Journal List > J Korean Acad Oral Health > v.38(4) > 1057611

Kim, Ahn, and Shin: How does private health insurance affect dental care utilization?

Abstract

Objectives

This study discussed dental care utilization efficiency and equity from the perspective of private health insurance policy using the 2011 Korea Health Panel dataset.

Methods

A total of 10,577 subjects, aged 20 years or older, were selected from a larger sample (N=18,256). The study conducted a two-part model analysis to determine the impact of private health insurance on utilization and amount of dental care.

Results

Average monthly payment of private health insurance is 76,727 KRW. Analysis of average monthly fees and income distribution by quartile showed that higher income groups pay proportionally more for private health insurance. The highest income group was 3.82 times more likely to have private health insurance than the lowest income group. Those with private health insurance coverage had a higher probability of using dental care but were not more likely to use a greater number of dental services.

Conclusions

Based on these empirical findings, a guarantee of health care system and policy equity and efficiency should be established for changes in private health insurance.

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Fig. 1.
Average monthly payments of private health insurance by household income quartile.
jkaoh-38-203f1.tif
Table 1.
Definition of operational variables
Variables Detail
Dependent variables Whether one uses dental care for a year or not No (1), Yes (2)
variables The visit number of dental care utilization for a year The visit number of dental care utilization for a year
Independent Private health insurance type of subscription status Uninsured (1), Fixed benefit insured (2), Indemnity insured (3)
variables Gender Male (1), Female (2)
Age 20-45 years (1), 45-65 years (2), ≥65 years (3)
Marital status Married (1), Unmarried (2), Divorced/Widowed/Separated (3)
Household income quartile Low (1), Low-middle (2), High-middle (3), High (4)
Chronic disease No (1), Yes (2)
Economic activity Non-activity (1), Activity (2)
Education level ≤Primary school (1), Middle school (2), High school (3), ≥College (4)
Table 2.
Demographic characteristics of the study subjects
Characteristics Classification Total outpatient (N=10,577) Dental outpatient (N=2,636)
Frequency Percentage Frequency Percentage
Gender Male 4,558 43.09 1,132 42.94
Female 6,019 56.91 1,504 57.06
Age 20-45 years 3,817 36.09 887 33.65
45-65 years 3,980 37.63 1,078 40.90
≥65 years 2,780 26.28 671 25.46
Education level ≤Primary school 2,630 24.87 581 22.04
Middle school 1,325 12.53 377 14.30
High school 3,282 31.03 828 31.41
≥College 3,340 31.58 850 32.25
Marital status Married 7,916 74.84 2,004 76.02
Unmarried 1,239 11.71 318 12.06
Divorced/Widowed/Separated 1,422 13.44 314 11.91
Economic activity Activity 6,141 58.06 1,523 57.78
Non-activity 4,436 41.94 1,113 42.22
Household income quartile Low 1,533 14.49 338 12.82
Low-middle 2,163 20.45 501 19.01
High-middle 3,094 29.25 761 28.87
High 3,787 35.80 1,036 39.30
Chronic disease Yes 7,396 69.93 1,905 72.27
No 3,181 30.07 731 27.73
Average number of visits 1.22 (3.34)* 4.91 (5.16)*

note: *Mean (Standard Deviation).

Table 3.
Demographic characteristics of the study subjects by private health insurance
Variables Classification Insured Non-insured P-value*
Frequency Percentage Frequency Percentage
Gender Male 3,036 42.47 1,522 44.40 0.060
Female 4,113 57.53 1,906 55.60
Age 20-45 years 3,214 44.96 603 17.59 <0.001
45-65 years 3,136 43.87 844 24.62
≥65 years 799 11.18 1,981 57.79
Education level ≤Primary school 1,057 14.79 1,573 45.89 <0.001
Middle school 856 11.97 469 13.68
High school 2,499 34.96 783 22.84
≥College 2,737 38.29 603 17.59
Marital status Married 5,665 79.24 2,251 65.67 <0.001
Unmarried 896 12.53 343 10.01
Divorced/Widowed/Separated 588 8.22 834 24.33
Economic activity Activity 4,702 65.77 1,439 41.98 <0.001
Non-activity 2,447 34.23 1,989 58.02
Household income quartile Low 472 6.60 1,061 30.95 <0.001
Low-middle 1,206 16.87 957 27.92
High-middle 2,274 31.81 820 23.92
High 3,197 44.72 590 17.21
Chronic disease Yes 4,521 63.24 2,875 83.87 <0.001
No 2,628 36.76 553 16.13

note: *by Chi-square test.

Table 4.
Characteristics of private health insurance (Unit: numbers/won)
Classification Frequency Percentage
Insured 7,14967.59 67.59
Non-insured 3,42832.40 32.40
Coverage status Fixed benefit insured 6,06984.89 84.89
Indemnity insured 1,080 15.10
Average number per total number of persons 1.36 (1.39)*
Average number per person 2.02 (1.23)*
Average monthly payment per total numberof persons 43,363 (60,889)*
Average monthly payment per sign upperson 76,727 (65,068)*

note: *Mean (Standard Deviation).

Table 5.
Effects of private health insurance coverage
Variables Exp (B) P-value* S.E. 95% CI
Gender
Male 1
Female 1.386 <0.001 0.076 1.244 1.543
Age
20-45 years 1
45-65 years 0.655 <0.001 0.053 0.560 0.766
≥65 years 0.136 <0.001 0.013 0.113 0.163
Education level
≤Primary school 1
Middle school 1.443 <0.001 0.120 1.226 1.698
High school 1.414 <0.001 0.107 1.219 1.640
≥College 1.710 <0.001 0.155 1.432 2.042
Marital status
Married 1
Unmarried 0.335 <0.001 0.031 0.280 0.401
Divorced/Widowed/Separated 0.783 <0.001 0.059 0.676 0.907
Economic activity
Non-activity 1
Activity 1.508 <0.001 0.081 1.357 1.676
Household income quartile
Low 1
Low-middle 1.637 <0.001 0.131 1.399 1.914
High-middle 2.429 <0.001 0.194 2.078 2.840
High 3.824 <0.001 0.322 3.242 4.510
Chronic disease
No 1
Yes 0.808 <0.001 0.052 0.709 0.921

note: *by Logistic regression.

Table 6.
Affecting factors to visit dental care utilization
Variables Exp (B) P-value* S.E. 95% CI
Gender
Male 1
Female 1.060 0.216 0.053 0.965 1.173
Age
20-45 years 1
45-65 years 1.403 <0.001 0.090 1.239 1.591
≥65 years 1.587 <0.001 0.141 1.335 1.889
Education level
≤Primary school 1
Middle school 1.349 <0.001 0.110 1.150 1.581
High school 1.228 0.006 0.092 1.061 1.423
≥College 1.256 0.007 0.107 1.063 1.484
Marital status
Married 1
Unmarried 1.205 0.022 0.098 1.028 1.413
Divorced/Widowed/Separated 0.875 0.079 0.067 0.753 1.016
Economic activity
Non-activity 1
Activity 0.942 0.237 0.048 0.853 1.040
Household income quartile
Low 1
Low-middle 1.042 0.619 0.086 0.886 1.226
High-middle 1.115 0.186 0.092 0.949 1.310
High 1.265 0.005 0.107 1.072 1.493
Private health insurance coverage
Uninsured 1
Fixed benefit insured 1.239 <0.001 0.074 1.104 1.393
Indemnity insured 1.218 0.027 0.108 1.021 1.446

note: *by two-part (part 1) Logistic regression.

Table 7.
Affecting factors of the number of dental care visits
Variables IRR S.E P-value* 95% CI
Gender
Male 1
Female 0.983 0.044 0.712 0.900 1.075
Age
20-45 years 1
45-65 years 1.218 0.069 <0.001 1.090 1.361
≥65 years 1.260 0.100 0.003 1.079 1.472
Education level
≤Primary school 1
Middle school 0.946 0.068 0.446 0.822 1.090
High school 0.972 0.068 0.683 0.848 1.114
≥College 0.938 0.074 0.418 0.803 1.095
Marital status
Married 1
Unmarried 1.158 0.083 0.040 1.007 1.333
Divorced/Widowed/Separated 1.010 0.067 0.879 0.887 1.150
Economic activity
Non-activity 1
Activity 0.982 0.045 0.693 0.897 1.075
Household income quartile
Low 1
Low-middle 1.242 0.090 0.003 1.077 1.432
High-middle 1.257 0.092 0.002 1.088 1.451
High 1.158 0.086 0.047 1.002 1.339
Private health insurance coverage
Uninsured 1
Fixed benefit insured 0.981 0.051 0.712 0.886 1.086
Indemnity insured 0.892 0.065 0.119 0.773 1.030

note: *by two-part (part 2) Poisson regression.

IRR: Incident Rate Ratio.

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