Pilotto Luciane Maria, Celeste Roger Keller
Department of Social and Preventive Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Community Dent Oral Epidemiol. 2022 Apr;50(2):99-105. doi: 10.1111/cdoe.12636. Epub 2021 Mar 14.
To explore contextual factors associated with overall dental service use, and investigate whether these factors influenced choice of the type of service according to the healthcare financing alternatives (public services; out-of-pocket services; and private health insurance), by adults and older individuals, based on the most recent Andersen's behavioural model.
Cross-sectional study with individual data on 17,305 adults from 177 Brazilian municipalities in the National Oral Health Survey (SBBrasil 2010). Municipal-level information was obtained from health information systems and census data. Multilevel multinomial logistic regression was carried out for multivariable analysis.
In the previous year, 38.2% of the individuals visited the dentist; of which 21.4% used out-of-pocket spending, 11.6% used public services and 5.2% private dental insurance. Municipalities with population coverage of public primary dental care >80% had higher chances of using public services (OR = 1.28, 95%CI:1.00-1.64) than those with ≤60%, but lower chances of using private insurance (OR = 0.56, 95%CI:0.38-0.83). Municipalities with population coverage of private dental insurance > 5% had lower chances of using public services (OR = 0.62, 95%CI:0.47-0.81) than those with <1% coverage, and greater chances of using private insurance (OR = 4.33, CI:95% 2.02-9.29). These factors were not associated with out-of-pocket dental services.
Municipal coverage of dental services is associated with dental care use, and this is different according to the type of financing system (public or private), as they may change the individual's choice of service. A large public healthcare system may increase public service use for those with reduced access and decrease private service use.
根据最新的安德森行为模型，探讨与总体牙科服务利用相关的背景因素，并调查这些因素是否会根据医疗保健融资方式（公共服务、自付费用服务和私人医疗保险）影响成年人及老年人对服务类型的选择。
在全国口腔健康调查（SBBrasil 2010）中，对来自巴西177个城市的17305名成年人的个体数据进行横断面研究。市级信息来自卫生信息系统和人口普查数据。进行多水平多项逻辑回归以进行多变量分析。
在前一年，38.2%的个体看过牙医；其中21.4%使用自付费用，11.6%使用公共服务，5.2%使用私人牙科保险。公共初级牙科保健人口覆盖率>80%的城市使用公共服务的几率（OR = 1.28，95%CI：1.00 - 1.64）高于覆盖率≤60%的城市，但使用私人保险的几率较低（OR = 0.56，95%CI：0.38 - 0.83）。私人牙科保险人口覆盖率>5%的城市使用公共服务的几率（OR = 0.62，95%CI：0.47 - 0.81）低于覆盖率<1%的城市，使用私人保险的几率更高（OR = 4.33，CI：95% 2.02 - 9.29）。这些因素与自付牙科服务无关。
牙科服务的市级覆盖率与牙科护理利用相关，并且根据融资系统类型（公共或私人）而有所不同，因为它们可能会改变个体对服务的选择。庞大的公共医疗系统可能会增加那些获得服务机会减少的人对公共服务的使用，并减少私人服务的使用。
