Does dental insurance make a difference in type of service received by Iranian dentate adults?

OBJECTIVES: To assess the relationship between insurance status and type of service received among dentate adults in a developing oral health care system. METHODS: A cross-sectional survey based on phone interviews in Tehran, Iran. Four trained interviewers collected data using a structured questionnaire. Of 1,531 subjects answering the phone call, 224 were <18 years; of the remaining 1,307, 221 (17%) refused to participate, and 85 (6%) were excluded as edentate or reporting no dental visit, leaving 1,001 eligible subjects in the sample. The questionnaire covered insurance status, socio-demographics, frequency of tooth brushing, dental attendance as reasons for, and time since last dental visit, and dental service received then. Data analysis included the chi-square test and logistic regression. RESULTS: Of the subjects, 71% had a dental insurance. Those with no insurance were more likely to report tooth extractions (OR=1.5) than those with an insurance coverage; for all other treatments no differences according to the insurance status appeared. Among the insured subjects, extractions were more likely for those reporting a problem-based dental visit (OR=6.0) or having a low level of education (OR=2.3). CONCLUSIONS: In Iran, with its developing oral health care system, dental insurance had only a minor impact on dental services reported.

Why do adults entitled to free or highly subsidized dental services select fully out-of-pocket-paid care?

OBJECTIVE: To investigate patients' reasons for selecting a dental clinic given their choice of free or highly-subsidized dental services. METHODS: The study was based on cross-sectional data obtained through phone interviews with adults in Tehran, Iran. The present study included those entitled to free or highly-subsidized dental services (n = 726). The data covered the patients' awareness of subsidized dental services and type of dental clinic for their most recent visit and their reasons for selecting that clinic. Awareness of subsidized dental services was dichotomized as being either aware or unaware of such subsidy. The type of clinic was dichotomized as providing either free or highly-subsidized (FHS) or fully out-of-pocket paid (FOP) services. Free format answers about the subjects' reasons for selecting a particular clinic were later sub-grouped as: convenient access, good technical aspects, good interpersonal aspects, low or reasonable fees, recommendation by a friend, and no reason. Socio-demographic status was based on background. Data analysis included the chi-square test and logistic regression model. RESULTS: Of the subjects (n = 726), 60% were women and 58% were under 35 years of age. The subjects' mean age was 33.5 years with no difference by gender (P = 0.24) and the majority had public insurance (91%). Of all the subjects, 60% selected FOP. Good interpersonal aspects were the strongest reason for selecting FOP (OR = 4.6), follow by good technical aspects (OR = 2.3). Those subjects who were unaware of their benefit had 4.6 times the odds of selecting FOP. CONCLUSIONS: Despite the opportunity to use highly-subsidized dental services, good interpersonal and good technical aspects lead patients to select private dentists and to pay fully out of pocket.

Impact of insurance scheme on adults' dental check-ups in a developing oral health care system.

OBJECTIVES: To find out the relationship between dental insurance and demand for dental care, the present study evaluated impact of insurance scheme on adults' dental check-ups in a developing oral health care system. METHODS: The target population included adults in the city of Tehran where the only telecommunication company provides 90% of the 1.9 million households with a fixed telephone. Of the 1531 subjects who answered the phone call, 224 were outside the target age (under 18), 67 said that they never had visited a dentist, and 221 refused to respond, leaving 1019 subjects in the final sample. Each interview lasted 15 minutes and was carried out using a structured questionnaire with fixed and open-ended questions. RESULTS: 71% of the subjects reported having dental insurance and 16% having visited a dentist for a check-up; 55%, more women than men, reported having had a dental visit within the past 12 months. CONCLUSIONS: The present results revealed the positive relationship between insurance and demand for dental care. Those having dental insurance were more likely to go to check-ups despite their generally low rate found in this country with a developing oral health care system. In such countries, health insurance schemes should therefore include obligatory regular dental check-ups to emphasize prevention-oriented dental care.