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Tan SHX, Lee GKY, Goh CE, Tong HJ, Chuang JCP, Ang KY, Lim DGX, Gao X. Impact of income and financial subsidies on oral health care utilization among persons with disabilities in Singapore. Community Dent Oral Epidemiol 2024; 52:336-343. [PMID: 38644526 DOI: 10.1111/cdoe.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND/AIM(S) Globally, studies have shown that the dental disease burden among persons with intellectual and/or developmental disabilities (IDD) is high and can be attributed to lower utilization levels of dental services. The aim of the study was to assess the influence of income and financial subsidies on the utilization of dental care services among persons with IDD in Singapore. METHODS Between August 2020 and August 2021, a cross-sectional study was conducted via centres offering Early Intervention Programme for Infants and Children, special education schools and adult associations in Singapore serving persons with IDD. A sample of 591 caregivers of children and adults with IDD completed the survey. Data on sociodemographic information, oral health behaviours and dental utilization were collected. Financial subsidy status was assessed by the uptake of a government-funded, opt-in Community Health Assist Scheme (CHAS) for low-income families that provided a fixed subsidy amount for dental services in the primary care setting. Statistical analysis was carried out using univariable, multiple logistic regression and modified Poisson regression. Propensity score matching was carried out in R version 4.0.2 to assess the impact of financial subsidies on oral health care utilization among persons with IDD. RESULTS Compared to those with lower gross monthly household incomes, the adjusted prevalence ratios of having at least one dental visit in the past year, having at least one preventive dental visit in the past year, and visiting the dentist at least once a year for persons with IDD with gross monthly household incomes of above SGD$4000 were 1.28 (95% CI 1.08-1.52), 1.48 (95% CI 1.14-1.92) and 1.36 (95% CI 1.09-1.70), respectively. Among those who were eligible for CHAS Blue subsidies (247 participants), 160 (62.0%) took up the CHAS Blue scheme and 96 (35.4%) visited the dentist at least yearly. There was no statistically significant difference in the utilization of dental services among individuals enrolled in the CHAS Blue subsidy scheme among those eligible for CHAS Blue subsidies. CONCLUSION Higher household income was associated with a higher prevalence of dental visits in the past year, preventive dental visits in the past year, and at least yearly dental visits. CHAS Blue subsidies alone had limited impact on dental utilization among persons with IDD who were eligible for subsidies.
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Affiliation(s)
- Sharon Hui Xuan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Charlene Enhui Goh
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Huei Jinn Tong
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | | | | | - David Guang Xu Lim
- Tzu Chi Singapore Free Clinic, Buddhist Compassion Relief Tzu Chi Foundation, Singapore, Singapore
- National Dental Centre Singapore, Singapore, Singapore
| | - Xiaoli Gao
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
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Tu RY, Liang P, Tan AJM, Tran DHG, He AM, Je H, Kroon J. Factors associated with regular dental attendance by aged adults: A systematic review. Gerodontology 2023; 40:277-287. [PMID: 36271656 DOI: 10.1111/ger.12661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine factors influencing regular dental attendance in aged adults 65 and over according to Andersen's Behavioural Model. BACKGROUND Regular attendance for dental visits is vital to improve and maintain oral health, quality of life and general well-being. Aged adults 65 years and older experience barriers to regular dental attendance, which in turn leads to an increased risk for oral diseases. MATERIALS AND METHODS An electronic search was undertaken in April 2021 in Cochrane, Embase, Medline, Cinahl, Dentistry & Oral Science Source via EBSCOhost and Embase for papers on factors influencing the frequency of attendance by older people. Risk of bias was assessed according to the Newcastle-Ottawa Scale for cohort and case-control studies, and with modified version of this tool for cross-sectional studies. Frequency effect size was calculated for factors described in Andersen's Behavioural Model (predisposing, enabling and needs-related). RESULTS Twenty-one studies were eligible for inclusion. Factors frequently investigated affecting regular dental attendance included: age, gender, education (predisposing); income, and social support (enabling); and remaining teeth, pain, perceived health (needs-related). Income was the only factors with a 100% positive association with regular dental attendance. CONCLUSIONS This systematic review confirms the complex interconnectedness of several factors and dental attendance in older adults. A number of factors were identified which warrant further investigation to improve access to dental care to socio-economically vulnerable older populations.
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Affiliation(s)
- Raychel Yap Tu
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Phoebe Liang
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Alan Jia-Ming Tan
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Daniel Hien Gia Tran
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Antonio Menglong He
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Heidi Je
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Jeroen Kroon
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
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Peng J, Townsend J, Casamassimo P, Coury DL, Gowda C, Meyer B. Dental Care Differences Among the Behavioral Health Population in an Accountable Care Organization: A Retrospective Cohort. Acad Pediatr 2022; 23:839-845. [PMID: 36055449 DOI: 10.1016/j.acap.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare dental utilization and expenditures between children with and without behavioral health (BH) diagnoses in an accountable care organization. METHODS This retrospective cohort study used enrollment and claims data of Medicaid-enrolled children in Ohio. Children with 7 years of continuous enrollment from 2013 to 2019 were included. We calculated 5 dental utilization outcomes: 1) Diagnostic only visits, 2) Preventive visits, 3) Treatment visits, 4) Treatment visits under general anesthesia (GA), and 5) Orthodontic visits. Total 7-year cumulative expenditures were calculated for each outcome. Multivariable logistic regression models were run for each outcome adjusting for demographics and medical comorbidities. RESULTS Among 77,962 children, 23% had ≥1 BH diagnosis. No utilization differences were noted between children with and without BH for diagnostic only visits, treatment visits, and orthodontic visits. BH status modified the likelihood of having a preventive visit and dental GA visits based on medical comorbidity. For example, children with BH diagnoses had significantly lower odds of a preventive visit (eg, non-complex chronic comorbidity: odds ratio [OR] = 0.87, 95% confidence interval [CI]: 0.85-0.89), and significantly higher odds of a dental treatment under general anesthesia visit (eg, non-chronic comorbidity: OR = 3.69, 95% CI: 3.26-4.18). The total cumulative dental expenditures were $10.5M greater for children with BH. CONCLUSIONS Children with BH diagnoses were significantly less likely to have preventive visits and more likely to have dental GA visits, which was expensive. Early identification and intervention could alter treatment approaches, improve care, reduce risk of harm, and achieve cost-savings within a pediatric accountable care organization.
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Affiliation(s)
- Jin Peng
- Information Technology Research and Innovation (J Peng), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Dentistry (J Peng, J Townsend, P Casamassimo, and B Meyer), Nationwide Children's Hospital; Columbus, Ohio
| | - Janice Townsend
- Department of Dentistry (J Peng, J Townsend, P Casamassimo, and B Meyer), Nationwide Children's Hospital; Columbus, Ohio; Division of Pediatric Dentistry (J Townsend and B Meyer), The Ohio State University, College of Dentistry; Columbus, Ohio
| | - Paul Casamassimo
- Department of Dentistry (J Peng, J Townsend, P Casamassimo, and B Meyer), Nationwide Children's Hospital; Columbus, Ohio
| | - Daniel L Coury
- Department of Developmental and Behavioral Pediatrics (DL Coury), Nationwide Children's Hospital; Columbus, Ohio
| | - Charitha Gowda
- Department of Infectious Diseases (C Gowda), Nationwide Children's Hospital; Columbus, Ohio; Partner's For Kids (C Gowda), Columbus, Ohio
| | - Beau Meyer
- Department of Dentistry (J Peng, J Townsend, P Casamassimo, and B Meyer), Nationwide Children's Hospital; Columbus, Ohio; Division of Pediatric Dentistry (J Townsend and B Meyer), The Ohio State University, College of Dentistry; Columbus, Ohio.
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Chen MC, Kung PT, Su HP, Yen SM, Chiu LT, Tsai WC. Utilization of tooth filling services by people with disabilities in Taiwan. Int J Equity Health 2016; 15:58. [PMID: 27044476 PMCID: PMC4820987 DOI: 10.1186/s12939-016-0347-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 04/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The oral condition of people with disabilities has considerable influence on their physical and mental health. However, nationwide surveys regarding this group have not been conducted. For this study, we used the National Health Insurance Research Database to explore the tooth filling utilization among people with disabilities. METHODS Using the database of the Ministry of the Interior in 2008 which included people with disabilities registered, we merged with the medical claims database in 2008 of the Bureau of National Health Insurance to calculate the tooth filling utilization and to analyze relative factors. We recruited 993,487 people with disabilities as the research sample. RESULTS The tooth filling utilization was 17.53 %. The multiple logistic regression result showed that the utilization rate of men was lower than that of women (OR = 0.78, 95 % CI = 0.77-0.79) and older people had lower utilization rates (aged over 75, OR = 0.22, 95 % CI = 0.22-0.23) compared to those under the age of 20. Other factors that significantly influenced the low tooth filling utilization included a low education level, living in less urbanized areas, low economic capacity, dementia, and severe disability. CONCLUSION We identified the factors that influence and decrease the tooth-filling service utilization rate: male sex, old age, low education level, being married, indigenous ethnicity, residing in a low urbanization area, low income, chronic circulatory system diseases, dementia, and severe disabilities. We suggest establishing proper medical care environments for high-risk groups to maintain their quality of life.
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Affiliation(s)
- Ming-Chuan Chen
- />Department of Public Health, China Medical University, Taichung, Taiwan R.O.C
- />Department of Health Services Administration, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402 Taiwan R.O.C
- />Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan R.O.C
| | - Pei-Tseng Kung
- />Department of Healthcare Administration, Asia University, Taichung, Taiwan R.O.C
| | - Hsun-Pi Su
- />Department of Dental Hygiene, China Medical University, Taichung, Taiwan R.O.C
| | - Suh-May Yen
- />Department of Chinese Medicine, Nantou Hospital, Nantou, Taiwan R.O.C
| | - Li-Ting Chiu
- />Department of Health Services Administration, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402 Taiwan R.O.C
| | - Wen-Chen Tsai
- />Department of Health Services Administration, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402 Taiwan R.O.C
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