Household expenditure for dental care in low and middle income countries.

Mohd Masood,Eduardo Bernabé,Aubrey Sheiham,Peter M Milgrom

doi:10.1371/journal.pone.0123075

Mohd Masood, Eduardo Bernabé + Show 2 more

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https://doi.org/10.1371/journal.pone.0123075

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Abstract

This study assessed the extent of household catastrophic expenditure in dental health care and its possible determinants in 41 low and middle income countries. Data from 182,007 respondents aged 18 years and over (69,315 in 18 low income countries, 59,645 in 15 lower middle income countries and 53,047 in 8 upper middle income countries) who participated in the WHO World Health Survey (WHS) were analyzed. Expenditure in dental health care was defined as catastrophic if it was equal to or higher than 40% of the household capacity to pay. A number of individual and country-level factors were assessed as potential determinants of catastrophic dental health expenditure (CDHE) in multilevel logistic regression with individuals nested within countries. Up to 7% of households in low and middle income countries faced CDHE in the last 4 weeks. This proportion rose up to 35% among households that incurred some dental health expenditure within the same period. The multilevel model showed that wealthier, urban and larger households and more economically developed countries had higher odds of facing CDHE. The results of this study show that payments for dental health care can be a considerable burden on households, to the extent of preventing expenditure on basic necessities. They also help characterize households more likely to incur catastrophic expenditure on dental health care. Alternative health care financing strategies and policies targeted to improve fairness in financial contribution are urgently required in low and middle income countries.

Highlights

The financial burden of illness and out-of-pocket expenditure on health care has been the focus of increasing attention in recent years
As costs of dental services are high in most countries [9,10] and dental diseases are very common worldwide [16,17,18], this study aimed to explore the extent of household catastrophic dental health expenditure and its possible determinants in 41 low and middle income countries
Data were from the World Health Survey (WHS) conducted in 2002–2004, which was launched by the World Health Organization (WHO) to provide valid, reliable and comparable information across 70 countries from all world regions regarding health status and health systems

Summary

Introduction

The financial burden of illness and out-of-pocket expenditure on health care has been the focus of increasing attention in recent years. Out-of-pocket payments are the primary source of health care financing in many countries, in the developing world [1], and are considered ‘catastrophic’ when they force households into having to reduce expenditure on basic necessities [2,3]. In the largest study to date including 89 countries covering 89% of the world population, 3% of households in low income countries, 1.8% of households in middle income countries and 0.6% of households in high income countries incur CHE [3]. Countries with lower Gross Domestic Product (GDP) per capita and greater income inequality were more likely to have higher proportions of households facing CHE [3] whereas rural residence, low income, presence of older adults and/or young children and lack of health insurance in the household were associated with higher propensity of CHE [2,8]

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