The differences in healthcare utilization for dental caries based on the implementation of water fluoridation in South Korea.
BACKGROUND
There were some debates about the water fluoridation program in South Korea, even if the program had generally substantial effectiveness. Because the out-of-pocket expenditures for dental care were higher in South Korea than in other countries, an efficient solution was needed. Therefore, we examined the relationship between the implementation of water fluoridation and the utilization of dental care.


METHODS
We used the National Health Insurance Service National Sample Cohort. In this study, data finally included 472,250 patients who were newly diagnosed with dental caries during 2003-2013. We performed survival analysis using cox proportional hazard model, negative binomial-regression, and regression analyses using generalized estimating equation models.


RESULTS
There were 48.49 % outpatient dental care visit during study period. Individuals with water fluoridation had a lower risk of dental care visits (HR = 0.949, 95 % CI = 0.928-0.971). Among the individuals who experienced a dental care visit, those with water fluoridation program had a lower number of dental care visits (β = -0.029), and the period of water fluoridation had an inverse association with the dental care expenditures.


CONCLUSIONS
The implementation of water fluoridation programs and these periods are associated with reducing the utilization of dental health care. Considering these positive impacts, healthcare professionals must consider preventive strategies for activating water fluoridation programs, such as changes in public perception and relations, for the effective management of dental care in South Korea.
Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.|Division of Management & Planning, Korea Health Promotion Foundation, Seoul, Republic of Korea.
Myung-Soo
MS
Cho
Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.|Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
Kyu-Tae
KT
Han
Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
Sohee
S
Park
National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea.
Ki Tae
KT
Moon
Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea. ecpark@yuhs.ac.|Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. ecpark@yuhs.ac.
Eun-Cheol
EC
Park
D003729:Dental Care; D003731:Dental Caries / Q000453:epidemiology*; D005457:Fluoridation; D006801:Humans; D009909:Oral Health; D056910:Republic of Korea; D014881:Water Supply
Dental caries; Healthcare expenditures; Public program; Water fluoridation