Determinants of Catastrophic Dental Health Expenditure in China

Abstract

This study explored catastrophic health expenditure in China, due to out-of-pocket payments for dental care, and its associated individual- and contextual-level factors. We pooled data from 31,566 adults who participated in the third National Oral Health Survey with province-level data from different sources. We defined catastrophic dental health expenditure (CDHE) as payments for dental services and/or medication for dental problems during the last year that exceeded the 10% and 20% of the household income. The association of individual and contextual factors with catastrophic dental health expenditure was evaluated using two-level logistic regression models with individuals nested within provinces. Socioeconomic position (education and household income), household size and dental status (pain in teeth or mouth and number of teeth) were the individual-level factors associated with CDHE among the full sample of participants; and, also, among those who used dental services in the past year. Greater gross domestic product per capita was the only contextual factor associated with CDHE, and only at the lower income threshold. This study shows that out-of-pocket expenses for dental services may put a considerable, and unnecessary, burden on households’ finances. Our findings also help characterise those households more likely to face catastrophic expenditure on health if they have to pay for dental services.

Measurement and determinants of catastrophic health expenditures among the elderly in China using longitudinal data from the CHARLS

“…Third, our logistical results show that healthcare needs and service utilization are key determinants of catastrophic health expenditure. These results were agreed with previous studies [14,[36][37][38]. Our study found household member(s) with chronic conditions.…”

Measurement and determinants of catastrophic health expenditure among the elderly households in China using longitudinal data from the CHARLS

“…Third, our logistical regression results show that healthcare needs and service utilization are key determinants of catastrophic health expenditure. These results agreed with those of previous studies [14,[36][37][38]. Our study found that at least 83% of households had member(s) with chronic disease.…”

Developmental regulation of lifelong dental experiences and beliefs in Guangzhou and Hong Kong

“…Scepticism about dental services in both cities also served as a secondary influence or reaction to concerns about the cost of dental treatment, the professional integrity of dentists, and the commercialisation of health promotion programs including the unsupported claims of toothpaste manufacturers. Out‐of‐pocket payments for dental care in Mainland China have been described as a catastrophic expenditure, and very little dental care is covered by insurance schemes …”

“…Further prospective studies are needed on possible differences in the developmental regulation of oral health care for men and women and for different social strata. This is especially so in China where older migrants have difficulty accessing health and social services, and in other parts of the globe where major migrations of people are underway. Future focus groups could include different age groups to reveal how personal and structural factors influence generational experiences.…”

“…Oral diseases and dysfunction are very serious and expensive public health concerns and in China, where dental caries, periodontal diseases and tooth loss are very prevalent and go mostly untreated in older people . These assertions of disease severity and costs are due in part to the rapidly changing psychosocial structure of life in China over the last century.…”