Rashidian Arash, Mehdizadeh Parisa, Dopeykar Nooredin, Hosseini Mostafa, Olyaeemanesh Alireza
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Health Economics Department, Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Dent Res J (Isfahan). 2020 Aug 14;17(4):306-313. eCollection 2020 Jul-Aug.
Recently, inequality in dental care has become increasingly popular in both developed and developing countries as a matter of health policy. Thus, the aims of this study were examining inequality in dental care expenditures and assessing the effects of insurance coverage and other variables on these services.
In this cross-sectional and descriptive-analytical study, we used secondary data of the National Health Accounts that has been conducted in 2008 in Iran. The sample size was 17,239 households in all over the country. All analyses were performed by Stata software using Mann-Whitney test and logistic regression. < 0.05 was considered statistically significant. To determine inequality in dental services, the concentration index (CI) was used.
CI for total dental expenditures was 0.315 and for orthodontics was 0.6. Findings showed that out-of-pocket expenditure for dental care was progressive and there was a significant relationship between total dental expenditure with residence areas (odds ratio [OR] =1.3; > 0.001), complementary insurance coverage (OR = 1.3; > 0.001), family size (OR = 1.46; > 0.001), and income (OR = 1.3; > 0.001).
Dental expenditures were progressive in Iran, and the rich have paid more share for these services. It seems that implementing insurance programs, changes in the financing of dental care, development of insurance basic benefits package, supporting programs for the poor, adopting educational policies, and promoting oral health for vulnerable people can have an effective role in decreasing inequality in using dental services.
近年来，作为一项卫生政策问题，牙科保健方面的不平等在发达国家和发展中国家都日益受到关注。因此，本研究的目的是考察牙科保健支出的不平等情况，并评估保险覆盖范围和其他变量对这些服务的影响。
在这项横断面描述性分析研究中，我们使用了2008年在伊朗进行的国民健康账户的二手数据。样本量为全国17239户家庭。所有分析均使用Stata软件进行，采用曼-惠特尼检验和逻辑回归。P<0.05被认为具有统计学意义。为了确定牙科服务的不平等情况，使用了集中指数（CI）。
牙科总支出的CI为0.315，正畸支出的CI为0.6。研究结果表明，牙科保健的自付费用是累进的，并且牙科总支出与居住地区（优势比[OR]=1.3；P>0.001）、补充保险覆盖范围（OR=1.3；P>0.001）、家庭规模（OR=1.46；P>0.001）和收入（OR=1.3；P>0.001）之间存在显著关系。
伊朗的牙科支出是累进的，富人在这些服务上支付了更多份额。看来实施保险计划、改变牙科保健的融资方式、制定保险基本福利套餐、为穷人提供支持计划、采取教育政策以及促进弱势群体的口腔健康，可能在减少牙科服务使用不平等方面发挥有效作用。
