{"title":"健康保险对印尼成人牙科使用模式中社会经济不平等的中介作用。","authors":"Safira Khairinisa, Yusuke Matsuyama, Sakura Kiuchi, Diah Ayu Maharani, Jun Aida","doi":"10.1111/cdoe.70013","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>From the perspective of Universal Health Coverage (UHC) to reduce health inequalities, health insurance plays a crucial role. This study examined the mediating effect of health insurance on the economic and educational inequalities in dental utilisation patterns among Indonesian adults.</p><p><strong>Methods: </strong>This cross-sectional study analysed self-reported data from participants (n = 26 351) of the Indonesian Family Life Survey-5 (IFLS-5) conducted during the transition of Indonesia's health financing system in 2014-2015. Economic and educational inequalities in dental utilisation were measured and examined using the relative concentration index (RCI). A multinomial logistic regression, adjusted for confounders (sex, age, ethnicity, religion, marital status, household size and residency based on province and rural-urban), examined the association of economic status (quintiles of adjusted monthly household expenditure) and educational status (unschooled to higher education) with dental utilisation patterns (never/irregular/regular). The extent to which the association was explained by health insurance ownership (public and private insurance) was assessed using the Karlson-Holm-Breen mediation method.</p><p><strong>Results: </strong>Among participants, 12.9% of individuals utilise dental visits irregularly and 1.4% regularly, with the utilisation concentrated among those with higher economic status (RCI: 0.30, standard error [SE]: 0.01) and educational status (RCI: 0.34, SE: 0.01). Compared to those with the lowest economic quintile, the highest economic quintile showed higher odds of irregular utilisation (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.89-2.48) and regular utilisation (OR: 4.28; 95% CI: 2.50-7.34). People with higher education were more likely to utilise dental care, with higher odds ratios of irregular utilisation (OR: 6.80; 95% CI: 5.04-9.18) and regular utilisation (OR: 7.34; 95% CI: 2.24-24.04) compared to unschooled individuals. Private insurance partly mediated the association with regular dental utilisation: stronger indirect effects were observed at the highest economic level (proportion mediated [PM]: 10.6%) and highest educational level (PM: 9.2%). In contrast, the mediation effects of public insurance were less remarkable.</p><p><strong>Conclusion: </strong>Education and economic status play a significant role in determining dental utilisation patterns, with limited mediating effects for public insurance on these associations. To ensure equitable access to quality dental utilisation across socioeconomic groups, it is crucial to strengthen public insurance programmes that effectively address the needs of disadvantaged populations.</p>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Mediating Role of Health Insurance on Socioeconomic Inequalities in Dental Utilisation Patterns Among Indonesian Adults.\",\"authors\":\"Safira Khairinisa, Yusuke Matsuyama, Sakura Kiuchi, Diah Ayu Maharani, Jun Aida\",\"doi\":\"10.1111/cdoe.70013\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>From the perspective of Universal Health Coverage (UHC) to reduce health inequalities, health insurance plays a crucial role. This study examined the mediating effect of health insurance on the economic and educational inequalities in dental utilisation patterns among Indonesian adults.</p><p><strong>Methods: </strong>This cross-sectional study analysed self-reported data from participants (n = 26 351) of the Indonesian Family Life Survey-5 (IFLS-5) conducted during the transition of Indonesia's health financing system in 2014-2015. Economic and educational inequalities in dental utilisation were measured and examined using the relative concentration index (RCI). A multinomial logistic regression, adjusted for confounders (sex, age, ethnicity, religion, marital status, household size and residency based on province and rural-urban), examined the association of economic status (quintiles of adjusted monthly household expenditure) and educational status (unschooled to higher education) with dental utilisation patterns (never/irregular/regular). The extent to which the association was explained by health insurance ownership (public and private insurance) was assessed using the Karlson-Holm-Breen mediation method.</p><p><strong>Results: </strong>Among participants, 12.9% of individuals utilise dental visits irregularly and 1.4% regularly, with the utilisation concentrated among those with higher economic status (RCI: 0.30, standard error [SE]: 0.01) and educational status (RCI: 0.34, SE: 0.01). Compared to those with the lowest economic quintile, the highest economic quintile showed higher odds of irregular utilisation (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.89-2.48) and regular utilisation (OR: 4.28; 95% CI: 2.50-7.34). People with higher education were more likely to utilise dental care, with higher odds ratios of irregular utilisation (OR: 6.80; 95% CI: 5.04-9.18) and regular utilisation (OR: 7.34; 95% CI: 2.24-24.04) compared to unschooled individuals. Private insurance partly mediated the association with regular dental utilisation: stronger indirect effects were observed at the highest economic level (proportion mediated [PM]: 10.6%) and highest educational level (PM: 9.2%). In contrast, the mediation effects of public insurance were less remarkable.</p><p><strong>Conclusion: </strong>Education and economic status play a significant role in determining dental utilisation patterns, with limited mediating effects for public insurance on these associations. To ensure equitable access to quality dental utilisation across socioeconomic groups, it is crucial to strengthen public insurance programmes that effectively address the needs of disadvantaged populations.</p>\",\"PeriodicalId\":10580,\"journal\":{\"name\":\"Community dentistry and oral epidemiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-08-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Community dentistry and oral epidemiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/cdoe.70013\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"DENTISTRY, ORAL SURGERY & MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Community dentistry and oral epidemiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/cdoe.70013","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
Mediating Role of Health Insurance on Socioeconomic Inequalities in Dental Utilisation Patterns Among Indonesian Adults.
Objectives: From the perspective of Universal Health Coverage (UHC) to reduce health inequalities, health insurance plays a crucial role. This study examined the mediating effect of health insurance on the economic and educational inequalities in dental utilisation patterns among Indonesian adults.
Methods: This cross-sectional study analysed self-reported data from participants (n = 26 351) of the Indonesian Family Life Survey-5 (IFLS-5) conducted during the transition of Indonesia's health financing system in 2014-2015. Economic and educational inequalities in dental utilisation were measured and examined using the relative concentration index (RCI). A multinomial logistic regression, adjusted for confounders (sex, age, ethnicity, religion, marital status, household size and residency based on province and rural-urban), examined the association of economic status (quintiles of adjusted monthly household expenditure) and educational status (unschooled to higher education) with dental utilisation patterns (never/irregular/regular). The extent to which the association was explained by health insurance ownership (public and private insurance) was assessed using the Karlson-Holm-Breen mediation method.
Results: Among participants, 12.9% of individuals utilise dental visits irregularly and 1.4% regularly, with the utilisation concentrated among those with higher economic status (RCI: 0.30, standard error [SE]: 0.01) and educational status (RCI: 0.34, SE: 0.01). Compared to those with the lowest economic quintile, the highest economic quintile showed higher odds of irregular utilisation (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.89-2.48) and regular utilisation (OR: 4.28; 95% CI: 2.50-7.34). People with higher education were more likely to utilise dental care, with higher odds ratios of irregular utilisation (OR: 6.80; 95% CI: 5.04-9.18) and regular utilisation (OR: 7.34; 95% CI: 2.24-24.04) compared to unschooled individuals. Private insurance partly mediated the association with regular dental utilisation: stronger indirect effects were observed at the highest economic level (proportion mediated [PM]: 10.6%) and highest educational level (PM: 9.2%). In contrast, the mediation effects of public insurance were less remarkable.
Conclusion: Education and economic status play a significant role in determining dental utilisation patterns, with limited mediating effects for public insurance on these associations. To ensure equitable access to quality dental utilisation across socioeconomic groups, it is crucial to strengthen public insurance programmes that effectively address the needs of disadvantaged populations.
期刊介绍：
The aim of Community Dentistry and Oral Epidemiology is to serve as a forum for scientifically based information in community dentistry, with the intention of continually expanding the knowledge base in the field. The scope is therefore broad, ranging from original studies in epidemiology, behavioral sciences related to dentistry, and health services research through to methodological reports in program planning, implementation and evaluation. Reports dealing with people of all age groups are welcome.
The journal encourages manuscripts which present methodologically detailed scientific research findings from original data collection or analysis of existing databases. Preference is given to new findings. Confirmations of previous findings can be of value, but the journal seeks to avoid needless repetition. It also encourages thoughtful, provocative commentaries on subjects ranging from research methods to public policies. Purely descriptive reports are not encouraged, nor are behavioral science reports with only marginal application to dentistry.
The journal is published bimonthly.
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