Journal List > J Korean Acad Oral Health > v.38(1) > 1057605

TOOLS
Kim, Ahn, Kim, Kim, and Shin: Trends of household income and dental care spending
Original Article

J Korean Acad Oral Health 2014;38(1):17-24.

Published online: 12 March 2014

DOI: https://doi.org/10.11149/jkaoh.2014.38.1.17

Trends of household income and dental care spending

Hye-sung Kim1, Eunsuk Ahn2, Min-Young Kim2, Sun-Mi Kim2, Hosung Shin2

1Apple Tree Dental Hospital, Ilsan, Korea

2Department of Humanity and Social Dentistry, Wonkwang University College of Dentistry, Iksan, Korea

Corresponding Author: Hosung Shin Department of Humanity and Social Dentistry, Wonkwang University College of Dentistry, 460 Iksan-dearo, Iksan 570-749, Korea Tel: +82-63-850-6915 Fax: +82-63-850-6934 E-mail: shinhosung@gmail.com

Received 11 December 2013       Revised 14 January 2014       Accepted 24 March 2014

Copyright © 2014 Journal of Korean Academy of Oral Health

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

This empirical study aimed to identify the differences in expenditures by household income level, as well as the patterns of dental care spending by dental services.

Methods

We analyzed the Korea Health Panel’s data collected between 2008 and 2010. We calculated expenditures by service items by itemizing dental care services such as conservative, prosthetic, orthodontic, periodontal, surgical, preventive, dental implant care. Then we obtained the ratios of spending per item and per visit to overall out-of-pocket spending on dental care and used these as the weights for dental care cost allocation. Income quintiles were derived using the equivalence scale. Kak-wani’s concentration index was used to determine the degree of disparity by income quintile, and 95% confidence intervals were computed.

Results

Out-of-pocket expenditures on dental care steadily increased over time and income quintile. The analysis of dental care spending by income quintile revealed that the level of expenditure of the first income quintile was 3.6 times lower than that of the fifth income quintile. In terms of expenditure comparison between 2008 and 2010, the first quintile households showed an increased spending on prosthetic and periodontal treatments, whereas the fifth quintile households spent a relatively high proportion on orthodontic and dental implant care. The concentration index revealed that conservative services and root canal treatments was significant and positive, indicating that the demand for, and utilization of, these services increase as household income increases. In contrast, prosthetic services showed a significant negative trend, indicating that these services are not as common among those with higher incomes.

Conclusions

To address the problems associated with the disparity in dental care expenditures based on income levels, it is necessary to establish policies that expand health insurance coverage and provide other supportive measures for low-income populations.

Keywords: Dental care expenditures, Household income, Concentration index, Korea Health Panel

References

1. Heo SI. Change in the financial burden of health expenditures by income level. Health-welfare Policy Forum. 2009; 5:48–62.
2. Song EC, Shin YJ. The effect of catastrophic health expediture on the transition to poverty and the persistence of poverty in South Korea. J Prev Med Public Health. 2010; 43:423–435.
3. Park MJ, Choi YS, Tae YH, Choi JH, Baek SJ, Lee HY. Survey on the benefit coverage rate of National Health Insurance. Seoul: Health insurance policy institute;2011. p. 61–83.
4. Millar WJ, Locker D. Dental insurance and use of dental service. Health Rep. 1999; 11:55–67.
5. Quiñonez C, Grootendorst P. Equity in dental care among Canadian households. Int J Equity Health. 2011; 10:1–14.
crossref
6. Yeo JY, Jeong HS. Determinants of dental screening and unmet dental needs: interaction effect between geographical accessibility and economic affordability. Korean J Health Econ Policy. 2012; 18:109–126.
7. Kim HS, Kim MK, Shin HS. Expenditure in ambulatory dental care and factors related to its spending. Korean J Health Policy Adm. 2012; 22:207–224.
crossref
8. Statistics Korea. Survey of Household Finances. Dae Jeon: Statistics Korea;2012. p. 26–39.
9. Jeong YH. A report on the Korea health panel survey: health care utilizations and out-of-pocket spending. Health-welfare Policy Forum. 2011; 179:64–81.
10. Kim DJ. Measurement of horizontal inequity in health care utilization using Korea health panal data. Health-welfare Policy Forum. 2012; 183:76–89.
11. Seo NG, Hwang YH, Kang TW, Ahn SJ, Beak SC, Lee DH. Total health expenditure long and medium term prospects. Seoul: National health insurance service;2012. p. 80–95.
12. Seo NK, Ahn SG, Hwang YH, Jeong YH, KO SJ. A report on the Korea health panel survey of 2010 II. Seoul: National health insurance service;2012. p. 41–42.
13. Kakwani N, Wagstaff A, Doorslaer E. Socioeconomic inequalities in health: measurement, computation, and statistical inference. J Econom. 1997; 77:87–103.
crossref
14. Jung HS. Korean national health accounts and total health expenditure in 2011. Seoul: Ministry of health and welfare, Yonsei institute of health and welfare;2011. p. 109–124.
15. OECD. Health at a glance 2011. Organization for Economic Cooperation and Development;2011.
16. Shin HS, Kim HD. Income related inequality of dental care utilization in Korea. Korea Institute for Health and Social Affairs policy report. 2006; 26:63–93.
17. Yoon YJ. Trend of horizontal equity in health care utilization and incidence of household catastrophic health expenditure [master’s thesis]. Seoul: Seoul National University;2012. [Korean].

Fig. 1.
Trend of dental service expenditures by household income quintile.
jkaoh-38-17f1.tif
Table 1.
The number of outpatient visits by service items (per capita)
Medical content 2008 2009 2010 Mean
N % N % N % %
Examination, consultation, Certification 0.23 1.63 0.19 1.20 0.23 1.52 1.45
Vaccination 0.67 4.71 0.71 4.57 0.85 5.63 4.97
Medication* 9.87 69.77 10.90 70.20 10.42 68.7 69.56
Rehabilitation, Physical treatment 1.18 8.35 1.32 8.47 1.36 8.98 8.60
Psychotherapy† 0.03 0.24 0.05 0.30 0.03 0.19 0.24
Surgery 0.06 0.42 0.06 0.39 0.06 0.39 0.40
Dental treatment 0.95 6.72 1.00 6.46 0.97 6.39 6.52
Oriental medicine 1.14 8.06 1.30 8.35 1.24 8.16 8.19
Other 0.01 0.09 0.01 0.06 0.01 0.04 0.06
Total (Number of visits per person per year) 14.15 100.0 15.53 100.0 15.16 100.0 100.0

*Injection, Prescription(prescription drug) etc.

† Therapeutic interview, Music/Art/Play psychotherapy including other.

Table 2.
Outpatient co-payments by service items (per capita)
Contents 2008 2009 2010 Mean
Cost (won) % Cost (won) % Cost (won) % %
Examination, consultation, Certification 11,693 4.45 8,950 3.41 9,093 3.46 3.60
Vaccination 26,196 9.97 28,712 10.93 33,511 12.75 10.63
Medication* 83,563 31.80 89,709 34.13 88,793 33.79 31.55
Rehabilitation, Physical treatment 5,183 1.97 5,245 2.00 6,311 2.40 2.01
Psychotherapy† 1,093 0.42 1,210 0.46 836 0.32 0.38
Surgery 11,439 4.35 12,295 4.68 15,872 6.04 4.76
Dental treatment 92,216 35.09 101,307 38.55 106,667 40.59 36.11
Oriental medicine 30,691 11.68 28,968 11.02 28,204 10.73 10.60
Other 735 0.28 1,380 0.52 782 0.30 0.35
Total (The cost per person per year) 262,808 277,782 290,074

*Injection, Prescription (prescription drug) etc.

† Therapeutic interview, Music/Art/Play psychotherapy including other.

Table 3.
Co-payment proportion by services (%)
Caries Denture Crown Implants Orthodontics Periodontics Endodontics Extraction Sealant Bleeching Other Impression Medical
Caries 0.50 0.73 0.74 0.80 0.62 0.28 0.31 0.33 0.33 0.76 0.41 0.47 0.12
Denture 0.27 0.50 0.51 0.59 0.38 0.13 0.14 0.15 0.15 0.54 0.21 0.25 0.05
Crown 0.26 0.49 0.50 0.58 0.36 0.12 0.14 0.15 0.15 0.53 0.20 0.24 0.04
Implants 0.20 0.41 0.42 0.50 0.29 0.09 0.10 0.11 0.11 0.44 0.15 0.19 0.03
Orthodontics 0.38 0.62 0.64 0.71 0.50 0.19 0.22 0.23 0.23 0.66 0.30 0.36 0.08
Periodontics 0.72 0.87 0.88 0.91 0.81 0.50 0.53 0.55 0.55 0.89 0.64 0.70 0.25
Endodontics 0.69 0.86 0.86 0.90 0.78 0.47 0.50 0.52 0.52 0.88 0.61 0.67 0.23
Extraction 0.67 0.85 0.85 0.89 0.77 0.45 0.48 0.50 0.50 0.87 0.59 0.65 0.22
Sealant 0.67 0.85 0.85 0.89 0.77 0.45 0.48 0.50 0.50 0.87 0.59 0.65 0.21
Bleeching 0.24 0.46 0.47 0.56 0.34 0.11 0.12 0.13 0.13 0.50 0.18 0.22 0.04
Other 0.59 0.79 0.80 0.85 0.70 0.36 0.39 0.41 0.41 0.82 0.50 0.56 0.16
Impression 0.53 0.75 0.76 0.81 0.64 0.30 0.33 0.35 0.35 0.78 0.44 0.50 0.13
Medical 0.88 0.95 0.96 0.97 0.92 0.75 0.77 0.78 0.79 0.96 0.84 0.87 0.50
Table 4.
The number of visits and co-payments by dental care items (unit : won)
Contents 2008 2009 2010 Mean
No Copay No Copay No Copay No Copay
Outpatient medical 13.20 170,592 14.53 176,474 14.19 183,407 13.97 176,824
Operative dentistry Cavity filling Total 0.26 25,638 0.25 27,932 0.23 23,947 0.25 25,839
Amalgam 0.09 1,951 0.06 920 0.06 886 0.07 1,252
Gold 0.07 12,459 0.06 14,010 0.05 10,321 0.06 12,263
Resin 0.09 10,403 0.12 12,135 0.11 10,393 0.11 10,977
Other 0.01 826 0.01 1,771 0.01 2,010 0.01 1,536
Endodontics 0.19 9,055 0.19 8,616 0.16 7,586 0.18 8,419
Prosthetics Denture 0.02 6,934 0.03 7,557 0.04 9,521 0.03 8,004
Gold crown 0.03 8,929 0.05 8,005 0.06 9,491 0.05 8,808
Implants 0.04 19,989 0.05 21,210 0.07 25,543 0.05 22,247
Orthodontics 0.06 7,661 0.07 11,973 0.08 13,551 0.07 11,062
Periodontics 0.19 6,133 0.22 8,900 0.22 8,256 0.21 7,763
Oral and Maxillofacial Surgery 0.09 5,089 0.09 4,890 0.08 4,463 0.09 4,814
Preventive Sealnat 0.03 1,197 0.02 956 0.01 856 0.02 1,003
Other 0.00 162 0.00 67 0.00 688 0.00 306
Other 0.03 1,428 0.03 1,187 0.02 2,459 0.03 1,691
Outpatient total per capita 14.16 262,808 15.53 277,782 15.16 290,074 14.95 276,888
Dental outpatient per capita 0.96 92,216 1.00 101,295 0.97 106,361 0.98 99,957
Dental outpatient per household 2.38 231,382 2.55 257,724 2.44 268,021 2.46 252,376

No, Number of visits; Other, Bleeching/Cosmetic dentistry; Copay, co-payment.

Table 5.
Annual co-payments of dental services by household income quintile (2008-2010) (unit : won)
Lowest quintile Second quintile Middle quintile Fourth quintile Highest quintile
Operative dentistry 40,703 77,944 103,322 144,989 212,273
Prosthetics 52,971 36,618 38,644 38,882 40,024
Implants 14,939 33,765 50,965 62,168 121,494
Orthodontics 6,698 14,437 22,437 36,413 82,312
Periodontics 15,576 14,021 23,427 27,282 24,531
Endodontics 4,565 7,341 6,948 7,163 12,318
Surgery 4,314 6,600 12,079 8,671 11,108
Other 4,416 5,704 5,355 10,660 15,888
Dental co-payment 144,183 196,430 263,177 336,228 519,949
Medical co-payment 481,542 599,067 720,996 914,310 1,329,612
TOOLS
Similar articles