Geographic location and indirect costs – a patient perspective

Background: The recently published National Survey of Adult Oral Health indicated that tooth loss, mean decayed, number of DMF teeth were all higher outside capital city locations but that there was no difference by geographical location in terms of financial barriers to dental care. Objectives: The objective of this research was to identify, quantify, and analyze some of the non-treatment costs associated with dental treatment from the perspective of the patient and to determine whether the perceived impact of those costs may limit access to dental care and oral health. Methods: This cohort study was nested within a clinical trial. Patients were randomly allocated to a treatment modality characterized by the dental practice they usually attended classified as major city; regional; remote. A questionnaire was developed from a series of focus groups. Patients were asked to identify and quantify the perceived non-treatment costs associated with a dental visit that was important to them. Factor analysis was used to reduce these items to four core scales. Reliability and validity were assessed. Regression and ANCOVA were used to explore differences in DMFS scores between the groups and a predictive model developed to adjust for potential confounders. Results: Two core scales were identified as key drivers for the perceived impact of indirect costs associated with dental visits; travel impact; family impact. Patients living in remote locations incurred significantly higher indirect costs associated with dental treatment (p<0.001) and higher mean DMFS scores (p<0.001).Conclusion: Patient perception of the impact of travel costs and impact on family life are major drivers restricting access to dental services for people in remote locations in NSW. Further research using outcomes directly related to access is required to validate the claim that patients living in regional and remote locations suffer both perceived and real financial barriers to dental care.