Abstract
BackgroundWhile oral health is part of general health and well-being, oral health disparities nevertheless persist. Potential mechanisms include socioeconomic factors that may influence access to dental care in the absence of universal dental care insurance coverage. We investigated the evolution, prevalence and determinants (including socioeconomic) of forgoing of dental care for economic reasons in a Swiss region, over the course of six years.MethodsRepeated population-based surveys (2007–2012) of a representative sample of the adult population of the Canton of Geneva, Switzerland. Forgone dental care, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods.ResultsA total of 4313 subjects were included, 10.6% (457/4313) of whom reported having forgone dental care for economic reasons in the previous 12 months. The crude percentage varied from 2.4% in the wealthiest group (monthly income ≥13,000CHF, 1CHF ≈ 1$) to 23.5% among participants with the lowest income (<3,000CHF). Since 2007/8, forgoing dental care remained stable overall, but in subjects with a monthly income of <3,000CHF, the adjusted percentage increased from 16.3% in 2007/8 to 20.6% in 2012 (P trend = 0.002). Forgoing dental care for economic reasons was independently associated with lower income, younger age, female gender, current smoking, having dependent children, divorced status and not living with a partner, not having a supplementary health insurance, and receipt of a health insurance premium cost-subsidy.ConclusionsIn a Swiss region without universal dental care insurance coverage, prevalence of forgoing dental care for economic reasons was high and highly dependent on income. Efforts should be made to prevent high-risk populations from forgoing dental care.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6831-14-121) contains supplementary material, which is available to authorized users.
Highlights
While oral health is part of general health and well-being, oral health disparities persist
Using population-based data from a Swiss urban region with a compulsory health insurance system but without a universal dental care insurance coverage, we found that forgoing dental care for economic reasons was frequently reported
After taking into account other factors, not having a supplementary health insurance doubled the odds of forgoing dental care for economic reasons. This is very similar to findings reported in France [28,40], and is in line with a phenomena called “unobserved behavior” by Manki et al This study reported that having medical insurance with or without coverage for dental care in a non-universal care healthcare system (e.g., United States) is associated with an increased likelihood of having a dental visit [41,42]
Summary
While oral health is part of general health and well-being, oral health disparities persist. In France, for example, the prevalence of the forgoing dental care for economic reasons has been shown to be higher in regions (i.e., departments) where dental procedure rates are highest [25]. This issue of access to dental care is of major concern because economically vulnerable populations are the most in need of this service [26,27]. While the conceptual model for oral health inequalities is complex, differential access to dental care may contribute to oral health disparities, given that forgoing dental care due to financial hardship is associated with poorer oral health in several prior reports [28,29,30,31,32]
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