Comparing protection-motivation theory-based intervention with routine public dental health care.

OBJECTIVES: Tooth brushing with fluoride toothpaste has a major effect on the reduction in dental caries. However, among young children, tooth brushing requires skill and motivation from caregivers and is not widely practised. To find a more effective way to train caregivers, Protection-Motivation Theory (PMT)-based educational programmes were compared with the basic one with regard to the incremental caries rate in children, caregiver's motivation and caregiver's awareness. METHODS: In a quasi-experimental study, 9- to18-month-old children and their caregivers (N = 102) were allocated to PMT or control groups. The PMT group received PMT-based oral health education programme while the control group received public hospital's current one. Children's caries status and motivation and awareness among caregivers were measured. Mann-Whitney U test was used to find out the difference between control and test groups. RESULTS: After 12 months, the PMT group showed lower dmft, dmfs and incremental caries rate compared with control. Chi-square test showed the control group was at more risk of developing additional dental caries (RR 2.23, 95% C.I.: 1.41-3.54, p < 0.001), and when early carious lesions were included (RR 2.40, 95% C.I.: 1.56-3.69, p < 0.001). In terms of motivation and awareness among caregivers, the PMT group rated their perception of disease severity and belief in self-efficacy significantly higher than the control group. CONCLUSIONS: PMT-based education programmes encourage suitable motivation and awareness that changes oral healthcare behaviour of caregivers, relating to decreased incremental caries rate in infants and toddlers comparing with regular health education methods.

Subjective and objective measures for evaluating masticatory ability and associating factors of complete denture wearers: A clinical study.

STATEMENT OF PROBLEM: The masticatory ability of complete denture (CD) wearers can be evaluated subjectively and objectively. Although an objective measure reflects a person's ability to masticate food, it is rarely used in clinical practice. Moreover, the factors associated with subjective and objective masticatory ability of CD wearers remain unclear. PURPOSE: The purpose of this clinical study was to identify subjective and objective measures that better reflect the masticatory ability of CD wearers and to investigate their associating factors. MATERIAL AND METHODS: Masticatory ability was evaluated in 130 CD wearers by using subjective and objective measures. The subjective indicators were oral impact on eating and denture satisfaction based on eating or mastication ability. Masticatory performance was objectively measured by using a median peanut particle size. The maximum occlusal force, number, and area of occlusal contacts were determined from a pressure-sensitive sheet. CD retention and stability were classified into acceptable and unacceptable denture quality following the CU-modified Kapur criteria. The occlusal pattern and oral conditions were examined and recorded. Intraexaminer reliability in determining CD quality and oral condition was shown by a Kappa score of 0.90 to 0.95. Multivariable linear and logistic regressions were performed to analyze the associations between CD quality, maximum occlusal force, and masticatory ability. The Spearman correlation was used to determine the association between subjective and objective measures. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) between subjective and objective measures were calculated. RESULTS: Unacceptable CD quality was significantly associated with oral impact on eating, eating dissatisfaction, and larger peanut particle size (P<.001). Peanut particle size increased with lower maximum occlusal force, which was related to fewer occlusal contacts and the female sex. The highest to lowest adjusted R2 values were related to masticatory performance, oral impact on eating, and eating satisfaction models. Among participants with unacceptable CD quality, 16% had higher masticatory performance, 25%, had no oral impact on eating, and 33% reported eating satisfaction. The sensitivity and specificity values of subjective measures in predicting lower masticatory performance were approximately recorded at 74% and 90%, respectively, whereas PPV and NPV were at 90% and 77%, respectively. CONCLUSIONS: CD retention and stability impact objective and subjective masticatory ability. Objective masticatory performance is the best measure for evaluating the masticatory ability of CD wearers, followed by oral impact on eating and eating satisfaction. A 3.6-mm peanut particle size is suggested as a cutoff value for identifying CD wearers with impaired masticatory ability.

Predisposing and enabling factors associated with public denture service utilization among older Thai people: a cross-sectional population-based study.

BACKGROUNDS: Tooth loss is one of the major oral health problems among older Thai people. However, there is the existence of socioeconomic-related inequalities in dental service utilization, especially denture service. The aim of this study was to assess the determinants associated with inequalities in denture service utilization among older Thai people using the Andersen Behavioural model. METHOD: This cross-sectional study involved secondary data analysis of the 2014 survey of older Thai people (N = 38,695). The dependent variable was a public denture service utilization over the past 5 years. Determinants were classified as predisposing and enabling factors. Predisposing variables included age, sex, education, economic condition and dependency status. Enabling variables included working status, health behaviours, health care utilization experience and social/community support. Data were analysed by using bivariate and multivariable analyses at α = 0.05. For bivariate analysis, chi-square test was used to determine the association between dependent and each independent variable. Then, all variables were incorporated into a multivariable binary logistic regression. RESULTS: The odds of denture service utilization were significantly higher for individuals who were older, female, and had a higher educational level and health-promoting behaviors. A positive dose-response relationship was demonstrated between denture service utilization and increased quartile of household assets. CONCLUSIONS: Predisposing variables had a greater impact than enabling variables in denture service utilization among older Thai people. Despite free public denture service, socioeconomic-related inequalities persist. The government needs to reduce socioeconomic disparities to improve denture treatment inequality.

Impacts of Denture Retention and Stability on Oral Health-Related Quality of Life, General Health, and Happiness in Elderly Thais.

PURPOSE: This study investigated denture and patient related factors associated with oral health-related quality of life (OHRQoL) of complete denture wearers and their association with general health and happiness. METHODS: This retrospective cohort study comprised 130 participants with complete edentulism, with maxillary and mandibular complete dentures treated at Chulalongkorn University Dental School during 2010-2017. The primary outcome was the presence of overall and domain-specific Oral Impacts on Daily Performances (OIDP). Secondary outcomes were diagnosed and perceived general health, and happiness. Denture retention and stability were classified as acceptable or unacceptable following the CU-modified Kapur criteria. Five esthetic-assessment criteria of the harmonization and proportions between facial and dental anatomical landmarks were measured from patient's photographs. Age, sex, previous complete denture experience, and denture age were recorded. The associations between each variable and oral impacts were analyzed using bivariate logistic regression, and the factors with p < 0.25 were further adjusted using multivariable analysis. Associations between oral impact scores and general health and happiness were assessed using Spearman's rank correlation. RESULTS: The most frequent oral impacts were on physical domain, while social domain was the least affected. Denture retention/stability was significantly associated with both overall and specific domains of oral impact. Happiness was found to be strongly correlated with perceived general health, but marginally with oral impact scores. CONCLUSIONS: Unacceptable complete denture retention and stability are substantial risk factors for impaired OHRQoL in complete edentulism. Maintaining optimal denture retention and stability in denture wearers is essential for good oral health and well-being with the goal of enhancing happiness.

Modified retention and stability criteria for complete denture wearers: A risk assessment tool for impaired masticatory ability and oral health-related quality of life.

STATEMENT OF PROBLEM: Some complete denture wearers report difficulty with daily activities, especially activities related to denture retention and stability. However, no standard criteria are available for professionally based assessment of complete denture quality. PURPOSE: The purpose of this clinical study was to determine the association between professionally based assessment of complete denture quality, evaluated by conventional and Chulalongkorn University (CU)-modified Kapur criteria and multiple patient-based outcomes: oral health-related quality of life (OHRQoL), eating satisfaction, and masticatory performance. The sensitivity and specificity of these criteria in estimating the outcomes were investigated. MATERIAL AND METHODS: The participants were 126 individuals with removable acrylic resin complete dentures. Denture retention and stability were scored based on the Kapur method, with excellent intraobserver reliability indicated by a Kappa score of 0.91 to 0.99. The clinical quality of the complete denture was classified according to conventional and CU-modified Kapur criteria. The participants were interviewed for OHRQoL by using the Thai version of the Oral Impacts on Daily Performances (OIDP) index and responses were reported as the absence or presence of oral impacts. Participants' satisfaction eating with their dentures was determined by using a 5-point Likert scale and dichotomized into satisfied and dissatisfied categories. Masticatory performance was evaluated by the multiple sieve method of peanut mastication. After adjusting for covariates, the associations between denture quality and overall and condition-specific (CS) impacts on eating and on eating satisfaction were analyzed by using binary logistic regression, while its association with masticatory performance was determined using linear regression. Goodness-of-fit post estimation was conducted to determine the sensitivity and specificity of each denture quality criterion in estimating patient-based outcomes. RESULTS: Complete denture retention and stability, evaluated by conventional and CU-modified Kapur criteria, were associated with multiple patient-based outcomes. However, denture stability showed a stronger association than retention. The CU-modified criteria assessed the quality of maxillary and mandibular dentures individually and revealed a higher sensitivity in estimating all patient-based outcomes. CONCLUSIONS: Retention and stability were important indicators in estimating the masticatory ability and OHRQoL of complete denture wearers. The CU-modified Kapur criteria can identify impaired masticatory ability and OHRQoL in complete denture wearers better than conventional criteria.

Geriatric oral lesions: A multicentric study.

AIM: To carry out an oral biopsy survey in geriatric patients from the participating institutions. METHODS: The biopsy records of the participating institutions were reviewed for oral lesions from patients aged 65 years and older diagnosed from 2003 to 2012. Demographic data and the site of the lesions were collected. Histopathological diagnoses were categorized into two categories: non-neoplastic lesions (reactive/inflammatory lesion, cyst, allergic/immunologic disorders, potentially malignant disorders, infection and others) and neoplastic lesions (benign and malignant tumors). Data were analyzed by appropriate statistics using stata11. RESULTS: Of the 76,045 accessioned cases, 11,346 cases (14.92%) were in geriatric patients. The mean age of the patients was 72.98 ± 6.25 years. A total of 5010 cases (44.16%) were diagnosed in males, whereas 6336 cases (55.84%) were diagnosed in females. The male-to-female ratio was 0.79:1. Non-neoplastic lesions outnumbered the neoplastic counterpart. The five most prevalent oral lesions in the geriatric population in the present study in descending order of frequency were squamous cell carcinoma, focal fibrous hyperplasia (irritation fibroma), radicular cyst, osteomyelitis and epithelial dysplasia, respectively. The site of predilection was labial/buccal mucosa, followed by gingiva, mandibular bone, tongue and maxillary bone, respectively. CONCLUSIONS: The geriatric oral lesions from the present study showed a similar trend with studies based on histopathological data, but different from the studies based on clinical data. This study also shed more light on potentially malignant disorders, as well as benign and malignant tumors.

Disparities in early childhood caries and its impact on oral health-related quality of life of preschool children.

This study aimed to investigate the caries experience and its impact on preschool children's quality of life and the associations between these outcomes and underlying determinants. A survey was conducted on 5- to 6-year-old children (503 in all) in Bangkok who were orally examined and interviewed on their oral health-related quality of life (OHRQoL). In addition, behavioral questionnaires were sent to parents. Associations between determinants and oral health outcomes were tested through logistic regression. It was found that 28% of children experienced high-level impacts on quality of life, mostly dental pain (58.3%) and eating difficulties (45.9%). Children of low socioeconomic status were more likely to have a high level of dental caries and subsequent OHRQoL impact. Oral status was related to oral behaviors and OHRQoL. Social disparities in preschool children's OHRQoL were identified.

Longitudinal associations between oral health impacts and quality of life among a national cohort of Thai adults.

BACKGROUND: There is limited evidence on the association between oral health and general health in middle-income countries. This study analysed data from 60,569 adult students enrolled at Sukhothai Thammathirat Open University and residing throughout Thailand who reported oral health impacts at the 2005 baseline and 2009 health status based on Short Form (SF-8) survey. FINDINGS: In 2005, 16.4% had difficulty chewing and/or swallowing, 13.4% reported difficulty speaking and/or discomfort with social interaction, and 10.8% of the cohort reported having pain associated with teeth or dentures. Cohort members reporting one or more oral health impacts in 2005 had lower SF-8 mean scores in 2009. In particular, monotonic dose-response gradients in 2005-2009 associations based on multivariate linear regression were found between an increase in number of oral impacts (0, 1, 2, 3) and a decline in SF-8 Physical Component Summary scores (adjusted means of 50.5, 49.2, 48.6, 47.9) as well as SF-8 Mental Component Summary scores (adjusted means of 43.2, 40.9, 40.3, 38.6) in younger cohort members. Similar dose response gradients were found in older cohort members. CONCLUSIONS: We found strong association between oral health impacts and adverse health and quality of life among Thai adults. This finding confirms that oral health is one of the key determinants of population health.

Inequality in oral health-care utilisation exists among older Thais despite a universal coverage policy.

AIM: To assess socioeconomic-related inequality in oral health-care utilisation among older Thais. METHOD: The data on 8951 and 11,402 older Thais (≥60 years) from national representative Thailand Health and Welfare Surveys (HWS) of 2003 and 2009, respectively, were analysed. Descriptive analyses were performed on oral health-care utilisation, and a concentration index (CI) quantified the extent of socioeconomic-related inequality in oral health-care utilisation. RESULTS: Analyses indicated that socioeconomic-related inequalities in oral health-care utilisation among older Thais existed, and tended to favour those of higher socioeconomic status. However, the older poor were more likely to utilise oral health care at public facilities, particularly primary care facilities, than those of higher socioeconomic status. CONCLUSION: Despite universal coverage policy, socioeconomic-related inequalities in oral health-care utilisations exist among the older Thais. To alleviate these, strengthening the primary health-care system deserves particular attention.

Experience of socioeconomic-related inequality in dental care utilization among Thai elderly under universal coverage.

AIM: To assess the socioeconomic-related inequality in dental care utilization among Thai elderly and to determine factors associated with the observed inequality after the country achieved universal coverage. METHODS: The data were taken from the nationally representative Thailand Health & Welfare Survey 2007. Data of 10,096 Thai elderly (aged over 60 years) were selected. Descriptive analyses of the features of dental care utilization among Thai elderly were carried out, in addition to the concentration index (Cindex ) being used to quantify the extent of socioeconomic-related inequality in dental care utilization. Logistic regression was used to determine factors associated with inequality in dental care. RESULTS: Socioeconomic-related inequality in dental care utilization among Thai elderly was shown. Also, utilization was more concentrated among wealthier older adults, as shown by the positive value of Cindex (equals 0.244). The poor elderly, however, were more likely to utilize dental care at public facilities, particularly primary care facilities. Multivariate analysis showed that certain demographic, socioeconomic and geographic characteristics were particularly associated with poor-rich differences in dental care utilization among Thai elderly. CONCLUSIONS: Although socioeconomic-related inequality in dental care utilization among Thai elderly exists, the pro-poor utilization at public facilities, particularly primary care facilities, substantiates the concerted effort to reducing inequality in dental care utilization for Thai elderly.

Factors associated with self-reported number of teeth in a large national cohort of Thai adults.

BACKGROUND: Oral health in later life results from individual's lifelong accumulation of experiences at the personal, community and societal levels. There is little information relating the oral health outcomes to risk factors in Asian middle-income settings such as Thailand today. METHODS: Data derived from a cohort of 87,134 adults enrolled in Sukhothai Thammathirat Open University who completed self-administered questionnaires in 2005. Cohort members are aged between 15 and 87 years and resided throughout Thailand. This is a large study of self-reported number of teeth among Thai adults. Bivariate and multivariate logistic regressions were used to analyse factors associated with self-reported number of teeth. RESULTS: After adjusting for covariates, being female (OR = 1.28), older age (OR = 10.6), having low income (OR = 1.45), having lower education (OR = 1.33), and being a lifetime urban resident (OR = 1.37) were statistically associated (p < 0.0001) with having less than 20 teeth. In addition, daily soft drink consumptions (OR = 1.41), current regular smoking (OR = 1.39), a history of not being breastfed as a child (OR = 1.34), and mother's lack of education (OR = 1.20) contributed significantly to self-reported number of teeth in fully adjusted analyses. CONCLUSIONS: This study addresses the gap in knowledge on factors associated with self-reported number of teeth. The promotion of healthy childhoods and adult lifestyles are important public health interventions to increase tooth retention in middle and older age.

Great inclination to smoke among younger adults coming from low-socioeconomic class in Thailand.

BACKGROUND: WHO estimates that 8.4 million deaths will be counted a year due to tobacco by 2020, and 70% of those deaths will occur in developing countries. Examination of the magnitude of socioeconomic differences in smoking between different age groups reveals specific groups anti-smoking programs should target on. This study aimed to measure socioeconomic gradients related inequality in smoking behavior among young and old Thai male population, where general progress in reduction on smoking prevalence has already shown. METHODS: Data of Thai males aged 21 years and older from Health and Welfare Survey and Socio-Economic Survey, Thailand, 2006 were used in the analyses. Variables in education, household income, age, marital status, and region of residence were used to examine their associations with smoking status. RESULTS: Of the 12,200 respondents, overall prevalence of smoking among males aged 21 years and older was 41.5%. Lower education was strongly associated with smoking (OR 3.15; 95% CI, 2.74-3.62). Youngest age, reside in South region and lowest income were more associated with smoking (OR = 2.66, 1.30, and 1.91, p < 0.05, respectively). Smoking among young adults (age 21-30) (OR = 5.88; 95% CI, 4.3-8.0) showed stronger gradients with educational level than that among older adults (OR = 3.96; 95% CI, 2.8-5.3). CONCLUSIONS: The inverse associations between smoking prevalence and socioeconomic status among the Thai adult male population were consistently confirmed. The social gradient in smoking was greater among young adult males than that among older adult males.

Socioeconomic inequality in self-reported oral health status: the experience of Thailand after implementation of the universal coverage policy.

OBJECTIVES: This study aimed to quantify the extent to which socioeconomic-related inequality in self-reported oral health status among Thais is present after the country implemented the Universal Coverage policy and to decompose the determinants and their associations with inequality in self-reported oral health status in particular with the worse condition. DESIGN AND METHOD: The study employed a concentration index to measure socioeconomic-related inequality in self-reported oral health status, and the decomposition method to identify the determinants and their associations with inequality in oral health-related measures. Data from 32,748 Thai adults aged 15-75 years from the nationally representative Health &Welfare Survey and Socio-Economic Survey 2006 were used in analyses. RESULTS: Reports of worse oral health status of the lower socioeconomic-status group were more common than their higher socioeconomic-status counterparts. The concentration index (equaling -0.208) corroborates the finding of pro-poor inequality in self-reported worse oral health. Decomposition analysis demonstrated certain demographic-, socioeconomic-, and geographic characteristics are particularly associated with poor-rich differences in self-reported oral health status among Thai adults. CONCLUSIONS: This study demonstrated socioeconomic-related inequality in oral health is discernable along the entire spectrum of socioeconomic status. Inequality in perceived oral health status among Thais is present even while the country has virtually achieved universality of health coverage. The study also indicates population subgroups, particularly the poor, should receive consideration for improving oral health status as revealed by underlying determinants.

Oral Health-Related Quality of Life among a large national cohort of 87,134 Thai adults.

BACKGROUND: Oral health has been of interest in many low and middle income countries due to its impact on general health and quality of life. But there are very few population-based reports of adult Oral Health Related Quality of Life (OHRQoL) in developing countries. To address this knowledge gap for Thailand, we report oral health findings from a national cohort of 87,134 Thai adults aged between 15 and 87 years and residing all over the country. METHODS: In 2005, a comprehensive health questionnaire was returned by distance learning cohort members recruited through Sukhothai Thammathirat Open University. OHRQoL dimensions included were discomfort speaking, swallowing, chewing, social interaction and pain. We calculated multivariate (adjusted) associations between OHRQoL outcomes, and sociodemographic, health behaviour and dental status. RESULTS: Overall, discomfort chewing (15.8%), social interaction (12.5%), and pain (10.6%) were the most commonly reported problems. Females were worse off for chewing, social interaction and pain. Smokers had worse OHRQoL in all dimensions with Odds Ratios (OR) ranging from 1.32 to 1.51. Having less than 20 teeth was strongly associated with difficulty speaking (OR = 6.43), difficulty swallowing (OR = 6.27), and difficulty chewing (OR = 3.26). CONCLUSIONS: Self-reported adverse oral health correlates with individual function and quality of life. Outcomes are generally worse among females, the poor, smokers, drinkers and those who have less than 20 teeth. Further longitudinal study of the cohort analysed here will permit assessment of causal determinants of poor oral health and the efficacy of preventive programs in Thailand.

Measurement and explanation of horizontal (in)equity in health care utilization among Thais after universal coverage policy implementation.

This study aimed to examine the extent to which income-related inequality and horizontal inequity in outpatient and inpatient care utilization among Thais are manifest after the country implemented the Universal Coverage (UC) policy, by using a concentration index and a horizontal inequity index, respectively. Furthermore, the study examined the determinants and their associations with the observed inequality, if any, in health care utilization through decomposition methods. The nationally representative Health and Welfare Survey 2005 was used to perform the analyses. Although there are socioeconomic gradients in health care utilization among Thais, the findings reveal that health care utilization tends to favor the poor in particular with utilization at the public facility and especially at the primary care level facility. Thailand has made impressive strides toward nearly universal health insurance coverage and improving access to and utilization of health care for its population, particularly among the poor.

Which households are at risk of catastrophic health spending: experience in Thailand after universal coverage.

The impact of the universal coverage policy implementation in Thailand is demonstrated by the declining incidence of catastrophic health spending among Thai households-particularly among the poor. The households who remain at risk of catastrophe, as defined here, are better-off households, because of their preference for using private facilities. Others with increased likelihood of incurring catastrophic health expenditures are households with a greater proportion of elderly members, those having a member with a chronic illness or disability, and those having a member who experienced hospitalization. These determinants should prompt policy concerns to protect such households from financial catastrophe.

Is there equity in oral healthcare utilization: experience after achieving Universal Coverage.

OBJECTIVES: To assess the socioeconomic-related (in)equality and horizontal (in)equity in oral healthcare utilization among Thai adults after Universal Coverage (UC) policy implemented nationwide, and to decompose the source of inequality in utilization. Further, to identify the determinants that effect to out-of-pocket payments for oral healthcare. METHODS: Using the data of 32748, Thai adults aged 15 years and over from nationally representative Health and Welfare Survey and Socio-Economic Survey in 2006. This study employs concentration index (CI) and horizontal inequity index (HI) to measure the socioeconomic-related inequality and horizontal inequity in oral healthcare utilization, respectively. Further, employing decomposition method to identify the sources of inequality comprising of a contribution of income, need determinants (i.e. self-assessed oral health, demographic characteristics), non-need determinants (i.e.working status, educational level attainment, type of insurance entitlement, geographic characteristics and marital status) and residual term. Two-part model is used to determine the factors effect to out-of-pocket payments for oral healthcare. RESULTS: There are the pro-rich inequality and inequity in oral healthcare utilization among Thais as indicated by significantly positive values of CI (=0.199) and HI (=0.206). The poor are more likely to access and utilize services at subsidized public facility particularly community hospital, as opposed to the better-off who tend to utilize services at private facility. Income and non-need determinants principally contribute to the pro-poor in public sector utilization, unlike pro-rich in private sector utilization. Need factors account for most of the pro-poor utilization. Type of treatment obtained and insurance used in the last visit are the substantial determinants effect to incurring out-of-pocket payments for oral healthcare. CONCLUSION: Notwithstanding the UC policy implementation made impressive strides toward improving of welfare coverage and an increase in accessibility of health services among Thais, inequality and inequity in oral healthcare utilization persist even when the country achieved universal coverage. Decomposition analyses demonstrate the association of each determinant to inequality in utilization which provides information for policy amendment to achieve the goal of equity in healthcare system.

Inequality in dental care utilisation among Thai children: evidence from Thailand where universal coverage has been achieved.

AIMS: To quantify the extent of the socioeconomic-related inequality in dental care utilisation among Thai children and to examine the characteristics of dental care utilisation, after the country achieved universal coverage. DESIGN: The data to perform analyses were taken from the nationally representative Health and Welfare Survey (HWS) and Socioeconomic Survey (SES) 2007 in Thailand. PARTICIPANTS: Data of 15,736 representative Thai children (aged below 15 years) were selected. METHODS: Descriptive analyses were performed to reveal the features of dental care utilisation among Thai children, in addition to use the concentration index (CI) to measure socioeconomic-related inequality in dental care utilisation. Logistic regression was employed to determine inequality in dental care across socioeconomic strata. RESULTS: The unequivocal gradient in dental care utilisation persistence among Thai children and the socioeconomic-related inequality in dental care utilisation is more concentrated among the better-off as the positive CI value (equals 0.069) emerged. Poor children, however, are more likely to utilise dental care at public facilities, particularly primary care facilities. CONCLUSION: The evidence from Thailand, where universal coverage has been virtually achieved, provides some lesson for other countries particularly developing countries. Although the socioeconomic-related inequality in dental care utilisation among Thai children still exists, the pro-poor dental care utilisation at public facilities, particularly primary care facilities substantiate the impressive stride towards the concerted effort to reducing inequitable dental care delivery for Thai children.

Payments for health care and its effect on catastrophe and impoverishment: experience from the transition to Universal Coverage in Thailand.

Equitable health financing was embodied in the reform strategies of Thailand's health care system when the country moved towards implementing the Universal Coverage (UC) policy in 2001. This study aimed to measure the pattern of household out-of-pocket payments for health care and to examine the financial catastrophe and impoverishment due to such payments during the transitional period (pre- and post-Universal Coverage policy implementation) in Thailand. This study used the nationally representative Socioeconomic Surveys in 2000 (pre-UC), 2002, and 2004 (post-UC), which contained data from 24747, 34758 and 34843 individual households, respectively. The proportion of out-of-pocket payments for health care as a share of household living standards among Thai households shows a decreasing pattern during the observed period. Moreover, the incidence and intensity of catastrophic payments for health care decline from the pre-UC to post-UC period. The distribution of incidence and the intensity of catastrophic payments for health care across quintiles also indicate that the lower quintile group (1st and 2nd quintiles) incurs lower catastrophic health care payments compared to the higher quintile group. The UC policy is also effective in preventing impoverishment due to out-of-pocket payments for health care since both the poverty headcount and poverty gap decline from the pre-UC to post-UC period. This study provides important evidence that the UC policy implementation is a valuable social protection and safety net strategy that contributes to the prevention of financial catastrophe and impoverishment due to out-of-pocket payments for health care. In conclusion, the UC policy in Thailand achieves one of the goals of improving the health system through equitable health care financing by reducing financial catastrophe and impoverishment due to out-of-pocket payments for health care.