TY - JOUR
T1 - Effect of Copayment on Dental Visits
T2 - A Regression Discontinuity Analysis
AU - Cooray, U.
AU - Aida, J.
AU - Watt, R. G.
AU - Tsakos, G.
AU - Heilmann, A.
AU - Kato, H.
AU - Kiuchi, S.
AU - Kondo, K.
AU - Osaka, K.
N1 - Funding Information:
JAGES 2016 was supported by a JSPS KAKENHI Grant (Japan Society for the Promotion of Science; JP15H01972), a Health Labour Sciences Research Grant (H28-Choju-Ippan-002, H30-Junkankitou-Ippan-004, 19FA2001), the Japan Agency for Medical Research and Development (JP17dk0110017, JP18dk 0110027, JP18ls0110002, JP18le0110009, JP19dk0110034, JP19 dk0110037), the Open Innovation Platform with Enterprises, Research Institute and Academia (JPMJOP1831) from the Japan Science and Technology, and the Research Funding for Longevity Sciences from the National Center for Geriatrics and Gerontology (29-42, 30-22). U. Cooray is supported by a Japanese Government Scholarship (MEXT).
Publisher Copyright:
© International & American Associations for Dental Research 2020.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Despite their prevalence and burdens, oral diseases are neglected in universal health coverage. In Japan, a 30% copayment (out of pocket) by the user and a 70% contribution by Japan’s universal health insurance (JUHI) are required for dental and medical services. From the age of 70 y, an additional 10% is offered by JUHI (copayment, 20%; JUHI, 80%). This study aimed to investigate the effect of cost on dental service use among older adults under the current JUHI system. A regression discontinuity quasi-experimental method was used to investigate the causal effect of the JUHI discount policy on dental visits based on cross-sectional data. Data were derived from the 2016 Japan Gerontological Evaluation Study. This analysis contained 7,161 participants who used JUHI, were aged 68 to 73 y, and responded to questions regarding past dental visits. Analyses were controlled for age, sex, number of teeth, and equalized household income. Mean ± SD age was 72.1 ± 0.79 y for the discount-eligible group and 68.9 ± 0.78 y for the noneligible group. During the past 12 mo, significantly more discount-eligible participants had visited dental services than noneligible participants (66.0% vs. 62.1% for treatment visits, 57.7% vs. 53.1% for checkups). After controlling for covariates, the effect of discount eligibility was significant on dental treatment visits (odds ratio [OR], 1.36; 95% CI, 1.32 to 1.40) and dental checkups (OR, 1.49; 95% CI, 1.44 to 1.54) in the regression discontinuity analysis. Similar findings were observed in triangular kernel-weighted models (OR, 1.38 [95% CI, 1.34 to 1.44]; OR, 1.52 [95% CI, 1.47 to 1.56], respectively). JUHI copayment discount policy increases oral health service utilization among older Japanese. The price elasticity for dental checkup visits appears to be higher than for dental treatment visits. Hence, reforming the universal health coverage system to improve the affordability of relatively inexpensive preventive care could increase dental service utilization in Japan.
AB - Despite their prevalence and burdens, oral diseases are neglected in universal health coverage. In Japan, a 30% copayment (out of pocket) by the user and a 70% contribution by Japan’s universal health insurance (JUHI) are required for dental and medical services. From the age of 70 y, an additional 10% is offered by JUHI (copayment, 20%; JUHI, 80%). This study aimed to investigate the effect of cost on dental service use among older adults under the current JUHI system. A regression discontinuity quasi-experimental method was used to investigate the causal effect of the JUHI discount policy on dental visits based on cross-sectional data. Data were derived from the 2016 Japan Gerontological Evaluation Study. This analysis contained 7,161 participants who used JUHI, were aged 68 to 73 y, and responded to questions regarding past dental visits. Analyses were controlled for age, sex, number of teeth, and equalized household income. Mean ± SD age was 72.1 ± 0.79 y for the discount-eligible group and 68.9 ± 0.78 y for the noneligible group. During the past 12 mo, significantly more discount-eligible participants had visited dental services than noneligible participants (66.0% vs. 62.1% for treatment visits, 57.7% vs. 53.1% for checkups). After controlling for covariates, the effect of discount eligibility was significant on dental treatment visits (odds ratio [OR], 1.36; 95% CI, 1.32 to 1.40) and dental checkups (OR, 1.49; 95% CI, 1.44 to 1.54) in the regression discontinuity analysis. Similar findings were observed in triangular kernel-weighted models (OR, 1.38 [95% CI, 1.34 to 1.44]; OR, 1.52 [95% CI, 1.47 to 1.56], respectively). JUHI copayment discount policy increases oral health service utilization among older Japanese. The price elasticity for dental checkup visits appears to be higher than for dental treatment visits. Hence, reforming the universal health coverage system to improve the affordability of relatively inexpensive preventive care could increase dental service utilization in Japan.
KW - access to care
KW - behavioral science
KW - dental public health
KW - epidemiology
KW - health services research
KW - prevention
UR - http://www.scopus.com/inward/record.url?scp=85088842728&partnerID=8YFLogxK
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U2 - 10.1177/0022034520946022
DO - 10.1177/0022034520946022
M3 - Article
C2 - 32735476
AN - SCOPUS:85088842728
SN - 0022-0345
VL - 99
SP - 1356
EP - 1362
JO - Journal of Dental Research
JF - Journal of Dental Research
IS - 12
ER -
