Inequalities in dental service utilization among Thai adults from 2000 to 2017.

OBJECTIVES: The Universal Coverage Health Scheme (UCS) was implemented in Thailand in 2002 to increase access to health services among the Thai population. This study aimed to evaluate socioeconomic inequalities in dental service utilization (DU) before and after UCS implementation and to assess factors associated with DU among Thai adults. METHODS: This study is based on secondary data from four Thai national oral health surveys in 2000-2001, 2006-2007, 2012 and 2017. Whether an individual from a nationally representative sample of Thai adults aged 35-44 went to see the dentist during the past year was used to define DU. The slope index of inequality (SII) and relative index of inequality (RII) were used to assess and compare education and income-related inequalities in DU. Poisson regression was used to assess factors associated with DU. Income inequalities were not reported for the year 2001 (Income data not available). RESULTS: Although DU increased after UCS implementation, socioeconomic inequalities persisted. DU was concentrated among high-education and income groups. Absolute educational inequalities were 0.16 (95% CI: 0.09-0.22), 0.21 (95% CI: 0.10-0.32), 0.26 (95% CI: 0.14-0.38) and 0.25 (95% CI: 0.18-0.32) in 2001, 2007, 2012 and 2017, respectively. Absolute income inequalities were 0.15 (95% CI: 0.04-0.26), 0.07 (95% CI: -0.04-0.18) and 0.12 (95% CI: 0.05-0.19) in 2007, 2012 and 2017, respectively. Occupation, type of health insurance scheme, sex and oral health-related behaviour were associated with DU. CONCLUSION: UCS has improved accessibility to dental services, but UCS alone might not narrow the inequalities gap for Thai adults.

Economic burden of becoming a dentist in Thailand.

OBJECTIVES: To determine the overall estimated financial impact and related expenses incurred over the duration of the undergraduate Dental Degree in Thailand. METHODS: A cross-sectional survey was conducted among all 658 dental undergraduates in Mahidol University, Thailand. Data was collected through a self-administered questionnaire, including the following information: (1) "Background and Demographics": household income, hometown, residence during study and source(s) of any financial aid received; (2) "Living Expenses": Living costs including food, transportation, rent, utility bills, and recreational expenses; (3) "Education related expenses": Including textbooks, stationeries, uniforms, and student activities fees. A cost-median was used as a baseline representation for the actual cost of each item. The mean differences of all expenses between groups before estimation was assessed by using the analysis of variance (ANOVA) method. The statistically significant differences were identified at p < 0.001. RESULTS: The estimated adjusted cost of becoming a dentist in Thailand is THB1,265,027 (36,143.63 USD) for students living at home and THB1,823,027 (52,086.49 USD) for those renting accommodation. Students who rented accommodation incurred significantly higher yearly living expenses than those who were living at home. (p < 0.001). The majority of participants (78.4%) were in households having a middle-to-high socioeconomic status. Ninety-five percentages of the participants' received 100% financial support from their families with no additional source of income, which reflects no real diversity in the socioeconomic background of Dental Degree students. CONCLUSION: The cost of a higher education Dental Degree in Thailand can be a significant barrier to entry and financial burden, especially for students from disadvantaged socioeconomic backgrounds. Government and Educational Policy makers need to pay more attention to this issue in order to provide equal opportunities for obtaining a University Dental Degree for all Thai students wishing to pursue this career path.