Prioritizing dental care in South Korean prisons: a dual-structured triage model integrating medical urgency and willingness to pay

Dental care in correctional institutions is often constrained by limited resources, raising concerns about treatment prioritization. This study explores how prison health dentists (PHDs) allocate dental treatments based on clinical urgency and inmates' willingness to pay (WTP), aiming to identify patterns in decision-making. A cross-sectional survey was conducted among 32 eligible PHDs, with 31 completing the survey (representing 96.8% of the target population). The responses covered dental care practices across 47 correctional institutions. The study assessed the availability of resources, treatment prioritization, and the influence of WTP on treatment decisions. A factor analysis was performed to categorize dental conditions based on urgency and financial considerations. PHDs classified dental conditions into four factors corresponding to a proposed tiered model: Tier 1 (Essential Care), which includes dental emergencies and severe infections, was prioritized solely based on medical necessity. Tier 2 (Variable Priority) comprised both urgent and routine conditions where financial considerations influenced prioritization, while Tier 3 (Elective Care) encompassed prosthetic, cosmetic, and orthodontic procedures largely contingent on financial willingness. Finally, Non-essential Care represented cases that PHDs deprioritized altogether. The findings suggest that while emergency treatments are consistently prioritized, urgent and routine care decisions exhibit variability based on financial factors and institutional pressures. Legal precedents further support this dual-structured approach, reinforcing that non-essential treatments need not be provided free of charge. PHDs navigate a complex balance between clinical urgency and financial constraints in correctional dental care. While emergencies are addressed irrespective of WTP, other treatments follow a stratified approach influenced by financial considerations. Implementing this dual-structured triage system as an administrative policy tool may enhance resource allocation while maintaining fairness in treatment access. Future research should assess the feasibility and impact of such a system on oral healthcare outcomes in correctional settings.