title: The impact of out-of-pocket payments for dental care on household finances in low and middle income countries.
abstract: Dental care is extremely costly and beyond most people means in developing countries. The primary aim of this study was to determine the impact of out-of-pocket payments for dental care on household finances in 40 low and middle income countries. A second aim was to compare the burden of payments for dental care with that for other health services.
  
  
  
  We used data from 174,257 adults, aged 18 years and above, who reported their total and itemized household expenditure in the past four weeks as part of the World Health Surveys. The financial burden on households was measured using the catastrophic health expenditure (CHE) and impoverishment approaches. A household was classified as facing CHE if it spent 40% or more of its capacity to pay, and as facing impoverishment if it fell below the country-specific poverty line after spending on health care was subtracted from household expenditure. The odds of experiencing CHE and impoverishment due to expenditure on dental care were estimated from two-level logistic regression models, controlling for various individual- and country-level covariates.
  
  
  
  Households that paid for dental care had 1.88 (95% Confidence Interval: 1.78-1.99) greater odds of incurring CHE and 1.65 (95% CI: 1.52-1.80) greater odds of facing impoverishment, after adjustment for covariates. Furthermore, the impact of paying for dental care was lower than that for medications or drugs, inpatient care, outpatient care and laboratory tests but similar to that of health care products, traditional medicine and other health services.
  
  
  
  Households with recent dental care spending were more likely to use a large portion of their disposable income and fall below the poverty line. Policy makers ought to consider including dental care as part of universal health care and advocate for the inclusion of dental care coverage in health insurance packages.
authors.affiliation: Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK. eduardo.bernabe@kcl.ac.uk.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bernabé
authors.affiliation: Department of Dentistry and Oral Health, La Trobe University, Melbourne, Australia.
authors.forename: Mohd
authors.initials: M
authors.lastname: Masood
authors.affiliation: Health Policy Institute, American Dental Association, Chicago, USA.
authors.forename: Marko
authors.initials: M
authors.lastname: Vujicic
mesh_terms: D000328:Adult; D003729:Dental Care / Q000191:economics*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D014943:Global Health / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000191:economics*
keywords: Cost of illness; Dental care; Developing countries; Multilevel analysis