Disparity in dental out-of-pocket payments among older adult populations: a comparative analysis across selected European countries and the USA

Abstract

Background The current study addresses the extent to which diversity exists in dental out-of-pocket payments across population subgroups within and between the United States and selected European countries. This represents the final paper in a series in which the previous 2 papers addressed diversity in dental coverage and dental utilization, respectively, using similar data and methods. Method We use 2006/2007 HRS and 2004-2006 SHARE data for respondents aged 51 years and older. We estimated the impacts of dental care coverage and demographic, socioeconomic, and health status on the likelihood and amount of dental out of pocket payments. Results Our findings show that older persons with the least education, lowest income, and worst health are most likely to pay nothing out of pocket (OOP) for their dental care and for persons with a payment OOP increase with income and education and are greater for persons who are uninsured, and in fair or poor health. These results were found in the USA but were not consistently found in the 10 European countries we studied. Conclusions European countries classified by social welfare state or presence of social health insurance (SHI) had no effect on the likelihood of making payments out of pocket for dental care nor, when OOP payments were made, on the amounts paid. Variation in generosity of coverage and procedures reimbursed by insurance, even within SHI countries, as well as differing needs, tastes and access to care across countries, contribute to this finding.

Financial Burden of Medical Care, Dental Care, and Medicines among Older-Aged Population in Slovenia, Serbia, and Croatia

“…Additionally, for Slovenia, the likelihood of having the financial burden of dental care was higher for each year spent in paid work. Previous results show that older people with lower educational level and lower income are most likely not to pay any out-of-pocket costs for dental care, and if out-of-pocket payments are made, the amounts are greater for those with higher income and with a higher level of education [ 44 ].…”

Unmet Dental Care Needs among Korean National Health Insurance Beneficiaries Based on Income Inequalities: Results from Five Waves of a Population-Based Panel Study

“…Previous studies have confirmed that vulnerable and deprived populations in many countries experience considerable barriers to dental care [12,[14][15][16]. Among those affected, older adults [17,18], individuals with lower income [11,15], and education levels [9,19], those without dental insurance [20,21], and the self-employed [22] are less likely to visit a dentist. Lee et al reported social inequalities in dental care access for periodontal treatments between insured employees and self-employed beneficiaries, with the latter less likely to receive such treatment [23].…”

Baby boomers in Europe: demography, socioeconomic and health status, and oral health needs

“…France, Switzerland, Denmark, and Sweden, free outpatient care was usually provided only for persons with the lowest-income. 44 A study in 11 European countries (Bulgaria, Estonia, France, Germany, Republic of Ireland, Lithuania, the Netherlands, Poland, Portugal, Slovakia, and Sweden) has reported that emergency dental care, tooth extraction and restorative care for acute pain due to carious lesions were provided in most of these countries. 45 However, root canal treatments, periodontal care and prosthetic restorations either required cost-sharing or were totally out of pocket.…”

“…There are large disparities among older Europeans about how much they are paying for out‐of‐pocket payments for dental care. In some countries like France, Switzerland, Denmark, and Sweden, free outpatient care was usually provided only for persons with the lowest‐income 44 …”