Dental expenditure and income-related inequality in Chinese adults

Abstract

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.