Income, dental insurance coverage, and financial barriers to dental care among Canadian adults
Income, dental insurance coverage, and financial barriers to dental care among Canadian adults
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DOI：
10.1111/j.1752-7325.2011.00277.x
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发表时间：
2011-09-01
影响因子：
2.3
通讯作者：
Quinonez, Carlos
中科院分区：
文献类型：
--
作者：
Locker, David;Maggirias, John;Quinonez, Carlos
目的：通过评估加拿大成年人的收入、牙科保险和牙科护理的经济障碍之间的关系，来探讨牙科护理的可负担性问题。方法：采用基于随机数字拨号的电话访谈调查的方法，从18岁及以上的全国成人样本中收集数据。调查询问了有关家庭收入和牙科保险覆盖范围的问题，以及有关获得牙科护理的成本障碍的三个问题。这些问题是：“在过去的三年里……牙科保健的费用对你来说是一种经济负担吗？……你是否因为费用而推迟或避免去看牙医？……你是否因为费用而无法接受牙医推荐的所有治疗？”结果：这项调查由2027人完成，其中超过一半的人(56.0%)由私人牙科保险覆盖，4.9%的人由公共牙科计划覆盖。其余39.1%的人自掏腰包支付牙科护理费用。最低收入群体中只有19.3%的人拥有私人保险，而最高收入群体的这一比例为80.5%(P<；0.001)。一半(48.2%)对关于成本障碍的三个问题中的至少一个做出了积极回应，14.8%对所有三个问题都做出了积极回应。低收入受试者(P<；0.001)和没有牙科保险的受试者(P<；0.001)最有可能报告护理方面的经济障碍。虽然私人牙科保险减少了牙科护理的经济障碍，但它并没有完全消除它，特别是对低收入者来说。那些报告这些障碍的人去看牙医的频率较低，在控制了收入和保险覆盖的影响后，口腔健康结果较差。结论：加拿大成年人报告了牙科护理的经济障碍，特别是低收入者。这些障碍似乎对牙科就诊和口腔健康结果产生了负面影响。对于政策来说，适当性将是关键，因为需要明确什么是实际需要，因此哪些牙科服务可以被视为公共卫生对负担能力的反应。
Objectives: To explore the issue of affordability in dental care by assessing associations between income, dental insurance, and financial barriers to dental care in Canadian adults.Methods: Data were collection from a national sample of adults 18 years and over using a telephone interview survey based on random digit dialing. Questions were asked about household income and dental insurance coverage along with three questions concerning cost barriers to accessing dental care. These were: "In the past three years...has the cost of dental care been a financial burden to you?...have you delayed or avoided going to a dentist because of the cost?...have you been unable to have all of the treatment recommended by your dentist because of the cost?"Results: The survey was completed by 2,027 people, over half of which (56.0%) were covered by private dental insurance and 4.9 percent by public dental programs. The remainder, 39.1 percent, paid for dental care out-of-pocket. Only 19.3 percent of the lowest income group had private coverage compared with 80.5 percent of the highest income group (P < 0.001). Half (48.2%) responded positively to at least one of the three questions concerning cost barriers, and 14.8 percent responded positively to all three. Low income subjects (P < 0.001) and those without dental insurance (P < 0.001) were most likely to report financial barriers to care. While private dental insurance reduced financial barriers to dental care, it did not entirely eliminate it, particularly for those with low incomes. Those reporting such barriers visited the dentist less frequently and had poorer oral health outcomes after controlling for the effects of income and insurance coverage.Conclusions: Canadian adults report financial barriers to dental care, especially those of low income. These barriers appear to have negative effects with respect to dental visiting and oral health outcomes. For policy, appropriateness will be key, as clarity needs to be established in terms of what constitutes actual need, and thus which dental services can then be considered a public health response to affordability.