title: Why do adults entitled to free or highly subsidized dental services select fully out-of-pocket-paid care?
abstract: 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.
authors.affiliation: Institute of Dentistry, University of Helsinki, Finland. fariborz.bayat@helsinki.fi
authors.forename: Fariborz
authors.initials: F
authors.lastname: Bayat
authors.forename: Miira M
authors.initials: MM
authors.lastname: Vehkalahti
authors.forename: Heikki
authors.initials: H
authors.lastname: Murtomaa
authors.forename: Heikki
authors.initials: H
authors.lastname: Tala
mesh_terms: D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D003740:Dental Clinics; D003752:Dental Health Services / Q000191:economics*; D003812:Dentist-Patient Relations; D004522:Educational Status; D005250:Fees, Dental; D005260:Female; D005380:Financing, Government / Q000191:economics*; D005382:Financing, Personal / Q000191:economics*; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D007347:Insurance, Dental / Q000191:economics*; D007492:Iran; D008297:Male; D008875:Middle Aged; D011203:Poverty; D011331:Private Practice; D012737:Sex Factors; D013674:Technology, Dental; D055815:Young Adult