title: Disparity in dental out-of-pocket payments among older adult populations: a comparative analysis across selected European countries and the USA.
abstract: BACKGROUND
  The current study addresses the extent to which diversity exists in dental out-of-pocket (OOP) payments across population subgroups within and between the USA and selected European countries. This represents the final paper in a series in which the previous two papers addressed diversity in dental coverage and dental utilisation, respectively, using similar data and methods.
  
  
  METHODS
  We used data from the 2006/2007 Health and Retirement Study (HRS) and from the 2004-2006 Survey of Health, Ageing and Retirement in Europe (SHARE) for respondents ≥51 years of age. We estimated the impacts of dental-care coverage and of demographic, socio-economic and health status on the likelihood and amount of dental OOP payments.
  
  
  RESULTS
  In the USA, older persons with the least education, lowest income and worst health are most likely to pay nothing OOP for their dental care and, for persons with an OOP payment, the amount of this payment increases with income and education and is higher for persons who are uninsured and in fair or poor health. However, these results were not consistently found in the 10 European countries we studied.
  
  
  CONCLUSIONS
  European countries classified according to social welfare state or the presence of social health insurance (SHI) showed no effect on the likelihood of making payments OOP for dental care nor, when OOP payments were made, on the amounts paid. Variation in generosity of coverage and procedures reimbursed by insurance, even within countries with SHI, as well as differing needs, tastes and access to care across countries, contribute to this finding.
authors.affiliation: Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Manski
authors.affiliation: Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA.
authors.forename: John
authors.initials: J
authors.lastname: Moeller
authors.affiliation: Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Chen
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Eeva
authors.initials: E
authors.lastname: Widström
authors.affiliation: Translational Health Economics Group, Department of Conservative Dentistry, Heidelberg University, Heidelberg, Germany.|Munich Center for the Economics of Aging, Max-Planck-Institute for Social Law and Social Policy, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Listl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D003729:Dental Care / Q000191:economics* / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007182:Income; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007347:Insurance, Dental / Q000706:statistics & numerical data; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011203:Poverty; D012044:Regression Analysis; D012179:Retirement / Q000191:economics; D012923:Social Class; D012946:Social Welfare; D014481:United States
keywords: Europe; Out-of-pocket payments; USA; dental attendance; dental insurance; older populations