The Impact of Expanded National Health Insurance Coverage of Dentures and Dental Implants on Dental Care Utilization among Older Adults in South Korea: A Study Based on the Korean Health Panel Survey

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.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Dental Expenditure by Household Income in Korea over the Period 2008–2017: A Review of the National Dental Insurance Reform

Shin

Cho

Kim

2021

“…Older adults may have delayed dental treatment, with the expectation of future expansion of benefit eligibility. For example, the OOP percentage was steadily reduced from 50% to 30% during the same period as the age of eligibility was lowered from 75 years or older down to 65 years or older [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…People aged 65 or older could save approximately 50–70% of their out-of-pocket expenditures for dental prosthetic treatment. However, such treatment may have continued to be unavailable to people with limited financial resources due to high costs [ 4 , 5 ]. For example, the average monthly income of older adults in Korea is less than 1000 USD [ 6 ]; however, they still need to pay approximately 700 USD for a covered dental prosthetic treatment (per denture service or a dental implant), regardless of their income level.…”

Section: Introductionmentioning

confidence: 99%

Did Expanded Dental Insurance Reduce Out-of-Pocket Expenditures on Dental Care among Older Adults in Korea? Interrupted Time-Series Analysis

Kim

Jung

Kawachi

2021

Self Cite

The Korean National Health Insurance extended its coverage to reduce the economic burden of receiving dentures and implants for older adults in 2012 and 2014, respectively. We examined whether the new policy resulted in reduced out-of-pocket dental care expenditure in the eligible population, specifically focusing on low-income adults. We used interrupted time-series analysis (ITSA), a quasi-experimental design, to identify the effects of the policy among persons aged 65 or older. Data were extracted from the Korea Health Panel Survey (KHP; 2008–2017). The main outcome was out-of-pocket expenditures on dental care. The ITSA showed that expenditures decreased annually by 4.5% (RR: 0.96, 95% CI: 0.95–0.96) between 2012 and 2014. However, expenditure increased by 7.8% (RR: 1.08, 95% CI: 1.07–1.08) after 2014. Dental insurance coverage did not contribute to reducing the out-of-pocket expenses for dentures among low-income adults, while coverage of dental implants led to an increase in dental expenditure.

“…In Sweden, one of the most generous countries regarding its health and welfare policies, payments for the dental implant are subsidized through a special high-cost protection scheme since 2012 [ 10 ]. The UK also provides coverage through a special subsidy, which depends on the clinical commissioning group [ 6 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Public Preferences in Resource Allocation for Insurance Coverage of Dental Implant Service in South Korea: Citizens’ Jury

Lee

Bae

Lee

et al. 2021

The Korean government sought to include dental implant services for the elderly in the benefits package of the national health insurance. In 2014, the Citizens’ Jury was held to discuss the topic, during which thirty jurors, randomly selected from the 2665 applicants, participated in a day-long deliberation process after having an information session on the topic by a team of experts. There was a substantial shift in opinion during the deliberation session toward a more cost-conscious view. Most jurors supported limiting the coverage of dental implant to only one tooth per individual given the extent of the financial burden that will be imposed on the population. They opposed covering implant services for the front teeth, given that the implant of front teeth generally serves aesthetic purposes rather than restoring mastication function. The government’s final decision in 2014 was to offer coverage up to two teeth, regardless of tooth location. This scheme based on the jury’s recommendations in 2014 has been implemented without policy failure to date, which shows that the lay public can meaningfully contribute to a decision-making process regarding controversial agendas such as benefits packages for expensive health services.