Oral health financing in Thailand.

Abstract

This document research, gathering various sources of data and database about oral health expenditure, behavior and outcomes during 1988 -1998, aimed to 1) analyze value and trend of oral health expenditure from 2 major sectors: household and government and 2) assess the achievement in oral health due to national investment. The results were as following

Monthly oral health expenditure of household continued increasing during 1988 - 1996 and dropped in 1998. But the proportions of monthly expenditure to total consumption were quite consistent (0.5-0.6 %). Yearly per capita toothbrush and toothpaste expenditure (87.5 Bahts in 1998) was more than of dental treatment (25.3 Bahts). Yearly per capita oral health expenditure was increasing tendency since 1988 and decreased in 1998. Its highest increasing rate was between 1990-1992. In 1998, oral health expenditure of people in Bangkok metropolis was highest, then those in central, south or north and northeast which were 257.0, 116.4, 88.9, 82.7 and 73.6 Bahts/person/year respectively. Among areas, people in municipal area paid higher than those in sanitary and village areas which were 132.7, 104.2 and 81.0 Bahts/person/year respectively.

Each year, government budget was allocated for dental treatment more than oral disease prevention. Remarkably, the prevention proportion continued increasing since 1988 to be equaled the treatment proportion in 1992 then slightly higher whereas the treatment proportion was inversely direction. The investment was found lack of equity since government spent in municipal area more than sanitary district and rural area. Even though value of oral health budget was increasing, it was steadily decreasing proportion in total health budget from 2.7 in 1988 to be 2.3 % in 1996. However, oral health budget were quite consistent proportioning to gross domestic product (GDP) which were between 0.02 (1988-1992) - 0.03 % (1994-1996).

At national level, overall expenditure from all sources as well as yearly per capita for oral health were increasing during each 2-years (89.1, 100.2, 122.4, 131.6 and 142.4 Baht/person/year, respectively). Proportioning to GDP, total oral health expenditure mainly came from people and slowly decreased and was compensated by increased government expenditure. Although the value of oral health promotion expenditure was more than treatment, its proportion was decreasing whereas that of the treatment was inversely increasing.

Oral health and risk behaviors were tooth brushing with fluoride dentifrice, consumption risky foods of dental caries and cigarette smoking which was periodontitis risk. Proportion of tooth brushing more than 2 times per day were increasing as well as consumption sugar cane and risky foods but a number of people in all age groups did not brush before bedtime. Smoking rate in each sex and age group tended to decrease and the starting age falling into the smoking also decreased. For dental service, dental extraction still was the main service which all groups of people received.

Achievement on oral health was conducted from comparing the whole investment to people's oral health status. Providing dental treatment was obviously success especially for primary school student and could preserve more permanent teeth. However, tooth loss in other groups still was important problem particularly in 17-18 aged group which the denture requirement would be followed. Increasing percentage of caries and periodontal disease affected in all aged groups stated that oral disease prevention was quite failed. Oral health problem may be more serious in the future if most of financing agencies especially specific welfare programs still tend to prior treatment rather than promotion and prevention. In addition, oral health promotion and disease prevention strategies would be reconsidered and reconstructed.