Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada.
Public Health Ontario, Toronto, Canada.
BMC Oral Health. 2024 Apr 29;24(1):503. doi: 10.1186/s12903-024-04271-0.
In Canada, as in many other countries, private dental insurance addresses financial barriers to a great extent thereby facilitating access to dental care. That said, insurance does not guarantee affordability, as there are issues with the quality and level of coverage of insurance plans. As such, individuals facing barriers to dental care experience poorer oral health. Therefore, it is important to examine more keenly the socio-demographic attributes of people with private insurance to particularly identify those, who despite having insurance, face challenges in accessing dental care and experience poorer oral health.
This study is a secondary data analysis of the most recent available cycle (2017-18) of the Canadian Community Health Survey (CCHS), a national cross-sectional survey. Univariate analysis was conducted to determine the characteristics of Ontarians with private insurance (n = 17,678 representing 6919,814 Ontarians)-bivariate analysis to explore their financial barriers to dental care, and how they perceive their oral health. Additionally, logistic regressions were conducted to identify relationships between covariates and outcome variables.
Analysis shows that the majority of those with private insurance do not experience cost barriers to dental care and perceive their oral health as good to excellent. However, specific populations, including those aged 20-39 years, and those earning less than $40,000, despite having private dental insurance, face significantly more cost barriers to access to care compared to their counterparts. Additionally, those with the lowest income (earning less than $20,000 annually) perceived their oral health as "fair to poor" more than those earning more. Adjusted estimates revealed that respondents aged 20-39 were six times more likely to report cost barriers to dental care and ten times more likely to visit the dentist only for emergencies than those aged 12-19. Additionally, those aged 40-59 were two times more likely to report poorer oral health status compared to those aged 12-19.
Given the upcoming implementation of the Canadian Dental Care Plan, the results of this study can support in identifying vulnerable populations who currently are ineligible for the Plan but can be benefitted from the coverage.
在加拿大，与许多其他国家一样，私人牙科保险在很大程度上解决了财务障碍，从而促进了人们获得牙科护理。也就是说，保险并不能保证人们能够负担得起，因为保险计划的质量和保障水平存在问题。因此，那些面临牙科护理障碍的人会经历更差的口腔健康。因此，重要的是要更深入地研究有私人保险的人的社会人口属性，特别是要确定那些尽管有保险，但在获得牙科护理方面面临挑战并经历较差口腔健康的人。
本研究是对加拿大社区健康调查（CCHS）最新可用周期（2017-18 年）的二次数据分析，这是一项全国性的横断面调查。进行单变量分析以确定安大略省有私人保险的人的特征（n=17678，代表 6919814 名安大略省人）-进行双变量分析以探讨他们获得牙科护理的财务障碍，以及他们如何看待自己的口腔健康。此外，还进行了逻辑回归以确定协变量和结果变量之间的关系。
分析表明，大多数有私人保险的人不会面临牙科护理的费用障碍，并且认为自己的口腔健康状况良好到优秀。然而，特定人群，包括 20-39 岁的人群和收入低于 40000 加元的人群，尽管有私人牙科保险，但与同龄人相比，他们在获得护理方面面临更多的费用障碍。此外，收入最低的人群（年收入低于 20000 加元）认为自己的口腔健康状况“一般到差”的比例高于收入较高的人群。调整后的估计显示，20-39 岁的受访者报告说，他们在获得牙科护理方面面临费用障碍的可能性是 12-19 岁受访者的六倍，而去看牙医只是为了治疗紧急情况的可能性是后者的十倍。此外，40-59 岁的人群与 12-19 岁的人群相比，报告口腔健康状况较差的可能性是后者的两倍。
鉴于加拿大牙科保健计划即将实施，本研究的结果可以支持确定目前不符合该计划资格但可以从覆盖范围中受益的弱势群体。
