Improving affordability of Oral Healthcare Through Income and Financial Hardship Interventions: A Longitudinal Modified Treatment Policy Analysis — The Association Specialists
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Improving affordability of Oral Healthcare Through Income and Financial Hardship Interventions: A Longitudinal Modified Treatment Policy Analysis (24200)

Gagandeep Kaur 1 2 3 , Upul Cooray 2 3 , Tania King 4 5 , Amalia Karahalios 1 , Ankur Singh 2 3
  1. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VICTORIA, Australia
  2. University of Sydney School of Dentistry, The University of Sydney, Sydney, New South Wales, Australia
  3. Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
  4. Social Equity Research Centre, School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
  5. Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia

Background: Both income and financial hardship are modifiable policy targets for improving oral healthcare affordability. However, empirical evidence evaluating the effects of income and financial hardship interventions on affordability of oral healthcare remains scarce.

Methods: We used data from the Household, Income and Labour Dynamics in Australia (HILDA) study to examine the impact of hypothetical interventions on income and financial hardship (measured in 2015-2017) on affordability of oral healthcare (2018) among working-age adults. We implemented longitudinal modified treatment policies, including Incremental Propensity Score Interventions (IPSI) that shifted the probability distribution of financial hardship under population-wide and targeted scenarios, alongside income intervention scenarios. These interventions were contrasted with the observed natural course. Targeted maximum likelihood estimation with Super Learner algorithm was used for estimation, adjusting for baseline and time-varying confounders identified using a directed acyclic graph.

Results: Targeted reductions in financial hardship among low-income (below median) individuals produced 48% improvement in oral healthcare affordability (RR: 0.52; 95% CI: 0.46, 0.59), while population-wide reductions in financial hardship also improved affordability (RR: 0.77; 95% CI: 0.73, 0.81). A universal annual income top-up of AUD$432 per person, equivalent to Australia’s per capita expenditure on dental services, produced an 11% improvement in affordability (RR: 0.89; 95% CI: 0.79, 1.00).

Conclusions: Policies aimed at reducing financial hardship may improve affordability-related unmet oral healthcare need, particularly when focused on financially disadvantaged populations. These findings highlight the importance of addressing lived financial hardship through upstream socio-economic welfare policies to improve affordability barriers to oral healthcare.