Impact of dental insurance on adults’ oral health care in Tehran, Iran.

The aim of the present study was to determine relationships between insurance status and utilization of oral health care and its characteristics and to identify factors related to insured patients’ selection of dental clinic or dentist. The study was based on cross-sectional data obtained through phone interviews. The target population included adults in the city of Tehran. Using a two-stage stratified random technique, 3,200 seven-digit numbers resembling real phone numbers were drawn; when calling, 1,669 numbers were unavailable (busy, no answer, fax, line blocked). Of the 1,531 subjects who answered the phone call, 224 were outside the target age (under 18), and 221 refused to respond, leaving 1,086 subjects in the final sample. The interviews were carried out using a structured questionnaire and covered characteristics of dental visits, the respondent’s reason for selecting a particular dentist or clinic and demographic and socio-economic background (gender, age, level of education, income, and insurance status). Data analysis included the Chi-square test, ANOVA, and logistic regression and the corresponding odds ratios (OR). Of all the 1,086 respondents, 57% were women, 62% were under age 35, 46% had a medium and 34% a high level of education, 13% were under the poverty line, and 70% had insurance coverage; 64% with the public, and 6% with a commercial insurance. Having insurance coverage was more likely for women (OR=1.5), for those in the oldest age group (OR=2.0), and for those with a high level of education (OR=2.5). Of those with dental insurance, 54% reported having had a dental visit within the past 12 months ; more often by those with commercial insurance in comparison with public (65% vs. 53% p<0.001). Check-up as the reason for the most recent visit occurred most frequently among those with commercial insurance (28%) compared with those having public insurance (16%) or being non-insured (13%) (p<0.001). Having had two or more dental visits within the past 12 months was most common among insured respondents, when compared with the non-insured (31% vs. 22% p=0.01). The non-insured respondents reported tooth extractions almost twice as frequently as did the insured ones (p<0.001). Of the 726 insured subjects, 60% selected fully out-of-pocket-paid services (FOP), and 53% were unaware of their insurance benefits. Of those who selected FOP, good interpersonal aspects (OR=4.6), being unaware of dental insurance benefits (OR=4.6), and good technical aspects (OR=2.3) as a reason had greater odds of selecting FOP. The present study revealed that dental insurance was positively related to demand for oral health care as well as to utilization of services, but to the latter with a minor extent. Among insured respondents, despite their opportunity to use fully or highly subsidized oral health care services, good interpersonal relationship and high quality of services were the most important factors when an insured patient selected a dentist or a clinic. The present findings indicate a clear need to modify dental insurance systems in Iran to facilitate optimal use of oral health care services to maximize the oral health of the population. A special emphasis in the insurance schemes should be focused on preventive care.Väitös hammashoitovakuutuksesta Iranilainen hammaslääkäri Fariborz Bayat väittelee Helsingin yliopistossa 28.5.2010 hammashoitovakuutuksen vaikutuksesta aikuisten suun terveyteen Teheranissa. Tutkimuksen tarkoituksena oli selvittää vakuutuksen vaikutusta hammashuoltopalvelujen käyttöön ja annetun hoidon sisältöön. Lisäksi määritettiin tekijöitä, jotka vaikuttavat vakuutettujen potilaiden hammaslääkärin valintaan. Tutkimus tehtiin puhelinhaastatteluin ja otos oli runsaat tuhat teheranilaista yli 18-vuotiasta asukasta. Hammashoitovakuutus oli yleisempi naisilla, vanhimmalla tutkitulla ikäryhmällä ja korkeimmin koulutetuilla. Runsaat puolet vakuutetuista oli käynyt hammaslääkärissä viimeksi kuluneen vuoden aikana ja yleisintä se oli kaupallisen vakuutuksen omaavien keskuudessa. Hampaiston tutkimus oli käynnin syy 28 prosentilla kaupallisen vakuutuksen omaavilla, 16 % julkisesti vakuutetuilla ja vain 13 % vakuuttamattomilla.Vakuutetuilla oli useampia hoitokäyntejä vuoden mittaan vakuuttamattomiin verrattuna. Hampaan poistot olivat lähes kaksi kertaa yleisempiä vakuuttamattomilla. Vaikka vakuutuksen omaavilla potilailla olisi ollut oikeus joko kokonaan tai osittain korvattuun hoitoon, niin monet kuitenkin maksoivat hoidon kokonaan itse, koska se mahdollisti hammaslääkärin valinnan ja toisaalta hoidon teknisen tason uskottiin olevan parempi korvaamattomassa yksityishoidossa. Toisaalta hieman yli puolet ei ollut edes tietoinen vakuutusturvastaan. Väittelijän mukaan Iranin nykyiset hammashuoltovakuutukset kaipaavat kehittämistä, jotta väestön suun ja hampaiden terveys voidaan maksimoida palvelujen sisältöä kehittämällä. Erityisen suuri tarve on sisällyttää ehkäisevä hoito vakuutusjärjestelmiin

A Model of Basic Dental Care Service for Iran

Objectives To study components of oral health care system in some developed countries and propose a model for Iran.Methods The present study was a qualitative, cross-sectional, and comparative research that took place in 2012. Oral health care systems in some developed countries have been reviewed to propose a framework for Iran. This framework has been discussed and reviewed by an expert panel using Delphi method.Results A table presenting type of service provider, type of centers and personnel, and methods for reimbursement in oral health care delivery system has been discussed by an expert panel. The experts, with an average 75% agreement rate, agreed on the need for a basic oral health care package free of charge for under 18-year-olds, compulsory periodical check-up examinations, and guarantee for payment of the services by national insurance funds. Simplicity, comprehensiveness, focus on prevention and at risk age groups facilitate the adaptability of the model to various populations.Conclusion An appropriate model for oral healthcare delivery system needs universal health insurance coverage, a basic service package focusing on preventive care with mandatory regular dental check-ups, participating of private practitioners, and financing services through government revenues, premium, and health tax

Assessment of demand for and utilization of dental services by insurance coverage in a developing oral health care system

Objectives This study aimed to evaluate the relationship between demand for and utilization of dental services by insurance coverage among adults in Iran.Methods A cross-sectional survey based on telephone interviews was done. A total of 6,029 adults participated in this study conducted in Iran. The interviews were carried out using a structured questionnaire and covered dental visits, demographics and socio-economic background.Results Of 6,029 participants, 86% reported having health insurance, 58% had public, and 28% had both public and commercial insurance. Those with both public and commercial insurance coverage had higher odds for dental visits within the past 12 months [odds ratio (OR) = 1.5], and for dental check-ups (OR = 1.5). Receipt of restorative and expensive services (OR = 1.4) was more likely by those with both public and commercial insurance. Tooth extraction was more likely in subjects with no insurance coverage (OR = 1.6).Conclusion This study revealed a positive relationship between insurance coverage and demand for and utilization of dental services in a country with a developing health care system

Varying manpower alters dental health in a developing healthcare system

Objectives: This study assessed relationships between oral health care workforce and dental health in 12-year-olds in a developing health care system in Iran from 1992 to 2014 and compared these findings with the most recent corresponding findings in selected countries. Methods: Data regarding oral health care workers from 1962 to 2014 were extracted from the comprehensive human resource data bank of the Shahid Beheshti Research Institute of Dental Sciences. Data regarding decayed, missing, and filled permanent teeth (DMFT) of 12-year-olds, extracted from official statistics, described dental health. Comparisons with other countries utilised the database of the World Health Organization. Changes in the DMFT index with fluctuations in the number of oral health care workers were investigated using exploratory data analysis methods. Associations of DMFT with the density of the oral health care workforce were evaluated using a multiple linear regression model. Results: The trend in supply of dental workforce in Iran began to expand in the 1970s and, after a reduction in 2003 to 2007, reached a peak by 2014. Means of DMFT indices of 12-year-olds in Iran fluctuated between 1.50 and 2.40 from 1992 to 2014. The relationship between the dentist to population ratio and the DMFT index of 12-year-olds showed a downwards trend (r = -0.994; P < .001) until 1998 and afterwards an upwards trend (r = 0.887; P < .001). Globally, the DMFT index decreased in countries with a preventively-oriented oral health care workforce. Conclusions: Increased numbers of dentists have no significant impact on improving dental health in 12-year-olds. To promote dental health, the system providing health services should implement a preventively-oriented approach when planning for the oral health workforce. (C) 2021 The Authors. Published by Elsevier Inc. on behalf of FDI World Dental Federation.Peer reviewe