Inequality in dental expenditures among Iranian households: A cross‑sectional survey using the National Health Accounts

Abstract

Background: Recently, inequality in dental care has become increasingly popular in both developed
and developing countries as a matter of health policy. Thus, the aims of this study were examining
inequality in dental care expenditures and assessing the effects of insurance coverage and other
variables on these services.
Materials and Methods: In this cross‑sectional and descriptive‑analytical study, we used secondary
data of the National Health Accounts that has been conducted in 2008 in Iran. The sample size was
17,239 households in all over the country. All analyses were performed by Stata software using
Mann–Whitney test and logistic regression. P < 0.05 was considered statistically significant. To
determine inequality in dental services, the concentration index (CI) was used.
Results: CI for total dental expenditures was 0.315 and for orthodontics was 0.6. Findings
showed that out‑of‑pocket expenditure for dental care was progressive and there was a significant
relationship between total dental expenditure with residence areas (odds ratio [OR] =1.3; P > 0.001),
complementary insurance coverage (OR = 1.3; P > 0.001), family size (OR = 1.46; P > 0.001), and
income (OR = 1.3; P > 0.001).
Conclusion: Dental expenditures were progressive in Iran, and the rich have paid more share for
these services. It seems that implementing insurance programs, changes in the financing of dental
care, development of insurance basic benefits package, supporting programs for the poor, adopting
educational policies, and promoting oral health for vulnerable people can have an effective role in
decreasing inequality in using dental services