Manski Richard, Moeller John, Chen Haiyan, Widström Eeva, Listl Stefan
Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA.
National Institute for Health and Welfare, Helsinki, Finland.
Int Dent J. 2017 Jun;67(3):157-171. doi: 10.1111/idj.12284. Epub 2017 Feb 17.
The current study addresses the extent to which diversity exists in dental out-of-pocket (OOP) payments across population subgroups within and between the USA and selected European countries. This represents the final paper in a series in which the previous two papers addressed diversity in dental coverage and dental utilisation, respectively, using similar data and methods.
We used data from the 2006/2007 Health and Retirement Study (HRS) and from the 2004-2006 Survey of Health, Ageing and Retirement in Europe (SHARE) for respondents ≥51 years of age. We estimated the impacts of dental-care coverage and of demographic, socio-economic and health status on the likelihood and amount of dental OOP payments.
In the USA, older persons with the least education, lowest income and worst health are most likely to pay nothing OOP for their dental care and, for persons with an OOP payment, the amount of this payment increases with income and education and is higher for persons who are uninsured and in fair or poor health. However, these results were not consistently found in the 10 European countries we studied.
European countries classified according to social welfare state or the presence of social health insurance (SHI) showed no effect on the likelihood of making payments OOP 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 countries with SHI, as well as differing needs, tastes and access to care across countries, contribute to this finding.
本研究探讨了美国国内以及美国与部分欧洲国家之间不同人群亚组在牙科自付费用方面的差异程度。这是该系列的最后一篇论文，前两篇论文分别使用类似的数据和方法探讨了牙科保险覆盖范围和牙科服务利用方面的差异。
我们使用了来自2006/2007年健康与退休研究（HRS）以及2004 - 2006年欧洲健康、老龄化与退休调查（SHARE）中51岁及以上受访者的数据。我们估计了牙科护理保险覆盖范围以及人口统计学、社会经济和健康状况对牙科自付费用的可能性和金额的影响。
在美国，受教育程度最低、收入最低且健康状况最差的老年人最有可能在牙科护理方面不进行自付费用，而对于有自付费用的人来说，这笔费用的金额随着收入和教育程度的提高而增加，并且对于未参保以及健康状况一般或较差的人来说更高。然而，在我们研究的10个欧洲国家中并非始终能得出这些结果。
根据社会福利国家或社会医疗保险（SHI）的存在情况进行分类的欧洲国家，在牙科护理自付费用的可能性方面没有影响，并且在有自付费用的情况下，对支付金额也没有影响。即使在有社会医疗保险的国家，保险覆盖范围和报销程序的慷慨程度存在差异，以及各国在需求、偏好和获得护理方面的不同，都导致了这一结果。
