Dental expenditure, progressivity and horizontal inequality in Chinese adults: based on the 4th National Oral Health Epidemiology Survey

Abstract

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.

Measuring and decomposing socioeconomic‐related inequality in the use of oral health services among Chinese adults

“…As in a previous study in China, 8 Chinese medical reform, especially reform of the dental system, has much room for improvement. 40 The results of the decomposition analyses supplement previous findings that socioeconomic-related inequality in dental care service utilization cannot be comprehensively explained by those variables influencing the affordability of dental care payments, which further suggests that this inequality may not be eliminated only by providing financial support. 10 Mirroring previous research that also found that education 5,8,14 and residential location 8 contributed to inequality in the use of oral health services, the present study suggests that educational attainment and residential location have more of an impact among younger adults aged 35-44 years than among older adults.…”

Income-related inequality and decomposition of edentulism among aged people in China

“…First, income inequality may lead to the reduction of investment on the public health resources such as water fluoridation [ 42 , 43 ]. Secondly, the percentage of routine expenditure on health care is low among the low-income group and the dental expenditure is still a tiny fraction in terms of the health care payments in China [ 44 ]. Besides, studies showed that people with low incomes tend to neglect health-related behaviors such as smoking and regular health care [ 21 , 22 , 45 ].…”

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

“…14 According to previous studies, dental service utilization among Chinese preschool children may be influenced by caregiver education background, socioeconomic status, perception of their children's oral health status, dental insurance dental fear and demographic factors. 16 Although some studies have found socioeconomic-related inequalities in dental service utilization among adults in China, [17][18][19] the evidence related to inequality in children's dental service utilization is insufficient.…”

“…19,[22][23][24] Inequality in dental care utilization among Chinese adults has been measured in previous studies by means of CI. [17][18][19] However, evidence related to inequality in dental care 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 socioeconomicrelated 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.…”