The impact of out-of-pocket payments for dental care on household finances in low and middle income countries

Eduardo Bernabé,Mohd Masood,Marko Vujicic

doi:10.1186/s12889-017-4042-0

Abstract

BackgroundDental care is extremely costly and beyond most people means in developing countries. The primary aim of this study was to determine the impact of out-of-pocket payments for dental care on household finances in 40 low and middle income countries. A second aim was to compare the burden of payments for dental care with that for other health services.MethodsWe used data from 174,257 adults, aged 18 years and above, who reported their total and itemized household expenditure in the past four weeks as part of the World Health Surveys. The financial burden on households was measured using the catastrophic health expenditure (CHE) and impoverishment approaches. A household was classified as facing CHE if it spent 40% or more of its capacity to pay, and as facing impoverishment if it fell below the country-specific poverty line after spending on health care was subtracted from household expenditure. The odds of experiencing CHE and impoverishment due to expenditure on dental care were estimated from two-level logistic regression models, controlling for various individual- and country-level covariates.ResultsHouseholds that paid for dental care had 1.88 (95% Confidence Interval: 1.78-1.99) greater odds of incurring CHE and 1.65 (95% CI: 1.52–1.80) greater odds of facing impoverishment, after adjustment for covariates. Furthermore, the impact of paying for dental care was lower than that for medications or drugs, inpatient care, outpatient care and laboratory tests but similar to that of health care products, traditional medicine and other health services.ConclusionHouseholds with recent dental care spending were more likely to use a large portion of their disposable income and fall below the poverty line. Policy makers ought to consider including dental care as part of universal health care and advocate for the inclusion of dental care coverage in health insurance packages.

Highlights

Dental care is extremely costly and beyond most people means in developing countries
Households that paid for dental care had 1.88 and 1.65 greater odds of facing catastrophic health expenditure (CHE) and impoverishment, respectively, than those that did not pay for dental care, after controlling for all individual— and country-level covariates
The odds of CHE were 1.52, 2.34 and 1.63, and the odds of impoverishment were 1.38, 1.90 and 1.59 in Low income countries (LIC), Lower middle income countries (LMIC) and Upper middle income countries (UMIC), respectively

Summary

Introduction

Dental care is extremely costly and beyond most people means in developing countries. The primary aim of this study was to determine the impact of out-of-pocket payments for dental care on household finances in 40 low and middle income countries. Governments around the world have been called on to move towards universal health coverage for their citizens [1] Such commitment requires that everyone receives needed health care services without experiencing financial difficulty [1, 2]. Despite recent efforts to search for alternative health financing mechanisms [3, 4], outof-pocket payments are the primary mechanism to finance health services in low and middle income countries [2, 5]. Households that are in rural areas, low income, have older adults, young children or disabled members, and lack health insurance are more likely to face CHE and impoverishment [11,12,13]. The use of specific health services, such as inpatient care, prescription drugs and Bernabé et al BMC Public Health (2017) 17:109 even visits to traditional healers, may lead to CHE and impoverishment [14,15,16,17]

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