Bernabé Eduardo, Masood Mohd, Vujicic Marko
Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK.
Department of Dentistry and Oral Health, La Trobe University, Melbourne, Australia.
BMC Public Health. 2017 Jan 23;17(1):109. doi: 10.1186/s12889-017-4042-0.
Dental care is extremely costly and beyond most people means in developing countries. The primary aim of this study was to determine the impact of out-of-pocket payments for dental care on household finances in 40 low and middle income countries. A second aim was to compare the burden of payments for dental care with that for other health services.
We used data from 174,257 adults, aged 18 years and above, who reported their total and itemized household expenditure in the past four weeks as part of the World Health Surveys. The financial burden on households was measured using the catastrophic health expenditure (CHE) and impoverishment approaches. A household was classified as facing CHE if it spent 40% or more of its capacity to pay, and as facing impoverishment if it fell below the country-specific poverty line after spending on health care was subtracted from household expenditure. The odds of experiencing CHE and impoverishment due to expenditure on dental care were estimated from two-level logistic regression models, controlling for various individual- and country-level covariates.
Households that paid for dental care had 1.88 (95% Confidence Interval: 1.78-1.99) greater odds of incurring CHE and 1.65 (95% CI: 1.52-1.80) greater odds of facing impoverishment, after adjustment for covariates. Furthermore, the impact of paying for dental care was lower than that for medications or drugs, inpatient care, outpatient care and laboratory tests but similar to that of health care products, traditional medicine and other health services.
Households with recent dental care spending were more likely to use a large portion of their disposable income and fall below the poverty line. Policy makers ought to consider including dental care as part of universal health care and advocate for the inclusion of dental care coverage in health insurance packages.
在发展中国家，牙科护理费用极其高昂，超出了大多数人的承受能力。本研究的主要目的是确定在40个低收入和中等收入国家，自掏腰包支付牙科护理费用对家庭财务的影响。第二个目的是比较牙科护理支付负担与其他医疗服务的支付负担。
我们使用了来自174257名18岁及以上成年人的数据，这些人在世界卫生调查中报告了他们过去四周的家庭总支出和明细支出。使用灾难性卫生支出（CHE）和贫困方法来衡量家庭的经济负担。如果一个家庭的支出占其支付能力的40%或更多，则被归类为面临灾难性卫生支出；如果在从家庭支出中减去医疗保健支出后，家庭收入低于该国特定的贫困线，则被归类为面临贫困。通过两级逻辑回归模型估计因牙科护理支出而经历灾难性卫生支出和贫困的几率，并控制各种个人和国家层面的协变量。
在调整协变量后，支付牙科护理费用的家庭发生灾难性卫生支出的几率高出1.88倍（95%置信区间：1.78 - 1.99），面临贫困的几率高出1.65倍（95%置信区间：1.52 - 1.80）。此外，支付牙科护理费用的影响低于支付药品、住院护理、门诊护理和实验室检查的影响，但与支付保健品、传统医学和其他医疗服务的影响相似。
近期有牙科护理支出的家庭更有可能花费其大部分可支配收入并低于贫困线。政策制定者应考虑将牙科护理纳入全民医疗保健范围，并倡导在健康保险套餐中纳入牙科护理覆盖范围。
