Dental Care Expenditures Research Articles

The relationship between preventive dental care and overall medical expenditures.

To examine the relationship between preventive dental visits (PDVs) and medical expenditures while mitigating bias from unobserved confounding factors. Retrospective data analysis of Indiana Medicaid enrollment and claims data (2015-2018) and the Area Health Resources Files. An instrumental variable (IV) approach was used to estimate the relationship between PDVs and medical and pharmacy expenditures among Medicaid enrollees. The instrument was defined as the number of adult enrollees with at least 1 nonpreventive dental claim per total Medicaid enrollees within a Census tract per year. In naive analyses, enrollees had on average greater medical expenditures if they had a prior-year PDV (β = $397.21; 95% CI, $184.23-$610.18) and a PDV in the same year as expenditures were measured (β = $344.81; 95% CI, $193.06-$496.56). No significant differences in pharmacy expenditures were observed in naive analyses. Using the IV approach, point estimates of overall medical expenditures for the marginal enrollee who had a prior-year PDV (β = $325.17; 95% CI, -$708.03 to $1358.37) or same-year PDV (β = $170.31; 95% CI, -$598.89 to $939.52) were similar to naive results, although not significant. Our IV approach indicated that PDV was not endogenous insomespecifications. This is the first study to present estimates with causal inference from a quasi-experimental study of the effect of PDVs on overall medical expenditures. We observed that prior- or same-year PDVs were not related to overall medical or pharmacy expenditures.

Dental Expenditures of population in Georgia

Nowadays the increasing cases of oral diseases requires to enlarge the costs of their treatment. However, in developing countries, including Georgia, where the majority of the population is low-income or unemployed, their spending on dental services is too small. Over the years, in Georgia, the share of healthcare expenses in the population's consumer expenditures varies within 10%, while the share of dental expenses in the whole consumer expenditures is about 0.5%. The share of dental expenses in healthcare expenditures is about 5%. 17.0% of respondents spend up to 100 GEL on dental services, 56.3% spend between 100 and 500 GEL, 12.0% spend between 500 and 1000 GEL, and 14.7% spend more than 1000 GEL. Expenditures for dental care vary significantly by gender, age, region, and between employed and unemployed persons. About a one third of the surveyed population cannot afford to visit a dentist for prevention or treatment due to low income.

Proposal and thoughts on establishing and improving multi-level dental insurance in China

Oral diseases are highly prevalent in China, while oral health services are generally underutilized and public health resources are wasted. Lacking oral insurance may be one of the leading causes. The basic medical insurance of China does not cover dental care in most cities, which is worthy to further discuss. To better understand the experience of dental insurance from international dental care practice, the dental coverage scope, content, co-pay ratio, and effects of oral insurance on oral health improvement from the abroad countries with typical health insurance systems were summarized by using scoping review. Then, we discussed the coverage scope for dental health of basic medical insurance and private insurance in China. We also analyzed the current issues of dental care coverage and cost-share. At last, we proposed thoughts and suggestions to establish and improve a multi-level oral health insurance system with Chinese characteristics under the basic medical insurance frame. In particular, we gave suggestions on increasing the coverage for high dental care xpenditure by ebasic medical insurance, supplying children and teenagers with preventive dental care, and encouraging private insurance companies to cover dental care expenditure.

The effects of orthodontic treatment on personal dental expenditures in South Korea: a follow-up study using Korean health panel survey

BackgroundThis study aimed to investigate the effects of orthodontic treatment on cumulative out-of-pocket (OOP) expenditures for up to 8 years and the factors contributing to changes in individual OOP dental expenses.MethodsThe data of adults aged ≥19 years, 218 with experience of orthodontic treatment (OT group) and 654 without experience of orthodontic treatment (non-OT group) were extracted from the Korea Health Panel Survey between 2009 and 2017 using the propensity score matching method. The total personal OOP expenditure for dental care incurred after orthodontic treatment in the OT group and that incurred in the matched non-OT group were calculated. Since dependent variables, cumulative dental expenditures, were continuous with excess zeros, Tweedie compound Poisson linear models were used to explore the influence of orthodontic treatment experience and demographic and socioeconomic factors, including private insurance, on per capita OOP dental expenditures.ResultsThe OT group had socioeconomic characteristics distinct from those of general dental patients. The Box–Cox transformed per capita OOP expenditures for dental care in the OT group were lower than those in the non-OT group (P < 0.05). When all covariates were held constant, the non-OT group spent 1.4-times more on OOP dental expenditures, but this was not statistically significant (P > 0.1). The data from those with higher incomes revealed the opposite trend (P < 0.05), while the other covariates were not statistically significant.ConclusionsOrthodontic treatment had no positive or negative effect on future oral care use. This finding is similar to the inconsistent results of previous clinical studies on oral health and orthodontic treatment.

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

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.

Socioeconomic inequalities in the utilization of dental services among adults in Saudi Arabia

BackgroundThis study used the Anderson Behavioral Model to assess the socioeconomic inequalities in dental services utilization among adults in Saudi Arabia, along with other predictors of utilization, to inform future planning of dental care services.MethodsThis cross-sectional study was a secondary analysis using national data from the 2019 Kingdom of Saudi Arabia World Health Survey (KSAWHS). The survey consisted of two interviewer-administered questionnaires: one household and one individual interview. The questions covered predisposing factors (age, gender, marital status, nationality, education, employment), enabling factors (income, household wealth, area-based socioeconomic class, health insurance, eligibility for free governmental health care, transportation and region of residence) and self-reported need for dental treatment. The main outcome was dental utilization in the past year; predisposing, enabling and need factors were independent variables. Hierarchical logistic regression analyses identified significant predictors of dental utilization, applying survey weights to adjust for the complex survey design. Adjusted odds ratios with 95% confidence intervals and p values were reported in the final model.ResultsThe final dataset included 8535 adults (response rate = 95.4%). Twenty percent of adults had visited the dentist at least once in the past year (95% CI 18–21%). There were socioeconomic inequalities in dental utilization. High household income (OR 1.43, p = 0.043), second and middle household wealth status (OR 1.51, p = 0.003 and OR 1.57, p = 0.006) and access to free governmental health care (OR 2.05, p = 0.004) were significant predictors in the final regression model along with perceived need for dental treatment (OR 52.09, p < 0.001).ConclusionSocioeconomic inequalities in the utilization of dental services exist in Saudi Arabia. The need for treatment was the strongest predictor suggesting predominantly symptomatic attendance. Increasing awareness about the importance of preventive dental visits rather than symptomatic attendance could be an important policy implication to improve oral health and optimize dental care expenditure. Further research should explore the drivers for adults to seek preventive care in the absence of any recognized dental problems.

Association between Participation in the Short Version of a Workplace Oral Health Promotion Program and Medical and Dental Care Expenditures in Japanese Workers: A Longitudinal Study.

Studies suggest that intensive oral health promotion programs in the workplace reduce dental and medical care expenditures. The purpose of this longitudinal study was to evaluate the short version of an oral health promotion program in the workplace from the viewpoint of dental and medical care expenditures. Data for annual expenditures and number of days of dental, periodontal, and medical treatment in fiscal year 2018 and participation in the short version of a workplace oral health promotion program of 2545 workers (20–68 years old) in a company in fiscal year 2017 and prior were obtained. Zero-inflated negative binomial regression models or negative binomial regression models were used to evaluate the association between participation in the program and expenditures or number of days of treatment after adjusting for sex and age. Program participants were more likely than non-participants to visit dentists for dental and periodontal treatment. Those who participated twice or more spent less on dental, periodontal, and medical treatment and had fewer visits to dentists than non-participants. These results suggest that the short version of an oral health promotion program in the workplace decreases expenditures for dental, periodontal, and medical treatment.

Inequality in dental care expenditure in Iranian households: analysis of income quintiles and educational levels

BackgroundOral health is a major public health issue which affects the human life. Access to dental care is one of the important factors in maintaining oral health. This study was aimed to investigate inequality in dental care expenditure in Iranian households.MethodsThe present study is a secondary analysis of a national cross-sectional survey. The data collected from the Households Income and Expenditure Survey in 2016 and 2017. The final sample consisted of 54,354 households living in rural and urban regions of all the provinces. Inequalities in household’s dental care expenditure per capita in respect to income quintiles and educational level were measured based on the Gini coefficient and concentration index.ResultsThe results showed that about 8% of households had paid for dental care during the month before sampling. The Gini coefficient value was estimated to be 0.97 and 0.96 for dental care expenditure per capita respectively in absolute and relative measure. It indicated a significant inequality in the dental expenditure among the sample households. The values of concentration index were positive and significant for all dental care subcategories in respect to the provincial and national income quintiles as well as the educational level of the head of the household.ConclusionsIncome and educational inequality in the both absolute and relative dental services expenditure of the Iranian households were in favor of higher income groups as well as higher educational level of household heads. Income inequality was higher in total dental care expenditure per capita and all its subcategories than the educational inequalities of dental expenditure. In order to reduce these inequalities, the policymakers need to pay special attention to low-income households, particularly those with low-educated heads.

Incremental Dental Expenditures Associated With Diabetes Among Noninstitutionalized U.S. Adults Aged ≥18 Years Old in 2016-2017.

Diabetes is associated with poor oral health, but incremental expenditures for dental care associated with diabetes in the U.S. are unknown. We aimed to quantify these incremental expenditures per person and for the nation. We analyzed data from 46,633 noninstitutionalized adults aged ≥18 years old who participated in the 2016-2017 Medical Expenditure Panel Survey. We used two-part models to estimate dental expenditures per person in total, by payment source, and by dental service type, controlling for sociodemographic characteristics, health status, and geographic variables. Incremental expenditure was the difference in predicted expenditure for dental care between adults with and without diabetes. The total expenditure for the U.S. was the expenditure per person multiplied by the estimated number of people with diabetes. Expenditures were adjusted to 2017 USD. The mean adjusted annual diabetes-associated incremental dental expenditure was $77 per person and $1.9 billion for the nation. Of this incremental expenditure, 51% ($40) and 39% ($30) were paid out of pocket and by private insurance, 69% ($53) of the incremental expenditure was for restorative/prosthetic/surgical services, and adults with diabetes had lower expenditure for preventive services than those without (incremental, -$7). Incremental expenditures were higher in older adults, non-Hispanic Whites, and people with higher levels of income and education. Diabetes is associated with higher dental expenditures. These results fill a gap in the estimates of total medical expenditures associated with diabetes in the U.S. and highlight the importance of preventive dental care among people with diabetes.

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

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.

Socio–Economic Disparities in Dental Health and Dental Care Utilisation Among Older Chinese

IntroductionDental care is mostly excluded from healthcare coverage in China. This study examines disparities in dental care and in the costs of such care, according to insurance type and socio–economic status, among Chinese older adults. MethodsThe data were obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). A final sample of 5,230 respondents was included, with a mean age of 72 years. Edentulousness, any dental visit and per-patient dental care expenditure were used as outcome variables. Both unweighted and weighted logistic regression analyses were used to examine the association of socio–economic status (education, insurance type and income) associated with edentulousness and use of dental care. ResultsWe found that 28% of Chinese older adults have no remaining teeth and that only 19% had used dental care in the past year. The uninsured and those with rural resident insurance had edentulousness rates of 31%, while the edentulousness rate in those with urban employee insurance was 19%. About 13% of the uninsured study respondents and 15% of those with rural resident insurance had used dental care compared with 30% of those with urban employee insurance. Those in the highest income and education groups and those enrolled in a plan with a lower coinsurance rate had a higher likelihood of using dental care services and spending more on dental care than did those in the lowest socio–economic groups. ConclusionsDental care disparities in China may be reduced through increasing the proportion of the population with insurance and expanding the range of dental treatments covered by all three major insurance schemes.

Barriers to the access of oral health care facilities among adults: an exploratory study from Lahore

Background: Oral health is one of the key indicators of the quality of life, overall health and well‑being of the general population. Globally, the high prevalence of the periodontal disease, excessive tooth loss, dental caries experiences, oral cancers and xerostomia are the major issues reported among adult populations. Timely access to oral healthcare facilities preserves the function, morbidity and mortality. The best possible health outcomes are only possible if the personal health care services are accessible timely. So, the primary objective of this study was to explore the barriers to the access of oral health care facilities among adults. In addition, the study also determined the association between adult’s demographic factors and their visits to dental clinics. &#x0D; Subjects and methods: This exploratory study was conducted for two months between November 2019 and January 2020. The study recruited 400 adults including 200 males and 200 females visiting outpatient department (OPD) of public hospital i.e. Jinnah Hospital, Lahore. Participants were included in this study if they were 18 years of age or older and had provided written informed consent before data collection. Data were collected using a structured questionnaire whereas barriers to access the oral healthcare facilities was confirmed by asking an open-ended question. Statistical Package for Social Sciences (SPSS) software was used to calculate descriptive statistics (i.e., mean, standard deviation, percentages). The study also determined the association between sociodemographic factors of adults and their tendency to visit dental clinics just for routine checkups using the chi-square test.&#x0D; Results: The average age of the participants was 36.81±9.29 years ranged from 18 – 63 years. Of the 400 participants, 259 (64.75%) reported costly treatment as a barrier affecting access to oral healthcare facilities followed by difficulty in access to dental clinics (27.75%) and fear of the pain of dental procedures (20.25%). Only 52 (13%) adults were regularly visiting dental clinics for routine check-ups whereas 21 (5.25%) respondents never had been to the dentist throughout their life. Nearly, half of the respondents i.e. 189 (47.25%) stated that dental care expenditures were borne by them and none of them was health insured. Statistically, a significant association was found between demographics (i.e. education, rural background and income) and the tendency to visit the dental clinics (p&lt;0.05).&#x0D; Conclusion: Expensive treatment, difficulty in accessing dental facilities and fear from dental procedures are the major barriers to the utilization of dental services. Access to dental clinics for routine check-ups is significantly influenced by sociodemographic factors.

Health and dental care expenditures in the United States from 1996 to 2016.

As total health and dental care expenditures in the United States continue to rise, healthcare disparities for low to middle-income Americans creates an imperative to analyze existing expenditures. This study examined health and dental care expenditures in the United States from 1996 to 2016 and explored trends in spending across various population subgroups. Using data collected by the Medical Expenditure Panel Survey, this study examined health and dental care expenditures in the United States from 1996 to 2016. Trends in spending were displayed graphically and spending across subgroups examined. All expenditures were adjusted for inflation or deflation to the 2016 dollar. Both total health and dental expenditures increased between 1996 and 2016 with total healthcare expenditures increasing from $838.33 billion in 1996 to $1.62 trillion in 2016, a 1.9-fold increase. Despite an overall increase, total expenditures slowed between 2004 and 2012 with the exception of the older adult population. Over the study period, expenditures increased across all groups with the greatest increases seen in older adult health and dental care. The per capita geriatric dental care expenditure increased 59% while the per capita geriatric healthcare expenditure increased 50% across the two decades. For the overall US population, the per capita dental care expenditure increased 27% while the per capita healthcare expenditure increased 60% over the two decades. All groups except the uninsured experienced increased dental care expenditure over the study period. Healthcare spending is not inherently bad since it brings benefits while exacting costs. Our findings indicate that while there were increases in both health and dental care expenditures from 1996 to 2016, these increases were non-uniform both across population subgroups and time. Further research to understand these trends in detail will be helpful to develop strategies to address health and dental care disparities and to maximize resource utilization.

PND124 INFLUENCE OF COMORBIDITIES ON HEALTHCARE EXPENDITURES AND PERCEIVED PHYSICAL AND MENTAL HEALTH STATUS AMONG ADULTS WITH MULTIPLE SCLEROSIS: A PROPENSITY SCORE MATCHED US NATIONAL-LEVEL STUDY

To evaluate the effect of comorbidities on healthcare expenditures and perceived physical and mental health status among adults with Multiple Sclerosis (MS) compared to propensity score-matched non-MS controls. A retrospective, cross-sectional, matched cohort study was conducted using the nationally representative Medical Expenditure Panel Survey (2005-2015) data. The base study sample consisted of adults (age ≥ 18 years) who were alive and had positive total healthcare expenditures during the calendar year. Adults with MS were propensity-matched (1:1) to non-MS controls based on age, gender, and race/ethnicity using a greedy matching algorithm (8:1-digit match). Healthcare expenditures consisted of total and subtypes (inpatient, outpatient, emergency room, prescription drugs, home health agency, dental care, and other expenditures) of healthcare expenditures. Health status consisted of perceived physical and mental health status. Comorbidities were identified using ICD-9-CM and Clinical Classification System codes. Ordinary Least Squares regression and multinomial logistic regression were used to analyze the healthcare expenditures and health status variables, respectively. The final study sample consisted of 541 adults in each MS and non-MS control groups after propensity score matching. Yearly average total expenditures (expressed in 2018 US$) were significantly (p<0.001) higher for adults with MS ($29,396) compared to propensity score-matched non-MS adults ($7,875). After adjusting for potential confounders, individuals with MS had greater total and sub-types of expenditures compared to non-MS controls, and several comorbidities (e.g., depression, hypertension) were significantly associated with increased healthcare expenditures. Individuals with MS were more likely to report good and poor/fair physical and good mental health status (reference group=excellent) compared to propensity score-matched non-MS controls, and several comorbidities (e.g., anxiety, depression, emphysema, hypertension) were significant independent predictors of lower health status. Findings from this study indicate substantial economic and health status burden among adults with MS at US national-level that are significantly influenced by comorbidities.

Estimating Lifetime Dental Care Expenditure in South Korea: An Abridged Life Table Approach.

The aim of this study was to measure the magnitude and distribution of a Korean’s lifetime dental expenses depending on age and sex, by constructing a hypothetical lifetime and life table of survival. Additionally, we estimated the difference in life expectancy between men and women and its impact on dental expenses. We used the 2015 Korea Health Panel Survey to calculate the total dental expenditure, including expenses paid directly by patients and those paid by insurers. We generated survival profiles to simulate dental expenses during a typical lifetime (from birth to age 95) using the abridged life table (five-year intervals for age groups) in 2015 from the South Korean Statistical Information Service. We independently calculated the remaining dental expenses for survivors of all ages. The results showed that an estimate of average lifetime dental expenditure was $31,851 per capita: $31,587 for men and $32,318 for women. Nearly 33% of the average per capita lifetime dental expenditure was attributable to the longer life expectancy of women, with no statistically significant difference in lifetime dental expenditure between men and women. Many survivors incurred 70% of their lifetime dental expenses before age 65. The results highlighted the need for policymakers to address spending on age-specific dental care owing to extended life expectancy, given the disproportionate share of healthcare resources supporting the elderly.

L’effet du non-recours aux soins médicaux et dentaires sur les dépenses de santé des personnes ayant une maladie chronique

BackgroundPeople with chronic disease often have dental (especially periodontal) disorders. Nevertheless, people with chronic disease seek dental care less often than others. We wanted to know if there is a relationship between the consumption of medical care and the consumption of dental care, and if so if the relationship is especially strong for people with chronic disease. MethodsWe conducted a longitudinal study that combined two data-sets: consumption data from the French National Health Insurance Fund and health and socioeconomic welfare data collected with a dedicated national survey. We studied healthcare expenditure and analyzed the association between healthcare consumption, health status and healthcare expenditure over a four-year period (2010–2013). ResultsPeople who did not seek medical or dental care in 2010 exhibited irregular consumer behavior thereafter. This pattern was particularly evident among those with chronic disease whose healthcare expenditures did not stabilize during the study period compared with the rest of the study population. Among people who did not seek medical care in 2010, variation in average dental care expenditure was 91% in people with chronic disease versus 42% for those without chronic disease. Lack of medical care during the first year of the study was also associated with greater expenditure-delay in people with chronic disease (77%) compared with 15% in people without chronic disease. ConclusionThe lack of medical or dental care in 2010 for people with chronic disease did not lead to an increase in medical and dental consumption in the following years. The catch-up delay was longer than four years. This highlights a problem of monitoring and identifies a marginalized population within the healthcare system.

Inequality in dental expenditures among Iranian households: A cross-sectional survey using the National Health Accounts

Recently, inequality in dental care has become increasingly popular in both developed and developing countries as a matter of health policy. Thus, the aims of this study were examining inequality in dental care expenditures and assessing the effects of insurance coverage and other variables on these services. In this cross-sectional and descriptive-analytical study, we used secondary data of the National Health Accounts that has been conducted in 2008 in Iran. The sample size was 17,239 households in all over the country. All analyses were performed by Stata software using Mann-Whitney test and logistic regression. P < 0.05 was considered statistically significant. To determine inequality in dental services, the concentration index (CI) was used. CI for total dental expenditures was 0.315 and for orthodontics was 0.6. Findings showed that out-of-pocket expenditure for dental care was progressive and there was a significant relationship between total dental expenditure with residence areas (odds ratio [OR] =1.3; P > 0.001), complementary insurance coverage (OR = 1.3; P > 0.001), family size (OR = 1.46; P > 0.001), and income (OR = 1.3; P > 0.001). Dental expenditures were progressive in Iran, and the rich have paid more share for these services. It seems that implementing insurance programs, changes in the financing of dental care, development of insurance basic benefits package, supporting programs for the poor, adopting educational policies, and promoting oral health for vulnerable people can have an effective role in decreasing inequality in using dental services.

Changes in dental care utilization and expenditure by the expansion policy of the health insurance coverage : Korea Health Panel Survey 2012-2016

Changes in dental care utilization and expenditure by the expansion policy of the health insurance coverage : Korea Health Panel Survey 2012-2016

The Effects of Dental Hygienist Autonomy on Dental Care Utilization

Because of the limited supply of health care providers relative to the demand for health care services, increases in provider autonomy are believed to improve access to health care by reducing barriers to the provision of certain services. However, research on the impact of scope of practice laws for health and dental professionals is limited. We investigate the effects of regulations governing the practice autonomy of dental hygienists on dental care use and expenditure using the 2001–2014 Medical Expenditure Panel Survey. We measure the strength of autonomy regulations by extending the Dental Hygiene Professional Practice Index to the years 2001–2014, allowing us to capture changes in regulations within states over time. Using a difference-in-differences framework, we find that relaxing supervision requirements to provide dental hygienists greater autonomy results in higher levels of dental care utilization in areas with a shortage of dental care providers. Moreover, expanding dental hygienist autonomy increased the use of many services that dental hygienists perform, such as cleanings, fluoride treatments, sealant applications, and fillings. We also find that greater autonomy reduces costs associated with dental treatment for both individuals and third-party payers.

Effects of expanding a non-contributory health insurance scheme on out-of-pocket healthcare spending by the poor in Turkey

IntroductionInsufficient or no health insurance creates financial access barriers to healthcare services, especially for vulnerable populations. The Green Card scheme, a non-contributory government-funded health insurance scheme for the poor in...