Dental expenditure, progressivity and horizontal inequality in Chinese adults: based on the 4th National Oral Health Epidemiology Survey.
Decomposition of concentration index
Dental expenditure
Horizontal inequality
Kakwani index
Socioeconomic determinants
Journal
BMC oral health
ISSN: 1472-6831
Titre abrégé: BMC Oral Health
Pays: England
ID NLM: 101088684
Informations de publication
Date de publication:
11 05 2020
11 05 2020
Historique:
received:
09
01
2020
accepted:
29
04
2020
entrez:
13
5
2020
pubmed:
13
5
2020
medline:
18
11
2020
Statut:
epublish
Résumé
The financial burden of oral diseases is a growing concern as the medical expenses rise worldwide. The aim of this study was to investigate the dental expenditure, analyze its progressivity and horizontal inequality under the general health finance and insurance system, and identify the key social determinants of the inequality for Chinese adults. A secondary analysis used the data of 13,464 adults from the 4th National Oral Health Epidemiological Survey (NOHES) in China was undertaken. The dental expenditure was collected and divided into out-of-pocket and health insurance payments. Horizontal inequality index and Kakwani index were used to analyze the horizontal inequality and progressivity, respectively. The decomposition model of the concentration index was set up to explore the associated socioeconomic determinants. The results showed that a mean dental expenditure per capita of Chinese adults was $20.55 (95% Confidence Interval-CI: 18.83,22.26). Among those who actually used dental service, the cost was $100.95 (95%CI: 93.22,108.68). Over 90% of dental spending was due to out-of-pocket expenses. For self-reported oral health, the horizontal inequality index was - 0.1391 and for the decayed tooth (DT), it was - 0.2252. For out-of-pocket payment, the Kakwani index was - 0.3154 and for health insurance payment it was - 0.1598. Income, residential location, educational attainment, oral hygiene practice, self-reported oral health, age difference were the main contributors to the inequality of dental expenditure. Dental expenditure for Chinese adults was at a lower level due to underutilization. The ratio of payments of dental expenditure and utilization was disproportional, whether it was out-of-pocket or insurance payment. Individuals who were more in need of oral care showed less demand for service or not required service in time. For future policy making on oral health, it is worth the effort to further promote the awareness of the importance of oral health and utilization of dental service.
Sections du résumé
BACKGROUND
The financial burden of oral diseases is a growing concern as the medical expenses rise worldwide. The aim of this study was to investigate the dental expenditure, analyze its progressivity and horizontal inequality under the general health finance and insurance system, and identify the key social determinants of the inequality for Chinese adults.
METHODS
A secondary analysis used the data of 13,464 adults from the 4th National Oral Health Epidemiological Survey (NOHES) in China was undertaken. The dental expenditure was collected and divided into out-of-pocket and health insurance payments. Horizontal inequality index and Kakwani index were used to analyze the horizontal inequality and progressivity, respectively. The decomposition model of the concentration index was set up to explore the associated socioeconomic determinants.
RESULTS
The results showed that a mean dental expenditure per capita of Chinese adults was $20.55 (95% Confidence Interval-CI: 18.83,22.26). Among those who actually used dental service, the cost was $100.95 (95%CI: 93.22,108.68). Over 90% of dental spending was due to out-of-pocket expenses. For self-reported oral health, the horizontal inequality index was - 0.1391 and for the decayed tooth (DT), it was - 0.2252. For out-of-pocket payment, the Kakwani index was - 0.3154 and for health insurance payment it was - 0.1598. Income, residential location, educational attainment, oral hygiene practice, self-reported oral health, age difference were the main contributors to the inequality of dental expenditure.
CONCLUSION
Dental expenditure for Chinese adults was at a lower level due to underutilization. The ratio of payments of dental expenditure and utilization was disproportional, whether it was out-of-pocket or insurance payment. Individuals who were more in need of oral care showed less demand for service or not required service in time. For future policy making on oral health, it is worth the effort to further promote the awareness of the importance of oral health and utilization of dental service.
Identifiants
pubmed: 32393260
doi: 10.1186/s12903-020-01128-0
pii: 10.1186/s12903-020-01128-0
pmc: PMC7216389
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
137Subventions
Organisme : Scientific Research Fund of National Health Commission of the People's Republic of China
ID : 201502002
Pays : International
Références
J Am Dent Assoc. 2017 Jun;148(6):361-368
pubmed: 28427720
Community Dent Oral Epidemiol. 2020 Feb;48(1):32-41
pubmed: 31621099
Community Dent Oral Epidemiol. 2003 Dec;31 Suppl 1:3-23
pubmed: 15015736
J Health Econ. 2008 Dec;27(6):1582-93
pubmed: 18774190
Aust Dent J. 2013 Dec;58(4):498-506
pubmed: 24320908
Lancet. 2018 Sep 15;392(10151):899-901
pubmed: 30055797
J Health Econ. 1991 Jul;10(2):169-205; discussion 247-9, 251-6
pubmed: 10113709
Community Dent Oral Epidemiol. 2018 Apr;46(2):154-160
pubmed: 29094770
J Dent Res. 2015 Oct;94(10):1355-61
pubmed: 26318590
Community Dent Oral Epidemiol. 2013 Dec;41(6):490-8
pubmed: 23383978
Eur J Health Econ. 2018 Jan;19(1):45-57
pubmed: 28064379
Healthcare (Basel). 2018 Jul 10;6(3):
pubmed: 29996547
Lancet. 2019 Jul 20;394(10194):261-272
pubmed: 31327370
Int J Oral Sci. 2011 Jan;3(1):7-12
pubmed: 21449210
J Health Soc Behav. 1995 Mar;36(1):1-10
pubmed: 7738325
Chin J Dent Res. 2018;21(3):161-165
pubmed: 30255167
J Dent Res. 2015 Jan;94(1):10-8
pubmed: 25394849
Health Policy. 2007 Jan;80(1):51-68
pubmed: 16584803
J Dent Res. 2017 Apr;96(4):380-387
pubmed: 28792274
Health Econ. 2017 Jan;26(1):35-53
pubmed: 26449483
J Dent Res. 2018 May;97(5):501-507
pubmed: 29342371
J Dent Res. 2019 Jul;98(8):853-860
pubmed: 31091113
Am J Public Health. 2017 May;107(S1):S50-S55
pubmed: 28661798
Br Dent J. 2017 May 26;222(10):809-817
pubmed: 28546591
J Public Health Dent. 1999 Winter;59(1):52-9
pubmed: 11396045
Lancet. 2019 Jul 20;394(10194):249-260
pubmed: 31327369
Community Dent Oral Epidemiol. 2018 Dec;46(6):576-585
pubmed: 29968253