The objective of this study is to characterize how financial hardship related to oral health care (OHC) out-of-pocket (OOP) spending has been conceptualized, defined, and measured in the literature and to identify evidence gaps in this area. This scoping review follows Arksey and O’Malley’s framework and synthesizes financial hardship from OHC concepts, methodologies, and evidence gaps. We searched Ovid-Medline, Ovid-Embase, PubMed, Web of Science, Scopus, EconLit, Business Source Premier, and the Cochrane Library. Gray literature was sourced from institutional websites (World Health Organization, United Nations, World Bank Group, Organisation for Economic Co-operation and Development, and governmental health agencies) as well as ProQuest Dissertations and Thesis Global. We used defined inclusion and exclusion criteria to select studies published between 2000 and 2023. Of the 1,876 records, 65 met our criteria. The studies conceptualized financial hardship as catastrophic spending, impoverishment, negative coping strategies, bankruptcy, financial burden, food insecurity, and personal financial hardship experience. We found heterogeneity in defining OHC OOP payments and services. Also, financial hardship was frequently measured as catastrophic health expenditure using cross-sectional designs and national household spending surveys from high-income and to a lesser extent lower-middle-income countries. We identify and discuss challenges in terms of conceptualizing financial hardship, study designs, and measurement instruments in the OHC context. Some of the common evidence gaps identified include studying the causal relationship in financial hardship from OHC, assessing the financial hardship and unmet dental needs due to cost relationship, and distinguishing the effect between pain/discomfort and esthetic/cosmetic dental treatments on financial hardship. Financial hardship in OHC needs further exploration and the use of consistent definitions as well must distinguish between treatments alleviating pain/discomfort from esthetic/cosmetic treatments. Our study is relevant for policy makers and researchers aiming to monitor financial protection of OOP payments on OHC in the wake of universal health coverage for oral health.

中文翻译：

---

口腔保健自付费用和经济困难：范围界定审查


本研究的目的是描述与口腔保健 （OHC） 自付费用 （OOP） 支出相关的经济困难在文献中的概念化、定义和衡量情况，并确定该领域的证据差距。本范围审查遵循 Arksey 和 O'Malley 的框架，并从 OHC 概念、方法和证据差距中综合了经济困难。我们检索了Ovid-Medline、Ovid-Embase、PubMed、Web of Science、Scopus、EconLit、Business Source Premier和Cochrane图书馆。灰色文献来自机构网站（世界卫生组织、联合国、世界银行集团、经济合作与发展组织和政府卫生机构）以及 ProQuest Dissertations 和 Thesis Global。我们使用明确的纳入和排除标准来选择2000年至2023年间发表的研究。在 1,876 条记录中，有 65 条符合我们的标准。这些研究将经济困难概念化为灾难性支出、贫困、消极应对策略、破产、经济负担、粮食不安全和个人经济困难经历。我们发现在定义 OHC OOP 支付和服务时存在异质性。此外，经济困难经常被衡量为来自高收入国家（在较小程度上是中低收入国家）的横断面设计和全国家庭支出调查的灾难性卫生支出。我们确定并讨论在 OHC 背景下概念化经济困难、研究设计和测量工具方面的挑战。 确定的一些常见证据差距包括研究 OHC 经济困难的因果关系，评估由于成本关系而导致的经济困难和未满足的牙科需求，以及区分疼痛/不适和美容牙科治疗对经济困难的影响。OHC 的经济困难需要进一步探索，并且使用一致的定义也必须区分减轻美学/美容治疗疼痛/不适的治疗。我们的研究与旨在在口腔健康全民健康覆盖之后监测 OHC 上 OOP 付款的财务保护的政策制定者和研究人员相关。