were included and followed-up for mortality until December 31, 2019. Dental visit behavior was defined as the time interval of last dental visit (TIDV, < 0.5 year, 0.5-1 year, 1-2 years, 2-5 years, and > 5 years) and the main reasons of the last dental visit (treatment, examination, and other reasons). The Cox proportional risk model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI).

RESULTS

Compared with participants with time interval of less than 0.5 year, the multivariate-adjusted HRs and 95%CI for participants with time interval of more than 5 years were 1.45 (1.31, 1.61) for all-cause mortality (P trend < 0.0001), 1.49 (1.23, 1.80) for cardiovascular diseases mortality (P trend = 0.0009) and 1.53 (1.29, 1.81) for cancer mortality (P trend = 0.013). Compared with dental visit for examination, participants who had their dental visit for treatment had higher risk for mortality. For participants with dental visit for examination, TIDV of less than 1 year showed lower risk for mortality, whereas TIDV of less than 0.5 year is recommend for population with dental visit for treatment.

CONCLUSIONS

Poor dental visit behavior is associated with an increased risk of mortality. Further well-designed studies are needed to confirm the association between professional dental visit and mortality.

CLINICAL RELEVANCE

This study highlights the potential benefits of regular dental visits in maintaining general health.

Regular Dental Check-Ups Are Associated with Choosing Uninsured Dental Restoration/Prosthesis Treatment in Japan

Since Japan has implemented Universal Health Coverage (UHC), most dental treatments are covered by public health insurance. Therefore, when receiving fixed dental restoration/prosthesis (FDRP) treatment, such as inlays, crowns, and bridges, the patient can choose whether or not it is covered by insurance. This study aimed to evaluate whether those who receive dental check-ups regularly chose uninsured FDRP treatment. Data were collected from 2088 participants, who had undergone FDRP treatment, via a web-based survey and analyzed. Among them, 1233 (59.1%) had received regular dental check-ups (RDC group) and 855 (40.9%) had not (non-RDC group). The multivariate logistic regression model showed that compared to the non-RDC group, those in the RDC group were statistically significantly associated with higher rates of good oral health behaviors (brushing teeth ≥ 3 times daily, odds ratios (OR):1.46; practiced interdental cleaning habitually, OR: 2.22) and received uninsured FDRP treatment more often (OR: 1.59), adjusted for socioeconomic factors. These results suggest that health policy interventions to promote access to RDC among individuals may improve the oral health of people and reduce the financial burden on the public health insurance system.

Indicators of integrating oral health care within universal health coverage and general health care in low-, middle-, and high-income countries: a scoping review

BACKGROUND

The World Health Organization (WHO) has recently devoted special attention to oral health and oral health care recommending the latter becoming part of universal health coverage (UHC) so as to reduce oral health inequalities across the globe. In this context, as countries consider acting on this recommendation, it is essential to develop a monitoring framework to measure the progress of integrating oral health/health care into UHC. This study aimed to identify existing measures in the literature that could be used to indicate oral health/health care integration within UHC across a range of low-, middle- and high-income countries.

METHODS

A scoping review was conducted by searching MEDLINE via Ovid, CINAHL, and Ovid Global Health databases. There were no quality or publication date restrictions in the search strategy. An initial search by an academic librarian was followed by the independent reviewing of all identified articles by two authors for inclusion or exclusion based on the relevance of the work in the articles to the review topic. The included articles were all published in English. Articles concerning which the reviewers disagreed on inclusion or exclusion were reviewed by a third author, and subsequent discussion resulted in agreement on which articles were to be included and excluded. The included articles were reviewed to identify relevant indicators and the results were descriptively mapped using a simple frequency count of the indicators.

RESULTS

The 83 included articles included work from a wide range of 32 countries and were published between 1995 and 2021. The review identified 54 indicators divided into 15 categories. The most frequently reported indicators were in the following categories: dental service utilization, oral health status, cost/service/population coverage, finances, health facility access, and workforce and human resources. This study was limited by the databases searched and the use of English-language publications only.

CONCLUSIONS

This scoping review identified 54 indicators in a wide range of 15 categories of indicators that have the potential to be used to evaluate the integration of oral health/health care into UHC across a wide range of countries.

An Anthropological Investigation of the Sociocultural and Economic Forces Shaping Dental Crowding Prevalence

OBJECTIVE

The aim of the current study is to explore country of origin and social race category differences in dental crowding prevalence through an anthropological approach.

DESIGN

Data were collected from individuals within five countries (Australia, China, Japan, South Africa, United States; n = 1008) and seven social race groups in two countries (American Black, American White, Latinx, and Indigenous in the United States, South African Black, South African White, and South African Coloured; n = 654). Statistical significance between groups was assessed with a Kruskal-Wallis test, while a Dunn's post-hoc test identified which groups significantly differed.

RESULTS

Results indicate South Africa is characterized by the lowest frequencies of dental crowding, with Coloured South Africans yielding the highest and Black South Africans displaying the lowest frequencies. Individuals in the United States exhibited relatively high levels of minor dental crowding. American Blacks had lower crowding levels, while the Indigenous group had high levels of severe crowding. Individuals within China and Japan exhibited higher relative prevalence of severe crowding.

CONCLUSIONS

Overall, significant differences exist in dental crowding prevalence across countries and social race categories using an anthropological grading system to assess crowding. These differences are likely impacted by sociocultural (aesthetic preferences) and economic (access to dental care) factors.

People's Willingness to Pay for Dental Checkups and the Associated Individual Characteristics: A Nationwide Web-Based Survey among Japanese Adults

This study aimed to determine the willingness-to-pay (WTP) values for dental checkups and analyze the association between the values and individual characteristics. This cross-sectional study was conducted using a nationwide web-based survey, and 3336 participants were allocated into groups that received regular dental checkups (RDC; n = 1785) and those who did not (non-RDC; n = 1551). There was a statistically significant difference in the WTP value for dental checkups between the RDC (median: 3000 yen [22.51 USD]) and non-RDC groups (2000 yen [15.01 USD]). In the RDC group, age 50-59 years, household income <2 million yen, homemaker and part-time worker employment status, and having children were significantly associated with decreased WTP values; male sex, household incomes ≥8 million yen, and tooth brushing ≥3 times daily were associated with increased WTP values. In the non-RDC group, age ≥30 years, household incomes <4 million yen, and having ≥28 teeth were significantly associated with decreased WTP values; household income ≥8 million yen was associated with increased WTP values. Conclusively, WTP values for dental checkups were lower in the non-RDC group than in the RDC group; in the non-RDC group, those with lower household income aged ≥30 years were more likely to propose lower WTP values, suggesting the need for policy intervention to improve access to RDC.

[The impact of primary prevention programs of dental diseases on the main trends in the development of dental services]

The vision of the global strategy on oral health is universal health coverage for oral health for all individuals and communities by 2030, enabling them to enjoy the highest attainable state of oral health and contributing to healthy and productive lives (WHO, 2022). To achieve this goal, it is necessary to ensure the development of the dental care system in Russia on the basis of primary prevention of dental diseases.

OBJECTIVE

Analysis of the methodology for the development, implementation and evaluation of programs for the primary prevention of dental diseases and their impact on the main trends in the development of dental services.

MATERIAL AND METHODS

The main research methods were search for publications, analysis and systematization of information on the methodology for developing, implementing and evaluating programs for the primary prevention of dental diseases.

RESULTS

Despite the single main goal of dental disease prevention programs, the analysis of the methodology of their construction and implementation must be carried out considering their impact on the main trends in the development of dental services.

CONCLUSIONS

The main directions of development of the methodology for the development, implementation, and evaluation of primary prevention programs of dental diseases should include the use of indicators of oral health recognized by the international community, which allow us to trace the degree of their influence on the development of the system of dental care.

The impact of dental care programs on healthcare system and societal outcomes: a scoping review

BACKGROUND

Dental diseases have detrimental effects on healthcare systems and societies at large. Providing access to dental care can arguably improve health outcomes, reduce healthcare utilization costs, and improve several societal outcomes.

OBJECTIVES

Our objective was to review the literature to assess the impacts of dental care programs on healthcare and societal outcomes. Specifically, to identify the nature of such programs, including the type of services delivered, who was targeted, where services were delivered, and how access to dental care was enabled. Also, what kind of societal and healthcare outcomes have been attempted to be addressed through these programs were identified.

METHODS

We conducted a scoping review by searching four databases, MEDLINE, EMBASE, CINAHL, and Sociological Abstracts. Relevant articles published in English language from January 2000 to February 2022 were screened by four reviewers to determine eligibility for inclusion.

RESULTS

The search resulted in 29,468 original articles, of which 25 were included in the data synthesis. We found minimal evidence that answers our proposed research question. The majority of identified programs have demonstrated effectiveness in reducing medical and dental healthcare utilization (especially for non-preventive services) and avert more invasive treatments, and to a lesser degree, resulting in cost-savings. Moreover, some promising but limited evidence about program impacts on societal outcomes such as reducing homelessness and improving employability was reported.

CONCLUSION

Despite the well-known societal and economic consequences of dental problem, there is a paucity of studies that address the impacts of dental care programs from the societal and healthcare system perspectives.

MESH TERMS

Delivery of Health Care, Dental Care, Outcome assessment, Patient acceptance of Health Care.

Inequality in access to dental services in a market-based dental care system: A population study from Norway 1975-2018

OBJECTIVE

To examine income-related inequalities in access to dental services from 1975 to 2018. In Norway, dental care services for adults are privately financed. This may lead to income-related inequalities in access. In the early 1970s, that is, at the beginning of the study period, there were marked inequalities in access to dental services according to personal income. However, from the beginning of the 1970s, there has been a large increase in gross national income per capita in Norway as a result of the growth of the oil and gas industry. This increase in income also meant that people with a low income in 1975 had a rise in their level of income. According to the law of diminishing utility, an increase in income leads to higher consumption of dental services for people with a low level of income compared to people with a high level of income. The study hypothesis is that the inequalities in access to dental services that existed in 1975 became less over time.

METHODS

Statistics Norway collected samples of cross-sectional health survey data for the following years: 1975, 1985, 1995, 2002, 2008, 2012 and 2018. For each sample, individuals 21 years and older were drawn randomly from the non-institutionalized adult population using a two-stage stratified cluster sample technique. Inequalities were measured using the concentration index. The dependent variable was the use of dental services during the last year, and the key independent variable was equivalized household income.

RESULTS

The concentration index for inequalities in use of dental services according to income decreased from 0.10 (95% CI = 0.09, 0.11) in 1975 to 0.04 (95% CI = 0.03, 0.05) in 2018. The decrease was particularly large from 2002 to 2012. This was a period with a large growth in gross national income.

CONCLUSION

People with a low income had a marked increase in their purchasing power from 1975 to 2018. This coincided with an increase in demand for dental care for this low-income group.

Association of marital status and access to dental care among the Japanese population: a cross-sectional study

Background

Health disparities according to marital status have been reported worldwide. Although spouses provide an important social network that influences heath behaviors, limited studies have examined the association between marital status and access to dental care. Therefore, this study aimed to analyze the association between marital status and access to dental care.

Methods

A secondary analysis of the 2013 Comprehensive Survey of Living Conditions in Japan which is a national survey, was performed in this study. Out of 367,766 respondents, 4111 respondents, aged over 40 years who selected oral symptoms as their most concerning subjective symptom were recruited as participants. The independent variable of interest was marital status—married or non-married (single, divorced, widowed); and the dependent variable was access to dental care. We performed Poisson regression analyses stratified by sex with adjustment for age, educational status, employment, equivalent household expenditure, and smoking habits.

Results

Among respondents who reported oral symptoms, 3024 were married, and 1087 were non-married. Further, 29.4% and 40.4% of married and non-married men, respectively, did not receive dental treatment for their symptoms. Meanwhile, 27.5% and 25.0% of married and non-married women, respectively, did not receive dental treatment for their symptoms. The prevalence ratio for not receiving dental treatment was significantly higher among non-married men (prevalence ratio: 1.33; 95% confidence interval: 1.14–1.56) than among married men. However, no significant association was observed among women.

Conclusions

Non-married men were highly unlikely to receive dental treatment than married men, while no significant association was observed among women. The results implicate the importance of implementing a public dental health policy for protecting the dental health of non-married individuals.

COVID-19 Effects on Income and Dental Visits: A Cross-sectional Study

OBJECTIVES

In April 2020, the Japanese government declared a state of emergency owing to the outbreak of the novel coronavirus disease (COVID-19) pandemic, which resulted in reduced workforce and job losses. Furthermore, income is one of the most consistent predictors of dental visits. Therefore, this study examined the association between income changes and dental clinic visits during the COVID-19 state of emergency in Japan.

METHODS

An online, self-reported cross-sectional survey about health activities including dental visits during the first COVID-19 state of emergency was conducted in Osaka, Japan (June 23 to July 12, 2020). Among participants with toothaches, the assessment for the association between "refrained from visiting a dentist despite wanting treatment for toothache during the state of emergency (refrained treatment)" and income changes before and after the state of emergency using a multivariate Poisson regression model adjusted for sex, age, self-rated health, frequency of regular dental visits, and employment status.

RESULTS

Among 27,575 participants, 3,895 (14.1%) had toothaches, and 1,906 (6.9%) reported refrained treatment. Among people with decreased income (n = 8,152, 29.6% of overall participants), the proportions of the refrained treatment group were 8.0% (income decreased by 1%-49%), 9.9% (50%-99% decreased), and 9.1% (100% decreased). Among participants with toothache, after adjusting for all variables, compared with participants with no income change, we observed significantly higher prevalence ratios (PRs) for refrained treatment in those who experienced a decreased income owing to COVID-19 (1%-49% decrease: PR = 1.08; 95% confidence interval [CI], 1.005-1.17; 50%-99% decrease: PR = 1.18; 95% CI, 1.06-1.32; 100% decrease: PR = 1.18; 95% CI, 1.04-1.33).

CONCLUSION

Decreased income was associated with refrained dental treatment during the COVID-19 state of emergency in Osaka, Japan. The economic damage related to the COVID-19 pandemic could lead to oral health inequalities.

KNOWLEDGE TRANSFER STATEMENT

Our study found that individuals with decreased income owing to COVID-19 before and after the state of emergency showed significantly higher prevalence ratios for refraining from visiting a dentist despite wanting treatment for toothache. We believe that our study makes a significant contribution because it provides novel, basic data that economic damages related to the COVID-19 pandemic might expand to oral health inequalities.

Inequality in dental care expenditure in Iranian households: analysis of income quintiles and educational levels

Background

Oral health is a major public health issue which affects the human life. Access to dental care is one of the important factors in maintaining oral health. This study was aimed to investigate inequality in dental care expenditure in Iranian households.

Methods

The present study is a secondary analysis of a national cross-sectional survey. The data collected from the Households Income and Expenditure Survey in 2016 and 2017. The final sample consisted of 54,354 households living in rural and urban regions of all the provinces. Inequalities in household’s dental care expenditure per capita in respect to income quintiles and educational level were measured based on the Gini coefficient and concentration index.

Results

The results showed that about 8% of households had paid for dental care during the month before sampling. The Gini coefficient value was estimated to be 0.97 and 0.96 for dental care expenditure per capita respectively in absolute and relative measure. It indicated a significant inequality in the dental expenditure among the sample households. The values of concentration index were positive and significant for all dental care subcategories in respect to the provincial and national income quintiles as well as the educational level of the head of the household.

Conclusions

Income and educational inequality in the both absolute and relative dental services expenditure of the Iranian households were in favor of higher income groups as well as higher educational level of household heads. Income inequality was higher in total dental care expenditure per capita and all its subcategories than the educational inequalities of dental expenditure. In order to reduce these inequalities, the policymakers need to pay special attention to low-income households, particularly those with low-educated heads.

Association between Dental Scaling and Reduced Risk of End-Stage Renal Disease: A Nationwide Matched Cohort Study

Periodontitis is prevalent in patients with chronic kidney disease (CKD) and is also associated with kidney function decline. It is unclear whether dental scaling treatment prevents the progression of CKD. In a nationwide cohort study, Taiwan's National Health Insurance Research Database was used to select people with CKD. Propensity score-matching procedures were performed to compare the long-term risk of end-stage renal disease (ESRD) between CKD patients with and without the receipt of dental scaling. A total of 33,637 matched pairs with CKD were included, with 503,373 person-years of follow-up for analyses. Dental scaling was significantly associated with a lower risk of ESRD (adjusted hazard ratio (aHR): 0.83, 95% confidence interval (CI): 0.77-0.90). In addition, there was a dose-dependent relationship between the frequency of dental scaling and a reduced risk of ESRD. Dental scaling was also linked to reduced risks of major adverse cardiovascular events (aHR: 0.91, 95% CI: 0.87-0.95), sepsis (aHR: 0.81, 95% CI: 0.77-0.85), and all-cause mortality (aHR: 0.81, 95% CI: 0.76-0.87). Dental scaling was significantly associated with lower risks of progression to ESRD in patients with CKD. Regular dental scaling may serve as a prophylactic measure for kidney function decline.

Socioeconomic-related inequality in dental care utilization among preschool children in China

OBJECTIVES

This study aimed to investigate socioeconomic-related inequality in dental care service utilization in the past 12 months among Chinese preschool children and to explore the contribution of various factors to this inequality.

METHOD

A total of 40 305 children aged 3-5 years from 372 kindergartens who participated in the Fourth National Oral Health Survey in China were included in the final analysis. The method of data weighting in complex sampling was adopted to make the samples more representative. Erreygers-corrected concentration index (EI) was used to measure socioeconomic-related inequality in dental care service utilization. The horizontal inequality index (HI) was employed to analyse horizontal inequality. Decomposition analyses were conducted to explore the contributions of income level, need variables (dmft, caregiver-evaluated oral health status and toothache experience) and nonneed variables (caregiver education level, residential location, age, and sex) to the inequality of health service utilization.

RESULT

The utilization of oral health services within the past 12 months among the high-, middle- and low-income groups was 17.4% (95% CI: 15.6-19.3), 13.6% (95% CI: 12.2-15.1) and 9.4% (95% CI: 8.1-11.0) respectively. The concentration curve was below the line of equality, and the EI and HI were 0.072 and 0.078, respectively, indicating that dental care utilization in children aged 3-5 years was concentrated in those who were better off. The contribution of the need variables to socioeconomic-related inequality in dental services was minimal, and most dental care utilization inequality could be explained by household income, caregiver education attainment and urban-rural disparities, accounting for 32.0%, 49.4% and 20.4% respectively.

CONCLUSION

This study reveals the existence of pro-rich inequality in dental care utilization among preschool children in China. The decomposition analysis suggests that income, caregiver education background and urban-rural disparities are the main factors contributing to this outcome. Equity-oriented policies and programmes are needed to achieve equitable dental care utilization.

Regional Inequality in Dental Care Utilization in Japan: An Ecological Study Using the National Database of Health Insurance Claims

BACKGROUND

This study examined regional inequalities in dental care utilization in Japan and the association of dental care utilization with socioeconomic factors.

METHODS

Using the Fourth National Database of Health Insurance Claims and Specific Health Checkups of Japan Open data, this ecological study analyzed 216 million pieces of aggregated data from April 2017 to March 2018. Nine indicators of dental care utilization were used: outpatient visits, outreach services, cavity fillings, pulpectomies, dental calculus removals, periodontal surgeries, tooth extractions, dental bridges, and dentures. Standardized claim ratios (SCRs) for these indicators were calculated for Japan's 47 prefectures, which were divided into three groups based on the number of dental clinics per population, average income per capita, and the proportion of university enrollments. Associations of the dental care utilization with dental supply and regional socioeconomic factors were examined.

FINDINGS

The ratios of maximum to minimum of SCRs were 1·4 for outpatient visits, 19·3 for outreach services, and 17·6 for periodontal surgeries. Dental supply was positively associated with outpatient visits, outreach services, dental calculus removal, and periodontal surgeries. Regional average income and educational level were positively associated with dental calculus removals, and negatively associated with pulpectomies, tooth extractions, dental bridges, and dentures.

INTERPRETATION

In Japan, regional inequalities in dental care utilization exist for periodontal care and outreach services but are smaller for urgent and substantial dental care. Regional income and educational levels appear to have influence on dental care utilization.

FUNDING

Ministry of Health, Labour and Welfare of Japan (H31-19FA1001).

Fraud and Abuse in the Saudi Healthcare System: A Triangulation Analysis

In the insurance industry, the majority of fraud and abuse cases fall into a limited number of patterns, yet false claims normally lead to negative national, local, and organizational effects. Through monitoring the exploitative and abusive behavior commonly found in healthcare services, this paper aims to analyze initiatives implemented by governmental and related healthcare insurance agencies in Saudi Arabia to reduce moral offenses. To accomplish this objective, major governmental health insurance policy documents were analyzed at the macro-level. At the meso-level, semi-structured interviews were conducted with five health insurance professionals on measures undertaken to prevent such incidents. At the micro-level, the critical factors of fraudulent behaviors were analyzed using a retrospective analysis. Data were retrieved from anti-fraud records of ten leading health insurance companies and the focus was mainly on individuals involved in unethical practices between 2014 and 2019. After a full audit was completed, the results concluded that the Saudi healthcare system is composed of twenty-six cooperative health insurance agencies and over 5,202 health services providers. The official documents contain the details of various moral hazard measures. On annual average, more than 196 fraudulent cases were reported with a claim rejection rate of approximately 15%. The majority of fraud cases were reported in dental services with invalid card usage, followed by obstetrics-gynecology services (47 and 113 cases, respectively). Females tended to make up most deceit cases in obstetrics-gynecology with a high level of abuse (95% confidence interval: −83.398 to −24.202; P < .003 and −28 > 638 to −7.362; P < .005, respectively). This study ultimately identifies basic measures employed at the macro-level to reduce moral hazards. However, such measures are not intended to be coherently implemented at the micro-level, especially by health insurance companies and healthcare providers.

Disparities in Dental Service Utilization among Adults in Chinese Megacities: Do Health Insurance and City of Residence Matter?

The aims of the study were to present the prevalence of dental service utilization among adults (age between 18 and 65) in Chinese megacities and to examine the associations of health insurance and city of residence with dental visits. This study was a cross-sectional analysis of the 2019 New Era and Living Conditions in Megacities Survey data with a sample of 4835 participants aged 18–65 from 10 different megacities in China. The data including gross domestic product (GDP) per capita of each megacity obtained from the National Bureau of Statistics of China as a city-level characteristic. After adjusting sampling weights, approximately 24.28% of the participants had at least one dental visit per year. Findings from multilevel mixed-effects linear models showed that participants residing in megacities with higher GDP per capita (β = 0.07, p < 0.001) who had Urban Employee Basic Medical Insurance (β = 0.25, p < 0.001) or Urban Resident Basic Medical Insurance (β = 0.19, p < 0.01) had more frequent dental visits after adjusting demographic characteristics, socioeconomic status, health status, health behavior and attitude, and oral health indicators. Margins post-estimation model results demonstrated disparities in the predicted probability of having never visited a dentist by types of health insurance and city of residence. In conclusion, the prevalence of dental visits in China was found to be low. This study highlights socioeconomic inequalities in dental service utilization. There is a great need to develop more dental care programs and services and expand health insurance to cover dental care in China.

Factors Related to Oral Healthcare Service Utilization among Korean Adults Aged 25-79 Years

The factors related to oral healthcare service utilization (OHSU) among Korean adults aged 25-79 years were assessed using the Andersen model with the sixth Korean National Health and Nutrition Examination Survey data. The study included 12,937 participants aged 25-79 years who answered questions on the predisposing, enabling, and need factors related to OHSU at dental clinics within the past 1 year. Age, sex, and education level were selected as predisposing factors; household income, residence region, and national and private health insurance status as enabling factors; and self-perceived oral health, dental pain, chewing status, and discomfort while speaking as need factors. These factors were assessed using multivariable complex logistic regression models. OHSU at dental clinics within the past 1 year was lower among less-educated participants, those with low, middle-low, and middle-high household income levels, rural participants, those benefiting from the Medicaid system, and non-insured participants. OHSU was higher among older participants, those who rated their self-perceived oral health status as bad, those with experience of dental pain, and those who experienced discomfort while chewing and speaking. The need factors were the most influential. Thus, interventions to reduce inequalities in OHSU are required to promote oral health for all.

Inequality in dental expenditures among Iranian households: A cross-sectional survey using the National Health Accounts

BACKGROUND

Recently, inequality in dental care has become increasingly popular in both developed and developing countries as a matter of health policy. Thus, the aims of this study were examining inequality in dental care expenditures and assessing the effects of insurance coverage and other variables on these services.

MATERIALS AND METHODS

In this cross-sectional and descriptive-analytical study, we used secondary data of the National Health Accounts that has been conducted in 2008 in Iran. The sample size was 17,239 households in all over the country. All analyses were performed by Stata software using Mann-Whitney test and logistic regression. P < 0.05 was considered statistically significant. To determine inequality in dental services, the concentration index (CI) was used.

RESULTS

CI for total dental expenditures was 0.315 and for orthodontics was 0.6. Findings showed that out-of-pocket expenditure for dental care was progressive and there was a significant relationship between total dental expenditure with residence areas (odds ratio [OR] =1.3; P > 0.001), complementary insurance coverage (OR = 1.3; P > 0.001), family size (OR = 1.46; P > 0.001), and income (OR = 1.3; P > 0.001).

CONCLUSION

Dental expenditures were progressive in Iran, and the rich have paid more share for these services. It seems that implementing insurance programs, changes in the financing of dental care, development of insurance basic benefits package, supporting programs for the poor, adopting educational policies, and promoting oral health for vulnerable people can have an effective role in decreasing inequality in using dental services.

Effect of Copayment on Dental Visits: A Regression Discontinuity Analysis

Despite their prevalence and burdens, oral diseases are neglected in universal health coverage. In Japan, a 30% copayment (out of pocket) by the user and a 70% contribution by Japan’s universal health insurance (JUHI) are required for dental and medical services. From the age of 70 y, an additional 10% is offered by JUHI (copayment, 20%; JUHI, 80%). This study aimed to investigate the effect of cost on dental service use among older adults under the current JUHI system. A regression discontinuity quasi-experimental method was used to investigate the causal effect of the JUHI discount policy on dental visits based on cross-sectional data. Data were derived from the 2016 Japan Gerontological Evaluation Study. This analysis contained 7,161 participants who used JUHI, were aged 68 to 73 y, and responded to questions regarding past dental visits. Analyses were controlled for age, sex, number of teeth, and equalized household income. Mean ± SD age was 72.1 ± 0.79 y for the discount-eligible group and 68.9 ± 0.78 y for the noneligible group. During the past 12 mo, significantly more discount-eligible participants had visited dental services than noneligible participants (66.0% vs. 62.1% for treatment visits, 57.7% vs. 53.1% for checkups). After controlling for covariates, the effect of discount eligibility was significant on dental treatment visits (odds ratio [OR], 1.36; 95% CI, 1.32 to 1.40) and dental checkups (OR, 1.49; 95% CI, 1.44 to 1.54) in the regression discontinuity analysis. Similar findings were observed in triangular kernel-weighted models (OR, 1.38 [95% CI, 1.34 to 1.44]; OR, 1.52 [95% CI, 1.47 to 1.56], respectively). JUHI copayment discount policy increases oral health service utilization among older Japanese. The price elasticity for dental checkup visits appears to be higher than for dental treatment visits. Hence, reforming the universal health coverage system to improve the affordability of relatively inexpensive preventive care could increase dental service utilization in Japan.

Wider Dental Care Coverage Associated with Lower Oral Health Inequalities: A Comparison Study between Japan and England

Countries with different oral health care systems may have different levels of oral health related inequalities. We compared the socioeconomic inequalities in oral health among older adults in Japan and England. We used the data for adults aged 65 years or over from Japan (N = 79,707) and England (N = 5115) and estimated absolute inequality (the Slope Index of Inequality, SII) and relative inequality (the Relative Index of Inequality, RII) for edentulism (the condition of having no natural teeth) by educational attainment and income. All analyses were adjusted for sex and age. Overall, 14% of the Japanese subjects and 21% of the English were edentulous. In both Japan and England, lower income and educational attainment were significantly associated with a higher risk of being edentulous. Education-based SII in Japan and England were 9.9% and 26.7%, respectively, and RII were 2.5 and 4.8, respectively. Income-based SII in Japan and England were 9.2% and 14.4%, respectively, and RII were 2.1 and 1.9, respectively. Social inequalities in edentulous individuals exist in both these high-income countries, but Japan, with wider coverage for dental care, had lower levels of inequality than England.

Factors influencing the utilization of dental services in East Java, Indonesia

Background : Despite high levels dental issues and insurance coverage in the East Java province Indonesia, the utilization of dental services is still low. This research aims to test whether certain individual-level sociodemographic, behavioural, and clinical characteristics influenced the current level of dental services utilization by East Java residents. Methods : A secondary analysis was undertaken using data on the East Java province from the Indonesian Basic Health Research 2013, which included 90,551 randomly selected respondents aged 5-100 years old. Socio-demographic characteristics (age, sex, education and residential location), dental behavior (tooth brushing habit), and clinical (dental) condition were self-reported through a questionnaire. Multivariable models were generated to estimate prevalence ratios (PR), and 95% confidence intervals (95% CI). Results : Prevalence of dental service utilization during the last 12 months in East Java province is only 9 %. Respondents 25-<50 years old showed the highest utilization of dental services. Being male, having lower education and living in a district (as opposed to municipalities) were indicators for having lower utilization of dental treatment (PR [95% CI] = 0.81 [0.79-0.84], PR [95% CI] = 0.89 [0.86-0.93] and PR [95% CI] = 0.91 [0.88-0.95], respectively). Respondents with poor tooth brushing habit showed lower utilization of dental services. Having teeth was associated with higher utilization of dental treatment (PR [95% CI] = 1.39 [1.16-1.66). Conclusions : Age, sex, education and residential location influence the utilization of dental services among Indonesia's East Java residents. Poor tooth brushing habits and being edentulous are also indicators of lesser utilization. These results call for urgent public health interventions to increase equitable dental care services utilization.

Does the national dental scaling policy reduce inequalities in dental scaling usage? A population-based quasi-experimental study

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.

Disparities in dental healthcare utilization in China

OBJECTIVES

The goal of this study was to investigate inequality in dental service utilization in Chinese middle-aged and senior adults and changes in inequality over time and to determine the sources of inequality.

METHODS

The data included 17 648 individuals aged 45 years and older in 2013 and 15 450 individuals in 2015 who participated in the China Health and Retirement Longitudinal Study (CHARLS). The concentration index was used to quantify the degree of inequality. A decomposition method was employed to determine the sources of inequality, including need variables (demographic characteristics, self-reported health status, and presence of chronic diseases), living standard (measured by household consumption expenditure per capita), other non-need variables (education level, marital status, region of residence, urban-rural difference and type of health insurance plans).

RESULTS

The better-off not only had a higher likelihood of using dental care services than did the worse-off but also used them more often than the worse-off. The concentration index for probability of dental care utilization increased from 0.074 to 0.112 between 2013 and 2015, and the concentration index for total number of dental visits increased from 0.085 to 0.127. Living standard, education, health insurance plans and urban-rural disparities showed a pro-rich contribution to the inequality. The living standard contributed about 70% to the pro-rich inequality.

CONCLUSIONS

Dental care utilization in the Chinese middle-aged and older adults was concentrated in the better-off. Inequality in dental care utilization widened from 2013 to 2015. Achieving equity in dental care utilization remains a challenge for the healthcare system in China.

Dental health-care service utilisation and its determinants in West Iran: a cross-sectional study

BACKGROUND

Dental health care is not only an effective strategy for the prevention, early diagnosis and treatment of oral diseases but also contributes to the general health of communities. This study aimed to investigate the situation of dental health-care service utilisation and its determinants in Kermanshah city, western Iran, in 2015.

METHODS AND MATERIALS

A cross-sectional study on a total of 894 household heads was conducted. The participants were selected using a multistage sampling technique. A self-administered questionnaire was used to collect the data. Multiple logistic regression was performed to assess factors associated with utilisation of dental-care services and a negative binomial regression was carried out to identify the main factor associated with the frequency of visiting a dentist for dental health care. A statistically significant association was considered at a value of P < 0.05. All the analyses were performed using STATA version 12.

FINDING

Of the total household heads who participated in the study, 60.3% and 9.9% reported visiting a dentist for dental treatment in the past year and for 6-monthly dental check-ups, respectively. The average ± standard deviation number of visits by a respondent was 2.08 ± 2.97. Of the total number of respondents, 281 (31.4%) reported visiting a dentist once or twice in the last 12 months for dental health-care services, while 28.9% reported visiting a dentist more than twice in the same time period. Ageing, having dental insurance, higher income, being a university graduate, self-rated poor oral health and not regularly brushing own teeth were the main factors associated with utilisation of dental health-care services.

CONCLUSION

Our study indicates that dental health-care utilisation among households in the study area was influenced by a number of factors, including being socio-economically disadvantaged, self-rated poor oral health and not regularly brushing own teeth. Therefore, in this setting, dental-intervention programmes, including dental health insurance, should focus on mechanisms that can strengthen utilisation of preventive dental health-care services among disadvantaged households.