Regional Inequality in Dental Care Utilization in Japan: An Ecological Study Using the National Database of Health Insurance Claims

Taira, Kento; Mori, Takahiro; Ishimaru, Miho; Iwagami, Masao; Sakata, Nobuchika; Watanabe, Taeko; Takahashi, Hideto; Tamiya, Nanako

doi:10.1016/j.lanwpc.2021.100170

Cited by 14 publications

(12 citation statements)

References 34 publications

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“…This may be because even though SSS and UCS provide full coverage for extraction, UCS subscribers might tend to be informal or low-income workers with poor oral health. When visiting a dentist, their oral diseases might have already progressed to the worst stage, requiring tooth extraction [ 25 ]. Another possibility is that both those covered by UCS and those who were insured but have to pay extra had serious tooth disease already and thus tended to require more definitive dental treatment such as extractions instead of treatments that require a series of appointments and repeated visits to the dentist [ 24 ].…”

Section: Econometrics Estimation and Resultsmentioning

confidence: 99%

“…e findings suggest that there may be fewer dental visits for preventive care since people with lower income and education levels tend to have dental diseases that had become serious by the time they visited the dentist [25].…”

Section: Literature Review On Moral Hazard and Demand For Dental Carementioning

confidence: 96%

“…A current study in Japan showed that average income per head and college enrollment were positively associated with preventive care and were negatively associated with curative care. The findings suggest that there may be fewer dental visits for preventive care since people with lower income and education levels tend to have dental diseases that had become serious by the time they visited the dentist [ 25 ].…”

Section: Literature Review On Moral Hazard and Demand For Dental Carementioning

confidence: 99%

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Moral Hazard and the Demand for Dental Treatment: Evidence from a Nationally Representative Survey in Thailand

Srimuang

Pholphirul

2022

International Journal of Dentistry

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Even though there are examples in the health economics literature of evidence investigating moral hazard in health insurance provided by general healthcare services, studies of moral hazard in dental care in developing countries are still scarce, especially when it comes to nationally representative data on dental care demand and expenditure. Using Thailand as a case study, we investigate here whether moral hazard in dental insurance exists and, if so, the extent to which it affects different dental insurance on the demand for dental care in developing countries. We use a nationally representative sample of 269,206 individuals to quantify the impacts of dental care insurance on four sets of dependent variables describing demand for dental care. They are: (i) dental care utilization, (ii) numbers of dental care visits, (iii) dental care expenditure, and (iv) each type of dental care. Our probit and tobit estimations show that there is no evidence of the existence of moral hazard in terms of dental care utilization and dental care expenditure. However, there is a moral hazard of dental insurance existence on the number of dental care visits and type of dental care. People with generous dental benefits coverage tend to use preventive dental treatments along with necessary treatment but also use costly restorative dental treatments more than do those with lower coverage. It can thus be concluded that, in the case of developing countries, dental care insurance is found to increase the use of dental care, especially for preventive care.

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Section: Econometrics Estimation and Resultsmentioning

confidence: 99%

Section: Literature Review On Moral Hazard and Demand For Dental Carementioning

confidence: 96%

Section: Literature Review On Moral Hazard and Demand For Dental Carementioning

confidence: 99%

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Moral Hazard and the Demand for Dental Treatment: Evidence from a Nationally Representative Survey in Thailand

Srimuang

Pholphirul

2022

International Journal of Dentistry

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“…The age distribution and sex ratio differ between secondary medical areas, and the standardized claim ratio (SCR) was calculated for each area, as performed in previous studies [14,22,31]. The rate of multi-psychotropic drug prescription (Number of prescriptions per population) for each age group and sex in Japan was calculated.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, data on medical expenses that are not covered by insurance and uninsured persons' data are not included in the NDB data [21]. Numerous studies have been carried out using the NDB's aggregate data which are publicly accessible as open data [14,22,23].…”

Section: Outcome Variablementioning

confidence: 99%

Regional difference in multi-psychotropic drug prescription in Japan and its associated factors: an ecological study using national health insurance claims data

Okui

Nakashima

2023

Res Health Serv Reg

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Background In Japan, regulations preventing the prescriptions of various types of psychotropic drugs have become stricter in recent years. However, the areas where multi-psychotropic drug prescriptions are common and the geographic factors that contribute to the regional difference, have not been studied. In this study, we used data from all claims in Japan to examine regional differences in the prescription for multi-psychotropic drugs using an ecological study. Methods The National Database of Health Insurance Claims and Specific Health Checkups of Japan Open data in 2019 were used. The outcome was the number of prescriptions for four or more different types of anxiolytics and hypnotics as well as for three or more of the same kind of psychotropic drugs (any one of anxiolytics, hypnotics, antipsychotics, antidepressants) for outpatients in each area. Among the 335 secondary medical areas in Japan, the data on 331 areas were used in the analysis. The standardized claim ratio (SCR), an indicator of the number of this multi-psychotropic drug prescription, correcting for regional differences in distribution of population by age and sex, was calculated for each of the secondary medical areas. The spatial cluster detection technique was used to locate a cluster of high-SCR areas. Furthermore, factors associated with regional differences in the SCRs were examined by a spatial statistics model. Results North Japanese regions tend to have high SCRs, and 13 areas in Hokkaido were identified as the most likely cluster (cluster with the highest likelihood ratio) for multi-psychotropic drug prescription. Furthermore, a spatial regression analysis revealed that the proportion of people with lower educational levels, the total number of prescriptions per capita, and the number of physicians working in psychiatric departments per capita were statistically positively associated with the SCR for the prescription of multiple psychotropic drugs. Conclusions It was suggested that socioeconomic and medical characteristics of areas are related to the regional variation in the multi-psychotropic drug prescriptions, however, further research using individual-level data is required to confirm these results.

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Preventive dental care reduces risk of cardiovascular disease and pneumonia in hemodialysis population: a nationwide claims database analysis

Mikami,

Mizutani,

Ishimaru

et al. 2024

Sci Rep

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This study aims to investigate the impact of dental care utilization status on the occurrence of fatal complications such as cerebral/cardiovascular disease (CVD) and infectious diseases in patients with end-stage renal disease (ESRD) undergoing hemodialysis. This retrospective cohort study was performed using the Japanese claims database and included patients who first underwent hemodialysis between April 2014 and September 2020. The exposure variable of interest was the pattern of dental utilization, which was categorized into three groups, “dental treatment group”, “preventive dental care group”, and “no-dental visit group”. The primary outcomes were the time interval until a composite end point of first major cardiovascular event (acute myocardial infarction, heart failure, or cerebral infarction) of infectious disease (pneumonia and sepsis). The secondary outcomes were the time interval until the incidence of each component of primary outcomes. Survival analyses, including log-rank tests and Cox proportional hazards regression analyses, were performed. Among the 10,873 patients who underwent the first dialysis treatment, 6152 were assigned to the no-dental visit group, 2221 to the dental treatment group, and 2500 to the preventive dental care group. The preventive dental care group had significantly lower hazard ratios (HRs) of the incidence of CVD (adjusted hazard ratio [aHR]: 0.86, 95% confidence interval [CI]: 0.77–0.96) and infectious diseases (aHR: 0.86, 95% CI: 0.76–0.97). As for pneumonia, preventive dental care and dental treatment groups had significantly lower HRs (aHR: 0.74 and 0.80, 95% CI: 0.61–0.88, 0.66–0.96) than the no-dental visit group. This study demonstrated that dental visits for preventive dental care were associated with a significant risk reduction in CVD and infectious complications in patients with ESRD undergoing hemodialysis.

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Regional Inequality in Dental Care Utilization in Japan: An Ecological Study Using the National Database of Health Insurance Claims

Cited by 14 publications

References 34 publications

Moral Hazard and the Demand for Dental Treatment: Evidence from a Nationally Representative Survey in Thailand

Moral Hazard and the Demand for Dental Treatment: Evidence from a Nationally Representative Survey in Thailand

Regional difference in multi-psychotropic drug prescription in Japan and its associated factors: an ecological study using national health insurance claims data

Preventive dental care reduces risk of cardiovascular disease and pneumonia in hemodialysis population: a nationwide claims database analysis

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