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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 2  |  Page : 104-109

Willingness to pay for orthodontic treatment in Kingdom of Saudi Arabia, Riyadh Province


1 Department of Preventive Dentistry, Head of Orthodontic Division, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
2 National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia

Date of Web Publication9-Aug-2016

Correspondence Address:
Eman Jameel Fatani
Department of Preventive Dentistry, Head of Orthodontic Division, Office No. 6th Floor North Tower Al Namuthajiya, Riyadh Colleges of Dentistry and Pharmacy, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-6816.188078

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  Abstract 

Aim: The purpose of this interview-based questionnaire study is to evaluate the patients' and parents' perspectives on orthodontic treatment and parent's willingness to pay (WTP) for orthodontic treatment of their child in Riyadh City.
Research Hypothesis: The higher the socioeconomic status and the severity of the child's malocclusion, the more willing the parents are to pay.
Materials and Methods: Data were collected from 171 patients and their parents who were personally surveyed from several dental centers. Two different questionnaires were used: one was for the patients who rated their satisfaction with their occlusion and the other was for the parents who were asked to approximate the amount of Saudi Riyal (SR) they would be willing to invest for the treatment of their children's malocclusion. The WTP was calculated using the competitive bidding process, with a median price of 10,000 SR.
Results: A total of 171 families and their children with malocclusion were interviewed, of which 71.6% of the parents disagreed to a statement that 10,000 SR/- is a fair amount for the orthodontic treatment. Approximately 47% have responded that their child needed orthodontic treatment. However, a high proportion of parents, i.e., 71.4% were willing to pay more amounts for advanced kind of treatment for their children.
Conclusion: The median price used in this study was unacceptable to many parents; however, those parents who found it acceptable were willing to pay more for advanced treatment procedures. Orthodontists in Saudi Arabia should educate the public to what it entitles to achieve a healthy, functional, and esthetically pleasing occlusion.

Keywords: Malocclusion, orthodontic treatment, quality of life, willingness to pay (WTP)


How to cite this article:
Fatani EJ, Al-Yousef SK. Willingness to pay for orthodontic treatment in Kingdom of Saudi Arabia, Riyadh Province. Saudi J Oral Sci 2016;3:104-9

How to cite this URL:
Fatani EJ, Al-Yousef SK. Willingness to pay for orthodontic treatment in Kingdom of Saudi Arabia, Riyadh Province. Saudi J Oral Sci [serial online] 2016 [cited 2019 May 21];3:104-9. Available from: http://www.saudijos.org/text.asp?2016/3/2/104/188078


  Introduction Top


There has been a steady increase in the number of patients pursuing orthodontic treatment in the modern era of Saudi Arabia over the past few decades. Factors such as age, sex, socioeconomic status, self-respect, and peer age group criteria affect self-understanding of malocclusion, and the uptake of orthodontic treatment has been known to influence the outcomes and patient satisfaction with orthodontic treatment.[1],[2] In Saudi Arabia, orthodontic treatment is made available by national health services for free to a limited number of patients with a long waiting list, causing the majority of patients to seek treatment in the private sector. Decisions to offer and receive orthodontic treatment are not elucidated merely by orthodontists but are ensued by conciliation among the children, parents, and payment agencies.[1] The patient's self-awareness is of substantial value in establishing treatment demand and collaboration while parents are mainly the most influential inspirational and only factor in the treatment.[1]

Economic analysis imparts nonbiased information to facilitate decisions among various modus operandi or concerning the allocation of definite resources.[3],[4],[5] The cost of orthodontic treatment varies depending on multiple factors; therefore, economic analysis can provide objective information to what factors may affect people's willingness to pay (WTP) for various orthodontic treatments.[4] WTP is a way of measuring cost–benefit analysis. Therefore, the purpose of this study is to investigate the maximum amount that parents were willing to pay to correct their children's malocclusion and to determine what monetary value do parents attach to address the need for esthetic and functioning occlusion.[5]


  Materials and Methods Top


This was an interview-based study, in which data were collected from a convenience sample of 171 patients requiring orthodontic treatment and parents of patients undergoing orthodontic treatment. Informed consent with two sets of questionnaire was distributed in various private clinics including the orthodontic clinic at Riyadh Colleges for Dentistry and Pharmacy and governmental university dental clinics. Mixture of closed-ended questions was shaped with answers presented as either clear yes or no choices. Two forms were distributed separately for patients and their parents and the purpose of study and questionnaire forms were elucidated by the surveyor. Demographic data covered were age, gender, income, occupation, and level of education. WTP was measured by setting an average fee for orthodontic treatment which was obtained by calculating the average fee from five different private clinics located in various demographic areas in Riyadh city. The responders were asked if that amount was acceptable or to select the maximum value they would be willing to pay for the correction of a dentofacial deformity. While the second part of the questionnaire was addressed to the patients, the patients were asked to rate their satisfaction with the appearance of their occlusion.

Statistical analysis

Acquired data were subjected to SPSS version 21 (IBM Corp., Armonk, NY, USA) statistical software. Descriptive statistics (mean, standard deviation, and percentages) were used to describe the quantitative and categorical variables. Pearson's Chi-square test was used to compare the distribution of responses of a 5-point categorical data. A P > 0.05 was considered to be statistically significant.


  Results Top


The analysis of data from parents to assess their WTP toward the orthodontic treatment of their children yielded the following results. Out of 168 parents (either mother or father), there were 44% males with the mean age of 30.3 years, and 60.9% had a university level education. About 42.1% of them had a monthly income of more than 8000 Saudi Riyal (SR)/- [Table 1]. Around 47.1% have responded positively for the need of orthodontic treatment of their child and 71.6% of them disagreed to the statement that 10,000 SR/- was a fair amount for the orthodontic treatment. The distribution toward the choice between metal bracket and esthetic appliance was not different as 51.2% opted for metal bracket and 48.8% for expensive esthetic appliance. A high proportion of parents (71.4%) were willing to pay more money for advanced kind of treatment for their children [Table 2a].
Table 1: Socio-Demographic characteristics of study subjects

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Table 2: Distribution of responses of parents towards Orthodontic treatment and Perceptions of patients towards their teeth:
a. Distribution of responses of parents towards Orthodontic treatment


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There was a statistically significant difference in the distribution of responses of patient's perceptions toward their teeth on a 5-point scale, which indicates significant number of patients shows positive perceptions of their teeth. However, there was a lack of knowledge of the effectiveness of orthodontic treatment as the data for Q13 and Q14 show no statistically significant difference in their binary (yes/no) responses [Table 2b].
Table 2: Distribution of responses of parents towards Orthodontic treatment and Perceptions of patients towards their teeth:
b. Perceptions of patients towards their teeth (n=169)


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There is no statistically significant association between the characteristics of parents (gender, educational level, and income status) and the binary responses for the statement, “Does your child need orthodontic treatment?” The distribution of “Yes” and “No” is not statistically significant across male and female patients (P = 0.27), across the 3 levels of education (P = 0.09), and across the 3 levels of income status (P = 0.09) [Table 3a].
Table 3: Association between study variables and responses of study parents for different statement:
a. Association between study variables and responses of study parents for a statement: “Does your child need orthodontic treatment”


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There is no statistically significant association between the characteristics of parents (gender and educational level) and the binary responses for the statement, “Do you think this amount (10,000 SR) is a fair amount?” The distribution of “Yes” and “No” is not statistically significant between male and female patients (P = 0.53) and among the three levels of education (P = 0.34) whereas there was a statistically significant difference seen among the three levels of family income. About 34.7% of parents whose income was above 8000 SR agreed that 10,000 SR amount was a fair amount for orthodontic treatment, whereas only 16.7% of parents whose income was less than 3000 SR agreed that 10,000 SR amount is a fair amount for orthodontic treatment, the difference was statistically significant (P = 0.012) [Table 3b].
Table 3: Association between study variables and responses of study parents for different statement:
b. Association between study variables and responses of study parents for a statement: “Do you think this amount (10000 SR) is a fair amount?”


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There was no statistically significant association between the educational level of parents and the choice between metal bracket and esthetic appliance. The distribution of these two choices of treatment was not statistically significant among the three levels of education (P = 0.093). Fathers (58.1%) were significantly more likely to choose esthetic appliances than mothers (42.6%, 58) (P = 0.045). Similarly, parents with a higher income were more likely to choose esthetic brackets compared to those of lower income groups [Table 3c].
Table 3: Association between study variables and responses of study parents for different statement:
c. Association between study variables and responses of study parents for a statement: “Would you go for standard metal and bracket treatment or more expensive esthetic appliances knowing that both treatments have same results”


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There was no statistically significant association between the characteristics of parents (gender, educational level, and income status) and the binary responses for the statement, “Are you willing to pay more for advanced treatment?” The distribution of “Yes” and “No” was not statistically significant between fathers and mothers (P = 0.63), among the three levels of education (P = 0.08) or among the three levels of income status (P = 0.06) [Table 3d].
Table 3: Association between study variables and responses of study parents for different statement:
d. Association between study variables and responses of study parents for a statement: “Are you willing to pay more for advanced kind of treatment”


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  Discussion Top


WTP is a well-known process for estimating the monetary value of health-care programs.[6],[7] WTP is a type of contingent valuation which initially originated in environmental economics.[3],[4],[5] It seeks to allocate financial values to both the expenses and results of health care and to evaluate the net benefit. In the milieu of health, this path attempts to institute what value public append to health care outcomes or involvements by asking them how much they would be willing to pay to attain the perks of treatment or evade the pessimistic aspects of illness.[3],[4]

Economic evaluations can be defined as the “process of ensuring that the value of what is gained from an activity outweighs the value of what is sacrificed.”[6],[7] For instance, the WTP perspective can be utilized to assess an individual's judgment of how much a person is willing to spend to have access to orthodontic treatment. Economic evaluations can be defined as the “process of ensuring that the value of what is gained from an activity outweighs the value of what is sacrificed.”[6],[7],[8] For instance, the WTP perspective can be utilized to assess an individual's judgment of how much a person is willing to spend to have access to orthodontic treatment.

We assessed the WTP of parents of children with malocclusion and established that this is a viable method to calculate the amount that the parents are willing to spend for orthodontic care. As there is no usually acknowledged technique for appraising WTP, the closed-ended questions or dichotomous questions were adopted. It has been pointed out that these types of dichotomous questions more closely resemble the market situation.[6] Consequently, we used closed-ended questions to obtain the WTP of the parents. Earlier research implied that open-ended measurements of WTP more frequently directed to denial to take part in the WTP procedure and often resulted in impractical WTP estimates. Furthermore, the closed-ended method more rationally estimates the nature of decisions that individual daily makes. WTP, in addition, can be measured by means of professed payment cards for various options of the WTP from which people can opt or distinct-choice questions, in which they are offered a specific charge for a treatment that would attain a precise health change.[6],[8]

When assessing the parental perception of their children's teeth, we found that 65% wanted to improve the appearance of their children's teeth and 98.8% agreed that healthy well-aligned teeth are important to their child's appearance but did not show much concern about the opinion of others or that it affected their social outlook. While there was no significant difference in their response to whether they needed orthodontic treatment or not, this might be attributed to the lack of information on the benefits of the treatment.

In this study, the WTP value fell short of the average market value; a possible explanation might be that approximately more than 50% of the subjects were attending free University hospitals and approximately 25% were treated by the Orthodontic Postgraduate Department in Riyadh Colleges of Dentistry where they are charged an average fee that was significantly lower than the given market rate. The remaining samples were collected from various private clinics; a similar response of reluctance to pay for a dental service was found in a study done on patients from a university dental hospital in Hong Kong.[9]

The fact that 71.6% of the parents found the fee of 10,000 SR was too high is of concern as it is internationally known that orthodontic treatment is a highly specialized costly treatment. A similar study on patients WTP for implants carried out in Saudi Arabia showed that the patients were willing to pay the average price, suggesting that perhaps the market rate in the given sample was too high.[10],[11] In economic terms, this could suggest that studies have also shown that the dentate individuals would be willing to pay a significant amount to receive mandibular two-implant overdentures if and when they become edentate.[12]

When assessing the orthodontic patients' perception of their appearance, we found that 65% wanted to improve the appearance of their teeth and 98.8% agreed that healthy well-aligned teeth are important to their appearance but did not show much concern about the opinion of others or that it affected their social outlook. This was in agreement with Fox et al.,[13] who noted that children rate their own esthetic appearance as attractive; we also found that there was no significant difference in their response to whether they needed orthodontic treatment or not this might be attributed to the lack of information on the benefits of the treatment.

Studies on the index of orthodontic treatment need (IOTN) state that the need for orthodontic treatment is multifactorial and influenced by elements other than measures of normative orthodontic treatment need and perceptions of esthetics. While patients seem mostly aware of their malocclusion traits, they do not perceive a need for treatment to the same extent as the dentist or orthodontist. Factors that may contribute to these differences are social class, economic considerations, individual perceptions of psychosocial benefits, and attitudes to appliances. Care must be taken not to generalize these findings as cultural differences between various study samples may influence perceptions of esthetics and treatment need. Further work is required to help quantify factors that influence patient and parent perceived need for orthodontic treatment and perhaps incorporate them into indices of treatment need such as the IOTN.[14],[15]

Prior studies proposed that WTP estimates may be influenced by the age of the patient under contemplation and WTP for adults and infants is more compared to children. WTP was probably afflicted by the awareness of the parents that they are not liable for the established WTP amount affirmed in the study. WTP may offer a more concrete measure of health care priorities than, for instance, altered scores of health-related quality of life measures. It remains to be established if there is a superlative method to assess health care preferences.[6] Future studies in the measurement characteristics of WTP estimates are essential to establish whether WTP has authentic gain over other techniques.


  Conclusion Top


Within the limitation of the study, we can conclude that the WTP is an effective method of assessing the market value of orthodontic care in Riyadh, Saudi Arabia. Our findings indicate that the majority of the parents perceived the fee to be excessive.

Acknowledgments

We thank doctors Alaa Hassanain, Yazeed Turkistani, Faisal Tawalah, Abdulrahman Sameer, Khalid Alshareef for their assistance with collecting data and explaining the scope of our survey to patients and parents.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Marques LS, Pordeus IA, Ramos-Jorge ML, Filogônio CA, Filogônio CB, Pereira LJ, et al. Factors associated with the desire for orthodontic treatment among Brazilian adolescents and their parents. BMC Oral Health 2009;9:34.  Back to cited text no. 2
    
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Srivastava A, Feine JS, Esfandiari S. Are people who still have their natural teeth willing to pay for mandibular two-implant overdentures? J Investig Clin Dent 2014;5:117-24.  Back to cited text no. 12
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  [Table 1], [Table 2a], [Table 2b], [Table 3a], [Table 3b], [Table 3c], [Table 3d]



 

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