Inequalities in Periodontal Disease According to Insurance Schemes in Thailand

Abstract

Few studies have considered the effects of insurance on periodontal disease. We aimed to investigate the association between insurance schemes and periodontal disease among adults, using Thailand’s National Oral Health Survey (2017) data. A modified Community Periodontal Index was used to measure periodontal disease. Insurance schemes were categorized into the Universal Coverage Scheme (UCS), Civil Servant Medical Benefit Scheme (CSMBS), Social Security Scheme (SSS), and “others”. Poisson regression was applied to estimate the prevalence ratios (PRs) of insurance schemes for periodontal disease, with adjustment for age, gender, residential location, education attainment, and income. The data of 4534 participants (mean age, 39.6 ± 2.9 years; 2194 men, 2340 women) were analyzed. The proportions of participants with gingivitis or periodontitis were 87.6% and 25.9%, respectively. In covariate adjusted models, lowest education (PRs, 1.03; 95% CI, 1.01–1.06) and UCS (PRs, 1.05; 95% CI, 1.02–1.08) yielded significantly higher PRs for gingivitis, whereas lowest education (PRs, 1.20; 95% CI, 1.05–1.37) and UCS (PRs, 1.17; 95% CI, 1.02–1.34) yielded substantially higher PRs for periodontitis. Insurance schemes may be social predictors of periodontal disease. For better oral health, reduced insurance inequalities are required to increase access to regular dental visits and utilization in Thailand.

Tooth Loss, Cognitive Impairment and Fall Risk: A Cross-Sectional Study of Older Adults in Rural Thailand

“…Our participants were older rural-dwellers who mostly live at a distance from medical services. Most only received basic dental care such as scaling and tooth extraction due to the limited coverage provided by the UCS [ 9 ]. We have provided further evidence of the association between number of teeth lost, cognitive impairment and fall risk.…”

“…Thailand’s universal coverage healthcare system is divided into three programs—a civil servant medical benefit scheme (CSMBS) covering 7% of the population, a social security scheme (SSS) for formal-sector private employees covering 15%, and a universal coverage scheme (UCS) for all other Thai citizens that covers about 76% of the population [ 8 ]. According to a recent study by Srinarupat and colleagues, low-income Thai people living in rural areas have a higher prevalence of gingivitis and periodontitis, but face the problem that the service charges for endodontic treatments and surgical removal of posterior teeth are not covered by the UCS [ 9 ]. Periodontitis is the major cause of tooth loss and affects masticatory functions and quality of life [ 10 ].…”

Understanding the feelings and experiences of patients with periodontal disease: a qualitative meta-synthesis

“…For instance, a systemic review found those in disadvantaged socio-economic status were more susceptible to PD because they had less access to dental care [ 32 ]. Several studies have already shown the necessity and social value of covering dental care benefits in healthcare insurance schemes [ 33 – 36 ]. Significantly, our findings provide new insight into this issue as well.…”

Relationship between the Social Development Index and Self-Reported Periodontal Conditions

“…The harsh conditions of social development are further affected by challenging barriers to accessing public healthcare and social security [90][91][92]. Regrettably, this situation is prevalent worldwide [93], and scant literature has considered the joint effects of social development on periodontal disease [94].…”