Objective The aim of this study was to estimate the dental expenditure and the availability of basic medical insurance in dental service for Chinese adults. Horizontal and vertical inequalities were examined and the key social determinants were identified to potentially explain such income-related inequalities in dental expenditure. Materials and Methods A secondary analysis used the data of 13,464 adults from the 4 th National Oral Health Epidemiological Survey (NOHES) in China was undertook. The dental expenditure including out-of-pocket and health insurance payments in the past year and in 13464 participants and 2740 of who used dental service in the past year was collected. Horizontal inequality index and Kakwani index were used to analyze the horizontal and vertical financial inequality, respectively. Decomposition of concentration index was made to explore the associated socioeconomic determinants. Results Mean dental expenditure per capita of Chinese adults was $20.54 (95% CI: 18.83,22.26) and for those who used dental service in the past one year, the number was $100.95(95%CI: 93.22,108.68). More than 90% of the expenditure was out-of-pocket. Horizontal inequality indices and Kakwani indices were both negative and that indicated inequalities were in favor of the rich. The socioeconomic factors including income, urban or rural area and educational attainment were the main contributors to the inequality of dental expenditure. Conclusion Social basic medical insurances hardly work in financial risk control of oral diseases. Deficiency and waste of dental service utilization coexist. The payments of dental expenditure were regressive. Socioeconomic status was the main determinant while oral hygiene practice and oral health status were the main individual determinants for the dental expenditure.

Background: The financial burden of oral diseases is getting more important. The aim of this study was to describe the dental expenditure, analyze its progressivity and horizontal inequality under the general health finance and insurance system, and identify the key social determinants of this inequality for Chinese adults. Methods: A secondary analysis used the data of 13,464 adults from the 4 th National Oral Health Epidemiological Survey (NOHES) in China was undertook. The dental expenditure in the past year divided into out-of-pocket and health insurance payments was collected. Horizontal inequality index and Kakwani index were used to analyze the horizontal inequality and progressivity, respectively. Decomposition of concentration index was made to explore the associated socioeconomic determinants. Results: Mean dental expenditure per capita of Chinese adults was $20.55 (95% CI: 18.83,22.26) and for those who used dental service in the past year, the number was $100.95(95%CI: 93.22,108.68). More than 90% of the expenditure was out-of-pocket. Horizontal inequality indices and Kakwani indices were both negative and that indicated inequalities were in favor of the rich. The socioeconomic factors including income, urban or rural area and educational attainment were the main contributors to the inequality of dental expenditure. Conclusion: Dental expenditure for Chinese adults was not too much under a pretty low utilization. The payments of dental expenditure were regressive. People with the most oral health need didn’t meet appropriate dental services. Socioeconomic characteristic including household income, area and education was the main determinant while oral hygiene practice and oral health status were the main individual determinants for the inequality of dental expenditure.

Background: The financial burden of oral diseases is a growing concern as the medical expenses rise worldwide. The aim of this study was to investigate the dental expenditure, analyze its progressivity and horizontal inequality under the general health finance and insurance system, and identify the key social determinants of the inequality for Chinese adults. Methods: A secondary analysis used the data of 13,464 adults from the 4 th National Oral Health Epidemiological Survey (NOHES) in China was undertaken. The dental expenditure was collected and divided into out-of-pocket and health insurance payments. Horizontal inequality index and Kakwani index were used to analyze the horizontal inequality and progressivity, respectively. The decomposition model of the concentration index was set up to explore the associated socioeconomic determinants. Results: The results showed that a mean dental expenditure per capita of Chinese adults was $20.55 (95% Confidence Interval-CI: 18.83,22.26). Among those who actually used dental service, the cost was $100.95 (95%CI: 93.22,108.68). Over 90% of dental spending was due to out-of-pocket expenses. For self-reported oral health, the horizontal inequality index was -0.1391 and for the decayed tooth (DT), it was -0.2252. For out-of-pocket payment, the Kakwani index was -0.3154 and for health insurance payment it was -0.1598. Income, residential location, educational attainment, oral hygiene practice, self-reported oral health, age difference were the main contributors to the inequality of dental expenditure. Conclusion: Dental expenditure for Chinese adults was at a lower level due to underutilization. The ratio of payments of dental expenditure and utilization was disproportional, whether it was out-of-pocket or insurance payment. Individuals who were more in need of oral care showed less demand for service or not required service in time. For future policy making on oral health, it is worth the effort to further promote the awareness of the importance of oral health and utilization of dental service.