Short Communication

The impact of national health insurance coverage on pit and fissure sealing experience

AUTHORS

name here
Jin-Sun Choi1
University Lecturer *

Deok-Young Park2 PhD, Professor

CORRESPONDENCE

*Dr Jin-Sun Choi

AFFILIATIONS

1, 2 Department of Preventive and Public Health Dentistry, Gangneung-Wonju National University, 7 Jukheongil, Gangneung, Ganwondo 25457, Republic of Korea

PUBLISHED

23 December 2018 Volume 18 Issue 4

HISTORY

RECEIVED: 18 February 2018

REVISED: 18 September 2018

ACCEPTED: 23 October 2018

CITATION

Choi J, Park D.  The impact of national health insurance coverage on pit and fissure sealing experience. Rural and Remote Health 2018; 18: 4804. https://doi.org/10.22605/RRH4804

AUTHOR CONTRIBUTIONS

ETHICS APPROVAL: Present state and prospect of public dental health service for children and adolescents in Korea. J Korean Acad Pediatr Dent 2008;35(3):578-588.2.Korea Ministry of Government Legislation. Available at: http://www.law.go.kr/. Accessed Month 02, 2016. 01.3.Lee YJ. An study on the inequality of health care resources distribution affected by regional characteristics. Journal of Critical Social Welfare 2005;2(21):49-78.

Except where otherwise noted, this work is licensed under a Creative Commons Attribution 4.0 International Licence


abstract:

Introduction:  The purpose of this study was to review the change of supplied amount of oral pit and fissure sealing (PFS) in urban and rural areas of South Korea after including PFS into the list of treatments covered by the National Health Insurance (NHI), and to check whether there is a difference in supplied amount in areas where the dental treatment accessibility is different based on the data of the Korean National Health and Nutritional Examination Survey (KNHANES).
Methods:  The KNHANES data year used for ‘before coverage’ was 2007, and that of ‘after coverage’ was 2012. Data analysis was done using STATA software.
Results:  Areas were classified as urban or rural. Reduction of out-of-pocket expenses, according to the NHI coverage PFS experience of children aged 6–14 years, increased from 28.7% before coverage to 34.9% after coverage. PFS experience of children aged 6–14 years in the urban area was increased from 29.2% before coverage to 35.6% after coverage. The increase in rural areas was from 27.2% before coverage to 31.5% after coverage.
Conclusions:  Although PFS supplying was increased after inclusion in NHI coverage, it is still insufficient to reduce the decayed, missing, filled teeth index effectively. To reduce inequality, supply of PFS in rural area by community oral health program should be strengthened. And also, waiving out-of-pocket money for PFS in NHI should be considered.

Keywords:

National Health Insurance, pit and fissure sealing, rural area, South Korea, urban area.

full article:

Introduction

The administrative regions of South Korea consist of about 172 urban areas (city, district) and about 86 rural areas (county). South Korea has a population of approximately 90% in urban areas and 10% in rural areas1. Urban areas have large populations and a high distribution of economic and medical resources. 

South Korea has made efforts to reduce the gap of oral health status between urban areas and socioeconomically poor rural areas by executing the free pit and fissure sealing (PFS) program mainly for rural areas during the period 2002–2007 as one of the national oral health programs promoted by the Ministry of Health and Welfare2. PFS began to be covered by the National Health Insurance (NHI) from December 2009 (Table 1). 

People need to visit a dental clinic to benefit from NHI coverage of PFS. This means that people living in an area of low dental accessibility may have disparity on benefits of NHI PFS coverage compared to people living in areas with easy access to dental treatment. This study proposed to examine the difference of experience in PFS among children aged 6–14 years before and after the coverage of PFS by NHI, and between urban and rural areas.

Table 1:  Changes to criteria for National Health Insurance coverage of oral pit and fissure sealing3, 2009–2013

Methods

Data for 2007 and 2012 from the Korean National Health and Nutritional Examination Survey (KNHANES IV, V) and the Korean Statistical Information Service4 were used for this study. KNHANES examines about 10 000 people over the age of 1 year by taking probability samples of 20 households in 192 regions each year. PFS was included in the NHI in December 2009. The KNHANES data year designated as ‘before coverage’ was 2007, and the ‘after coverage’ year was 2012.

This study used the complex sample analysis method. The subject age range was 6–14 years. Areas were classified as either urban or rural. Data were analysed using STATA v13.0 (StataCorp; http://www.stat.com). The number who experienced PFS was calculated by multiplying the population of children aged 6–14 years by the proportion of PFS that derived from sampled survey coverage (Table 2).

Table 2:  Characteristics of survey sample

Ethics approval

The Institutional Review Board of the Korea Centers for Disease Control approved the Korean National Health and Nutritional Examination Survey (KNHANES IV, V) (2007-02CON-04-P, 2012-01EXP-01-2C)5.

Results

Reduction of out-of-pocket expense according to NHI coverage PFS experience of children aged 6–14 years increased from 28.7% before coverage to 34.9% after coverage (Fig1). PFS experience of children aged 6–14 years in urban areas increased from 29.2% before coverage to 35.6% after coverage. In rural areas, coverage increased from 27.2% before coverage to 31.5% after coverage. However, after the coverage of PFS by NHI, PFS experience in the rural area is still low and the difference between urban and rural areas increased from 2.0% to 4.1%. The average number of sealed teeth per person in urban areas increased from 0.75 before coverage to 1.16 after coverage. The average number of sealed teeth per person in rural areas increased from 0.64 before coverage to 0.92 after coverage (Fig2).

The number of urban children aged 6–14 years who experienced PFS was estimated as 1 456 399 before coverage and 1 615 785 after coverage. The number of rural children aged 6–14 years was estimated as 28 532 before coverage and 18 423 after coverage (Table 3).

Figure 1: Proportion of population having pit and fissure sealing and mean number of sealed teeth among Korean children aged 6–14 years, before and after National Health Insurance coverage.

Figure 2: Proportion of urban and rural populations having pit and fissure sealing and mean number of sealed teeth among Korean children aged 6–14 years, before and after National Health Insurance coverage.

Table 3: Estimated number of people experiencing pit and fissure sealing among Korean children aged 6–14 years, before and after National Health Insurance coverage

Conclusions

With coverage by NHI, the percentage of beneficiaries and the mean number of sealed teeth per child aged 6–14 years doubled in urban areas, but in rural areas the percentage of beneficiaries increased insignificantly, and the mean number of sealed teeth per person decreased, showing regional inequality.

Covering PFS, which has been provided through public health programs, by NHI can increase the supply of PFS using private resources, but it may cause disparity in supply because of different accessibility to private medical institutions among areas. It has been reported that the regional distribution of a nation’s medical resources does not necessarily reflect the need for medical services, which can result in an unequal use of medical services or access between regions6. Solving this problem requires changes to public health programs and national health insurance schemes. In South Korea, the solution may be raising accessibility of people with low income by reducing or remitting copayments and, at the same time, increasing the supply of PFS in rural areas through school%u2010based oral health programs.

references:

1 Statistics Korea. Urban population status [in Korean]. Available: http://kosis.kr/statHtml/statHtml.do?orgId=315&tblId=TX_315_2009_H1113# (Accessed 7 February 2018).
2 Lee KH, Kim JY, Song JH, Kim YH, Im KU, Jeong SY. Present state and prospect of public dental health service for children and adolescents in Korea. Journal of the Korean Academy of Pediatric Dentistry 2008; 35(3): 578-588.
3 Korean Statistical Information Service. Statistics by subject [in Korean]. Available: http://kosis.kr/index/index.do (Accessed 22 May 2018).
4 Korea Centers for Disease Control and Prevention. Korea National Health and Nutrition Examination Survey [in Korean]. Available: https://knhanes.cdc.go.kr/knhanes/sub03/sub03_06_02.do (Accessed 1 April 2018).
5 Lee YJ. A study on the inequality of health care resources distribution affected by regional characteristics. Journal of Critical Social Welfare 2005; 2(21): 49-78.
6 Korea Ministry of Government Legislation. National Law Information Center [in Korean]. Available: http://www.law.go.kr (Accessed 1 February 2016).
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