Since 2009, the National Health Insurance in Korea (NHI) has been implementing a series of policies to expand the scope of dental benefits. This study reviewed the changes in co-payments and dental use patterns before (2008 to 2012) and after (2013 to 2017) the NHI’s dental health insurance reform. The study used Korea Health Panel data of 7681 households (16,493 household members) from a 10-year period (2008–2017). Dental expenditures and equivalent income using square root of household size were analyzed. Dental services were categorized into 13 types and a concentration index and 95% confidence interval using the delta method was calculated to identify income-related inequalities by a dental service. Dental expenditures and the number of dental services used increased significantly, while the proportion of out-of-pocket spending by the elderly decreased. The expenditure ratio for implant services to total dental expenditures increased substantially in all age groups, but the ratio of expenditures for dentures and fixed bridges decreased relatively. The concentration index of implant services was basically in favor of the rich, but there was no longer a significant bias favoring the better-off after the reforms. The dental health insurance reform in Korea appears to contribute not only to lowering the ratio of out-of-pocket to total dental expenses per episode in the elderly but also to improving the inequality of dental expenses.

ObjectiveThis study aimed to calculate the distance patients travel to dental clinics, the rate of bypassing nearby dental clinics and the distance covered when bypassing nearby dental clinics, and explored factors associated with patients’ spatial access to dental clinics.DesignA secondary data analysis.SettingKorea Health Panel.ParticipantsWe included users of dental care services from 2008 to 2011. A total of 2375 patients and 15 978 dental visits were analysed.Primary outcome measuresKorea Health Panel data (2008–2011) were used to geocode patients’ and healthcare facilities’ addresses. The distance travelled was calculated using road network information. To analyse the panel data, we adopted a generalised estimating equation: geographical measures on the choice of dental care facility were examined based on sex, age, educational level, equivalent income, treatment details and regional classification.ResultsThe median distance travelled to a dental clinic was 1.8 km, which is farther for rural (8.4 km) than for urban (1.5 km) patients. The bypass rate was 58.9%. Patients bypassing nearby dental clinics travelled 9.6 times farther for dental care (p<0.001). Unlike bypass distance, travel distance was not associated with equivalent income. People with higher education and those with implants/orthodontic treatment were more likely to bypass nearby dental clinics and travelled 1.27 times and 1.17 times farther (p<0.01), respectively.ConclusionsGiven the spatial barrier to available dental resources, factors associated with spatial access were mostly the same between travel and bypass distance except for equivalent income. The findings of this study suggest that spatial distance acts as a utilisation barrier and demands additional opportunity cost. At the same time, patients’ preferences for services also increase their willingness to bypass nearby dental clinics and travel greater distances.

, missing tooth). The chi-square test and logistic regression analysis were performed to identify the association between oral health status and RA. Results of logistic regression analysis for association between periodontal status and RA was no significant. Results of logistic regression analysis for association between missing tooth and RA was statistically significant. The odds ratio (OR) for RA participants was 3.03 (95% confidence interval [CI], 1.47∼6.23) in missing tooth 19∼28 than missing tooth 0∼8. The OR for RA participants was 2.08 (95% CI, 1.06∼4.08) in missing tooth 9∼18 than missing tooth 0∼8. After adjustment for confounders (socio-demographic factors, health behaviors), results of logistic regression analysis was no significant. More missing tooth among adults was greater the risk of RA. By promoting the improvement of oral hygiene and oral health would contribute to reduce the risks associated with systemic diseases. Future study is needed to examine the detailed causal relations between oral health status and RA bidirectionally.

Background The present study aimed to investigate the association between oral health literacy and oral health behaviors among North Korean defectors. Methods This study involved the collection of self-reported questionnaires from 123 North Korean defectors visited a dental clinic that offered complimentary services, to receive dental treatment in a metropolitan area of South Korea from December 2017 to April 2018. Oral health literacy was measured with the Test of Korean Functional Health Literacy in Dentistry (TOKFHLiD), which consists of 30 items concerning verbal oral health literacy and 42 items concerning functional oral health literacy (28 items for reading comprehension and 14 items for numeracy). In addition, the questionnaire contains 15 and 14 items related to demographic characteristics and oral health behaviors (interest, lifestyle, diet, prevention), respectively, for a total of 101 items. Results The mean oral health literacy score was 44 (out of a maximum possible score of 72). Oral health literacy and oral health behaviors were positively correlated ( r = 0.526, P < 0.001), and oral health literacy also had a significant effect on oral health behaviors (Beta = 0.26, 95% CI: 0.04–0.33). However, although functional oral health literacy had a significant effect on oral health behaviors (Beta = 0.20, 95% CI: 0.01–0.43), verbal oral health literacy did not (Beta = 0.13, 95% CI: − 0.06-037). Conclusions Educational interventions are needed to improve oral health literacy, and thus oral health behaviors, as a part of the health promotion measures undertaken to facilitate the stable adjustment of North Korean defectors in South Korean society.

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