Tendências de gastos com cuidados odontológicos por provedores e serviços de saúde, e Quintis do índice sociodemográfico em 195 países, de 2000 a 2017

Abstract

The number of people affected by oral diseases in the world is approximately 3.5 billion. In this scenario, dental care spending is uneven across countries. Health expenditure analyses have been conducted to understand the current global health financing situation and to assist in health planning. The objective of this study is to describe trends in dental care spending, by health providers and services, and by Socio-Demographic Index quintiles in 195 countries, between 2000 and 2017. Health account data were extracted from 195 countries and expenditures categorized according to the System of Health Accounts. Missing or non-existent data were estimated using a Bayesian multivariate model to construct complete time series. Spending trends were measured using generalized linear regression and the Prais-Winsten method. The results showed that per capita expenditure and total expenditure, in millions of dollars, on dental care by total and outpatient/clinical service providers revealed a clear gradient, with values increasing with greater socioeconomic development. In 2017, countries in high quintile had per capita expenditure 278 and 93 times higher than countries in the low and lower-middle quintile, respectively. Dental expenditure represented a small share in relation to total health expenditure, regardless of the level of development of the countries (in 2017, low quintile – 2,55% and high – 4,66%). In the trend analysis, all quintiles showed an increase in per capita expenditure and total dental expenditure, in relation to total dental providers and outpatient/clinical care. It was concluded that there were large inequalities in the distribution by levels of economic development in dental care spending. To date, this work is the most comprehensive proposal for analyzing trends in dental care expenditure. The findings of this study can help managers identify the prioritization that has been given to public oral health policies, also considering the context of the Universal Health Coverage Agenda, the Global Oral Health Strategy and the Sustainable Development Goals.