Demand and Burden of Dental Care in Canadian Households Mustafa Andkhoie, MPH PhD student, Epidemiology University of Saskatchewan May 27 th, 2015
Introduction Dental Health Expenditure In Canada second-largest share of private-sector health care spending in 2010 annual growth of 5.9% since 2000. only 5% total dental health expenditure in Canada is publicly funded
Introduction Main source of financing for dental care: Employment-based insurance and out-of-pocket (OOP) expenditure 62% of Canadians have private dental insurance, 6% have public insurance and 32% have no dental insurance.
Purpose The purpose of this study was to examine the financial burden associated with out-of-pocket dental spending in Canada in order to investigate inequities requiring policy interventions.
Research Questions 1. A linear model was used to estimate the income elasticity of Canadians with respect to dental care. 2. A logistic model was used to identify the factors that predict the demand for dental care in Canada. 3. A multinomial model was used to identify the subsets within the Canadian population who were more or less likely to have higher or lower burden of dental expenditure on their income.
Study Design Survey of Household Spending: 2009 cycle (published by Statistics Canada) Variable of interest Control variables Province Income Private dental insurance Age Sex and Marital Status Rural Residence Employment and Education Household Size
Model 1: Income Elasticity Sensitivity of dental demand with change in household income Income elastic = 0.146 Normal necessity good Example, if income increases by 10% then dental expenditure increase by 1.46%, ceteris paribus.
Model 2: Demand for Dental Care Odds of spending on dental care in a household in Canada (n=9,831) Variable Odds Ratio Variable Odds Ratio Income Age $100,000 < 1.937* 65 and older 1.96* $70,000-$100,000 2.561* 50-64 years 1.50* $47,000-$69,000 3.054* 40-49 years 1.40* $27,000-$46,000 2.966* Private Insurance 1.54*
Model 3: Burden of Dental Care Likelihood of high financial burden due to dental care costs (n=9,831) Variable RRR Variable RRR Income Age $27,000 > 8.96* 65 and older 2.55* $27,000-$46,000 3.84* 50-64 years 1.78* $47,000-$69,000 2.23* 40-49 years 1.63* $70,000-$100,000 1.54* Private Insurance 0.84* Definitions: Higher burden: 1% of total household income spent on dental care Lower burden: >0% to <1% of total household income spent on dental care
Province Likelihood of high financial burden due to dental care costs (n=9,831) Province Burden (RRR) NFLD 0.61* NS 0.56* NB 0.70* QB 0.76 ON 1.16 MB 0.79 AB 1.16 BC 1.09 YTN 1.23
Limitations No dental utilization and dental health status data available in the Statistics Canada file Spending $0 on dental care may represent the subset of the population that do not spend on dental care and also those that have excellent dental care insurance coverage
Key messages Middle income = Highest odds of accruing out-of-pocket expenses on dental care and also, face high financial burden Private insurance increases demand for dental care but also reduces financial burden Households in Atlantic provinces least likely to have high financial burden Seniors have the highest odds of accruing out-of-pocket expenses on dental care and also, face high financial burden
Canadian Population
Implications The projected increase in dental care demand due to demographic changes in Canada requires further debate on universal dental insurance for basic primary dental care services.
References 1. Andkhoie M, Pandovska-Pelivanova E, Emmanuel S, Lateef F, Szafron M, Farag ME. (2014). Demand and Burden of Dental Care in Canadian Households. International Journal of Economics and Finance. 6(9): 73-82. 2. CIHI. (2012). National Health Expenditure Trends: 1975 to 2012. Canadian Institute for Health Information. Retrieved from https://secure.cihi.ca/free_products/nhextrendsreport2012en.pdf 3. Health Canada. (2010). Summary report on the findings of the oral health component of the Canadian Health Measures Survey: 2007 2009. Retrieved from http://www.fptdwg.ca/assets/pdf/chms/chms-e-summ.pdf
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