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Semprini J. Incentivizing dental services in healthy behaviour Medicaid waivers. Community Dent Oral Epidemiol 2024. [PMID: 38679753 DOI: 10.1111/cdoe.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 03/25/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE In the United States, adult dental benefits are optional in the state-managed, public insurance program, Medicaid. States also have the option to adapt their Medicaid program via waivers which pair healthy behaviour incentives (HBI) with cost-sharing. These waivers have proven ineffective, but the empirical evidence has ignored differences between states. This study aims to evaluate the impact of four state's HBI Medicaid waiver on dental visits among low-income adult population subject to incentives and cost-sharing requirements by the HBI waiver. METHODS Analysing biannual data from the Behavioural Risk Factor Surveillance System's Oral Health module (2008-2018) with a Difference-in-Differences design, this study estimated the effect of a Healthy Behaviour Incentive waiver on the probability of visiting the dentist in the past year. The three states that implemented an HBI Waiver (Indiana, Michigan and Wisconsin) were analysed separately. Secondary outcomes included being uninsured and having all teeth extracted. Matrix Completion methods accounted for dynamic treatment and tested for non-common trends. Inference was based on randomization inference tests. RESULTS Only in Michigan was an HBI waiver consistently associated with a significant increase in the probability of a dental visit (Est. = 5.6%-points, p = .01). There was little convincing evidence that HBI waivers were associated with being uninsured or having all teeth extracted. CONCLUSIONS Between 2010 and 2019, many states have implemented an HBI waiver, each with a different approach to incentivizing dental visits. These implementation differences may explain the heterogeneous effects by state. More work is needed to evaluate how Medicaid waivers impact health outcomes in low-income populations.
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Affiliation(s)
- Jason Semprini
- Department of Epidemiology, University of Iowa College of Public Health, Iowa, Iowa, USA
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Murphy K, Gondro JV, Moharrami M. Factors associated with the use of oral health care services among Canadian children and youth. Health Rep 2024; 35:15-26. [PMID: 38630920 DOI: 10.25318/82-003-x202400400002-eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background This study investigates the association between dental insurance, income, and dental care access for Canadian children and youth aged 1 to 17 years. It contributes to a baseline understanding of oral health care use before the implementation of the Canadian Dental Care Plan (CDCP). Data and methods This study used data from the 2019 Canadian Health Survey on Children and Youth (n=47,347). Descriptive statistics and logistic regression models were employed to assess the association of dental insurance, adjusted family net income, and other sociodemographic factors on oral health care visits and cost-related avoidance of oral health care. Results A large percentage of children under the age of 5 had never visited a dentist (79.8% of 1-year-olds to 16.4% of 4-year-olds). Overall, 89.6% of Canadian children and youth aged 5 to 17 had visited a dental professional within the past 12 months: 93.1% of those who were insured and 78.5% of those who were uninsured. Insured children and youth had a 4.5% cost-related avoidance of dental care, contrasting with 23.3% for uninsured children and youth. After adjustment for sociodemographic variables, children and youth with dental insurance were nearly three times more likely (odds ratio [OR]: 2.94; 95% confidence interval [CI]: 2.60 to 3.33) to have visited a dental professional in the past 12 months than uninsured children and youth. Having dental insurance (OR: 0.19; 95% CI: 0.16 to 0.21) was protective against barriers to seeing a dental professional because of cost. There was a strong income gradient for both dental service outcomes. Interpretation The study emphasizes the significant association of dental insurance and access to oral health care for children and youth. It highlights a significant gap between insured and uninsured children and youth and points out the influence of sociodemographic and income factors on this disparity.
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Affiliation(s)
| | | | - Mohammad Moharrami
- Centre for Direct Health Measures, Statistics Canada
- Faculty of Dentistry, University of Toronto
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Moharrami M, Sano Y, Murphy K, Hu X, Clarke J, McLeish S, Fortin Y. Assessing the role of dental insurance in oral health care disparities in Canadian adults. Health Rep 2024; 35:3-14. [PMID: 38630919 DOI: 10.25318/82-003-x202400400001-eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background This study examines the association of dental insurance with oral health care access and utilization in Canada while accounting for income and sociodemographic factors. It contributes to a baseline of oral health care disparities before the implementation of the Canadian Dental Care Plan (CDCP). Data and methods This retrospective study of Canadians aged 18 to 64 years is based on data from the 2022 Canadian Community Health Survey. Multivariable logistic regression was employed to evaluate the association of dental insurance with the recency and frequency of dental visits, as well as avoidance of dental care because of cost. Results Overall, 65.7% of Canadians reported visiting a dental professional in the previous year: 74.6% of those with private insurance, 62.8% with public insurance, and 49.8% uninsured. Cost-related avoidance of dental care was 16.0%, 20.9%, and 47.4% for the privately insured, publicly insured, and uninsured, respectively. After adjustment, adults with private (odds ratio [OR]=2.54; 95% confidence interval [CI]: 2.32 to 2.78) and public (OR=2.17; 95% CI: 1.75 to 2.68) insurance were more likely to have visited a dental professional in the last year compared with those without insurance. Similarly, both private (OR=0.22; 95% CI: 0.20 to 0.25) and public (OR=0.22; 95% CI: 0.17 to 0.29) insurance holders showed a significantly lower likelihood of avoiding dental visits because of cost when compared with uninsured individuals. Interpretation This study showed the significant association of dental insurance with access to oral health care in Canada, contributing to setting a critical benchmark for assessments of the CDCP's effectiveness in addressing oral health disparities.
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Affiliation(s)
- Mohammad Moharrami
- Centre for Direct Health Measures, Statistics Canada
- Faculty of Dentistry, University of Toronto
| | - Yujiro Sano
- Centre for Direct Health Measures, Statistics Canada
| | | | - Xuefeng Hu
- Centre for Direct Health Measures, Statistics Canada
| | - Janine Clarke
- Centre for Direct Health Measures, Statistics Canada
| | - Scott McLeish
- Centre for Direct Health Measures, Statistics Canada
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Horter L, Richardson C, Paul M, Meyer BD. Adverse childhood experiences, dental insurance, and developmental disability: Association with unmet dental needs in Ohio. J Public Health Dent 2024. [PMID: 38517099 DOI: 10.1111/jphd.12605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/24/2023] [Accepted: 12/19/2023] [Indexed: 03/23/2024]
Abstract
OBJECTIVE This study investigated whether insurance status and/or developmental disability moderated the association between adverse childhood experiences (ACE) and unmet dental needs among children aged 0 to 17 in Ohio. METHODS We utilized cross-sectional data from the 2021 Ohio Medicaid Assessment Survey to assess the dental needs of children. ACE scores, dental insurance status, and developmental disability status were analyzed using multivariable logistic regression to identify their potential association with parental-reported unmet dental needs. RESULTS The weighted sample represented 2,752,222 children in Ohio. Over half reported zero ACEs (55.8%) and no dental needs (56.1%). Approximately 1 in 9 lacked dental insurance (11.1%), and 1 in 10 had a developmental disability (9.9%). Children with one to three ACEs had three times the odds of unmet dental needs compared to children with zero ACEs (OR = 3.20; 95%CI [2.10, 4.89]), and children with four or more ACEs had eight times the odds of unmet dental needs (OR = 8.78; 95%CI [5.26, 14.67]). Children lacking dental insurance had over six times higher odds of unmet dental needs compared to children with dental insurance (OR = 6.10; 95%CI [3.92, 9.49]). The presence of developmental disability status did not moderate the presence of unmet dental needs; however, the lack of dental insurance status significantly moderated the association between ACEs and unmet dental needs. CONCLUSION Insurance status, not developmental disability, moderated the association between ACEs and unmet dental needs among children in Ohio. Efforts to ensure continuous access to dental insurance are warranted.
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Affiliation(s)
- Lili Horter
- Department of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Carson Richardson
- Department of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Marika Paul
- Department of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Beau D Meyer
- Division of Pediatric Dentistry, College of Dentistry, The Ohio State University, Columbus, OH, USA
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Pendleton M, Moss ME, Wu Q, Tempel R, Garcia R, Al-Dajani M. Payment Methods and Demographics Influence Patterns of Dental Service Utilization. J Public Health Manag Pract 2023; 29:929-935. [PMID: 37290126 PMCID: PMC10549891 DOI: 10.1097/phh.0000000000001774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe the patterns of specific dental service utilization among the various sociodemographic groups in North Carolina served by the East Carolina University School of Dental Medicine (ECU SoDM). DESIGN This was a descriptive study utilizing self-reported patients' sociodemographic information, payment method history, and CDT codes of procedures performed. Deidentified clinical data recorded for 26 710 patients and 534 983 procedures from 2011 to 2020 were extracted from a centralized axiUm database. Data were analyzed using IBM SPSS Statistics, version 25.0. Cross-tabulations between dental service utilizations, patients' demographics, and payment method were performed using chi-square analysis. SETTING Nine dental clinic sites across the state of North Carolina. PARTICIPANTS In total, 26 710 adults 23 years to older than 65 years were included in the sample for this study. MAIN OUTCOME MEASURES In total, 534 983 procedure codes completed for the eligible patients were cross-tabulated with payment method. RESULTS Payment method was significantly related to individual characteristics including location of service, age, race, ethnicity, and untreated decay ( P < .001). Payment method is associated with the dental service type utilized by an individual ( P < .001). Patients who received Medicaid benefits were more likely to receive restorative procedures, removable prosthetics, or oral surgery. Despite NC Medicaid covering preventive procedures, patients who received Medicaid benefits showed lower utilization of preventive procedures than expected. Privately insured or self-paying individuals demonstrated a greater variety of service option utilization, as well as more frequent usage of more specialized procedure options such as endodontics, periodontics, fixed prosthodontics, and implants. CONCLUSIONS Payment method was found to be related to patients' demographics and type of dental service utilized. Adults older than 65 years demonstrated a higher proportion of self-payment for dental care, indicating a lack of payment options for this population. In the interest of providing care for underserved populations in North Carolina, policy makers should consider expanding dental coverage for adults older than 65 years.
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Affiliation(s)
- Matthew Pendleton
- School of Dental Medicine (Mr Pendleton, and Drs Moss, Tempel, and Al-Dajani) and Department of Public Health (Dr Wu), East Carolina University, Greenville, North Carolina; and Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts (Dr Garcia)
| | - Mark E. Moss
- School of Dental Medicine (Mr Pendleton, and Drs Moss, Tempel, and Al-Dajani) and Department of Public Health (Dr Wu), East Carolina University, Greenville, North Carolina; and Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts (Dr Garcia)
| | - Qiang Wu
- School of Dental Medicine (Mr Pendleton, and Drs Moss, Tempel, and Al-Dajani) and Department of Public Health (Dr Wu), East Carolina University, Greenville, North Carolina; and Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts (Dr Garcia)
| | - Rob Tempel
- School of Dental Medicine (Mr Pendleton, and Drs Moss, Tempel, and Al-Dajani) and Department of Public Health (Dr Wu), East Carolina University, Greenville, North Carolina; and Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts (Dr Garcia)
| | - Raul Garcia
- School of Dental Medicine (Mr Pendleton, and Drs Moss, Tempel, and Al-Dajani) and Department of Public Health (Dr Wu), East Carolina University, Greenville, North Carolina; and Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts (Dr Garcia)
| | - Mahmoud Al-Dajani
- School of Dental Medicine (Mr Pendleton, and Drs Moss, Tempel, and Al-Dajani) and Department of Public Health (Dr Wu), East Carolina University, Greenville, North Carolina; and Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts (Dr Garcia)
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Dill J, Fontana M, Bader J, Chaffin J, Strock S, Eckert G. Impact of the COVID-19 pandemic on oral health care use in the United States through December 2021. J Am Dent Assoc 2023; 154:937-947.e3. [PMID: 37656082 DOI: 10.1016/j.adaj.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/30/2023] [Accepted: 07/20/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The purpose of this study was to assess the effects of the COVID-19 pandemic on oral health care provided from July 2020 through December 2021 using national claims data. METHODS Deidentified quarterly claims from 2017 through 2021 were analyzed (2017-2019 provided prepandemic data). Data were sorted into multiple treatment categories. Analyses compared prepandemic with postpandemic procedure volumes and were stratified according to age groups (0-5 years, 6-18 years, 19-64 years, ≥ 65 years). RESULTS For children aged 0 through 5 years, use of sealants and topical fluorides other than varnish were considerably lower in 2021, as were direct operative and palliative procedures from 2020 through 2021. Only use of silver diamine fluoride, prefabricated crowns, and oral surgery increased significantly (P < .05) in some quarters. For children aged 6 through 18 years, diagnostic, direct operative, periodontic, oral surgery, and palliative procedures were significantly lower in most of 2020 through 2021, and only prefabricated crowns and indirect operative procedures increased significantly in more than 3 quarters. For adults aged 19 through 64 years, diagnostic and preventive procedures were significantly lower in 3 quarters, and direct operative, gingival surgery, endodontic, and palliative procedures were significantly lower in most of 2020 through 2021. Only occlusal guards and scaling and root planing increased significantly in more than 3 quarters. For adults 65 years and older, direct operative, gingival and osseous surgery, and palliative procedures were significantly lower in more than 3 quarters; all other procedures increased significantly in more than 3 quarters. CONCLUSIONS The pandemic was associated with changes in the provision of oral health care that persisted for more than 1 year. PRACTICAL IMPLICATIONS Reductions in preventive procedure volumes across age groups younger than 65 years may have implications for longer-term effects of the pandemic.
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Elani HW, Figueroa JF, Kawachi I, Rosenthal M. Early changes in health coverage and access to dental care associated with Medicaid expansion under the COVID-19 pandemic. Health Aff Sch 2023; 1:qxad032. [PMID: 38500761 PMCID: PMC10948102 DOI: 10.1093/haschl/qxad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
The extent to which the COVID-19 pandemic has affected early changes in health coverage and access to dental care services in states that expanded Medicaid versus those that did not is currently not well known. Using data from the National Health Interview Survey, we found that, during the first year of the COVID-19 pandemic, states that had previously expanded their Medicaid programs under the Affordable Care Act had lower uninsurance rates for White low-income adults (-8.8 percentage points; 95% CI: -16.6, -1.0) and lower dental uninsurance rates for all low-income adults (-5.4 percentage points; 95% CI: -10.4, -0.5). Our findings also suggest that the combination of Medicaid expansion with coverage of adult dental benefits in Medicaid was associated with improved dental coverage and access to dental care during the pandemic. With the expiration of the public health emergency declaration, states are considering strategies to prevent disruptions in Medicaid coverage. Our study adds to the evidence of the importance of Medicaid expansion in stabilizing health coverage during a public health crisis.
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Affiliation(s)
- Hawazin W. Elani
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA 02115, United States
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Jose F. Figueroa
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Meredith Rosenthal
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
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Gupta A, Salway T, Jessani A. Cost-related avoidance of oral health service utilization among lesbian, gay, and bisexual individuals in Canada. J Public Health Dent 2023; 83:254-264. [PMID: 37329179 DOI: 10.1111/jphd.12574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/12/2023] [Accepted: 05/17/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES This study estimates the frequency of cost-related oral health service avoidance (CROHSA) among lesbian, gay, and bisexual (LGB) individuals in Canada relative to heterosexual persons. METHODS Heterosexual and sexual minority individuals in Canada were compared using the national probability-based Canadian Community Health Survey 2017-2018. Logistic regression was used to quantify associations between LGB status and CROHSA. Mediators were tested following Andersen's behavioral model of health service utilization and included partnership status, oral health status, presence of dental pain, educational attainment, insurance status, smoking status, general health status, and personal income. RESULTS From our sample of 103,216 individuals, 34.8% of LGB individuals reported avoiding oral health care due to cost compared to 22.7% of heterosexual persons. Disparities were most pronounced among bisexual individuals (odds ratio [OR] 2.29 95% confidence interval [CI] 1.42, 3.49). Disparities persisted despite adjustment for confounding using age, gender/sex, and ethnicity (OR 2.23 95% CI 1.42, 3.49). Disparities were fully mediated by eight hypothesized mediators namely, educational attainment, smoking status, partnership status, income, insurance status, oral health status, and the presence of dental pain (OR 1.69 95% CI 0.94, 3.03). In contrast, lesbian/gay individuals did not have elevated odds of experiencing CROHSA compared to heterosexual individuals (OR 1.27 95% CI 0.84, 1.92). CONCLUSION CROHSA is elevated for bisexual individuals relative to heterosexual individuals. Targeted interventions should be explored to improve oral healthcare access among this population. Future research should assess the role of minority stress and social safety on oral health inequities among sexual minority groups.
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Affiliation(s)
- Amit Gupta
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Travis Salway
- British Columbia Centre for Disease Control, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Abbas Jessani
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
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Burns LE, Gencerliler N, Gold HT. A comparative analysis of public and private dental benefit payer types for the provision and outcomes of root canal therapy on permanent teeth of children and adolescents in Massachusetts. J Am Dent Assoc 2023; 154:151-158. [PMID: 36528395 PMCID: PMC10026184 DOI: 10.1016/j.adaj.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/13/2022] [Accepted: 10/27/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite substantial increases in dental benefits and improvements in the use of dental services among children and adolescents in the United States, oral health disparities according to dental insurance payer type persist. METHODS The authors used an all-payer claims (2013-2017) database to perform a comparative analysis of the provision and treatment outcomes of an endodontic procedure (root canal therapy) in the permanent teeth of a pediatric population aged 6 through 18 years, according to dental insurance payer type. Statistical analyses, including logistic regression, Cox proportional hazards regression, and the Kaplan-Meier method, were performed at person and tooth levels. RESULTS Compared with privately insured children and adolescents, public-payer children and adolescent beneficiaries were more likely to have had root canal therapy (adjusted odds ratio, 1.91; 95% CI, 1.73 to 2.11) and had poorer treatment outcomes associated with the procedure (adjusted hazard ratio, 2.19; 95% CI, 1.53 to 3.14; P < .0001) during the study period. Those enrolled in private insurance were more likely to receive treatment from an endodontist (specialist in providing root canal therapy) (P < .0001). Amounts allowed and paid by the insurer were significantly higher for private payers (P < .001). CONCLUSIONS There were significant differences in the provision and outcomes of endodontic treatment between privately and publicly insured children and adolescents. PRACTICAL IMPLICATIONS Despite ostensibly equal access to care, differences in the provision of oral health care exist between privately and publicly insured patients. These differences may be contributing to persisting oral health disparities.
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Molino AR, Minnick MLG, Jerry-Fluker J, Karita Muiru J, Boynton SA, Furth SL, Warady BA, Ng DK. Health and Dental Insurance and Health Care Utilization Among Children, Adolescents, and Young Adults With CKD: Findings From the CKiD Cohort Study. Kidney Med 2022; 4:100455. [PMID: 35518833 PMCID: PMC9062328 DOI: 10.1016/j.xkme.2022.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Rationale & Objective To understand the association between health and dental insurance status and health and dental care utilization, and their relationship with disease severity in a population with childhood-onset chronic kidney disease (CKD). Study Design Observational cohort study. Settings & Participants Nine hundred fifty-three participants contributing 4,369 person-visits (unit of analysis) in the United States enrolled in the Chronic Kidney Disease in Children (CKiD) Study from 2005 to 2019. Exposures Health insurance (private vs public vs none) and dental insurance (presence vs absence) self-reported at annual visits. Outcomes Self-reported suboptimal health care utilization in the past year, defined separately as not visiting a private physician, visiting the emergency room, visiting the emergency room at least twice, being hospitalized, and self-reported suboptimal dental care utilization over the past year, defined as not receiving dental care. Analytical Approach Repeated measures Poisson regression models were fit to estimate and compare utilization by insurance type and disease severity at the prior visit. Additional unadjusted and adjusted models were fit, as well as models including interactions between insurance and Black race, maternal education, and income. Results Those with public health insurance were more likely to report suboptimal health care utilization across the CKD severity spectrum, and lack of dental insurance was strongly associated with lack of dental care. These relationships varied depending on strata of socioeconomic status and race but the effect measure modification was not significant. Limitations Details of insurance coverage were unavailable; reasons for emergency care or type of private physician visited were unknown. Conclusions Pediatric nephrology programs may consider interventions to help direct supportive resources to families with public insurance who are at higher risk for suboptimal utilization of care. Insurance providers should identify areas to expand access for families of children with CKD.
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Affiliation(s)
- Andrea R. Molino
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Maria Lourdes G. Minnick
- Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Judith Jerry-Fluker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jacqueline Karita Muiru
- Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sara A. Boynton
- Department of Pediatrics, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Susan L. Furth
- Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Bradley A. Warady
- Department of Pediatrics, Division of Nephrology, Children’s Mercy Kansas City, Kansas City, MO
| | - Derek K. Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Chronic Kidney Disease in Children Study
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Pediatrics, Division of Nephrology, Children’s Mercy Kansas City, Kansas City, MO
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Cărămidă M, Țâncu AMC, Imre M, Dumitrache MA, Mihai C, Sfeatcu R. Patients' Perspective on Their Experience of Dental Treatments Covered by Public Health Insurance in Romania-A Pilot Study. Int J Environ Res Public Health 2021; 19:272. [PMID: 35010534 PMCID: PMC8744563 DOI: 10.3390/ijerph19010272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Although the aims of any public health coverage are prevention, diagnosis, treatment, rehabilitation, and maintenance, dental services are hardly ever included in services. The goal of our pilot study is to assess the perspective of a group of adult patients on their covered dental treatments. The present cross-sectional study was conducted on 140 patients who reported their perception by filling in a questionnaire. All the collected data were statistically analyzed using IBM SPSS Statistics 25. Most of the subjects (40.7%, n = 57) were treatment oriented, visiting the dentist only in an emergency situation. A total of 40.7% (n = 57) of the participants stated that all the dental treatments had coverage and 22.8% (n = 13) had to split their treatment plan because of the insurance budget limit. The subjects who had chosen covered dental services because they considered it was a right they should benefit from (53.7%, n = 22) and those who had chosen covered dental services because of financial reasons (29.3%, n = 12) were more frequently unsatisfied with the types of covered dental services. The reduced level of satisfaction was associated mainly with the list of dental procedures accepted for coverage and also with younger and highly educated patients. For a more accurate description, the present study should be completed by future studies not only on a representative population at national level, but also by assessing the perspective of dental professionals.
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Affiliation(s)
- Mariana Cărămidă
- Department of Oral Health and Community Dentistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania; (M.C.); (M.A.D.); (R.S.)
| | - Ana Maria Cristina Țâncu
- Department of Complete Denture, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania;
| | - Marina Imre
- Department of Complete Denture, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania;
| | - Mihaela Adina Dumitrache
- Department of Oral Health and Community Dentistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania; (M.C.); (M.A.D.); (R.S.)
| | - Christina Mihai
- Department of Preventive Dentistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania
| | - Ruxandra Sfeatcu
- Department of Oral Health and Community Dentistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania; (M.C.); (M.A.D.); (R.S.)
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Cooper PF, Manski RJ. Enrollment trends in employer-sponsored health plans that include dental benefits. J Am Dent Assoc 2021; 152:377-384. [PMID: 33926624 DOI: 10.1016/j.adaj.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In this study, the authors provide a better understanding of enrollment trends associated with dental plans embedded in private-sector, employer-sponsored insurance health plans for the years 2005, 2010, 2015, and 2018. METHODS Data used were from the insurance component of the Medical Expenditure Panel Survey. The authors present the number of employees enrolled in employer-sponsored insurance health plans and the percentage of these employees enrolled in health plans that include dental benefits. The authors present yearly estimates for 2005, 2010, 2015, and 2018, according to employer characteristics and state. RESULTS While the number of embedded dental benefit plans has decreased from approximately 14.1 million plans to slightly more than 9.3 million plans in 2018 since 2005, the percentage of enrollees in employer-sponsored insurance health plans with dental coverage has decreased from approximately 23.2% of enrollees to slightly more than 15.0%. CONCLUSIONS Although the percentage of embedded dental plans is decreasing, they are still an important component of the dental insurance market and are especially important to those employees who are enrolled. PRACTICAL IMPLICATIONS Information will provide a better understanding of the source and extent of embedded dental plans provided via private-sector employers. These plans are often less generous than stand-alone plans.
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Kim NH, Jung SH, Kawachi I. Did Expanded Dental Insurance Reduce Out-of-Pocket Expenditures on Dental Care among Older Adults in Korea? Interrupted Time-Series Analysis. Int J Environ Res Public Health 2021; 18:3003. [PMID: 33804211 DOI: 10.3390/ijerph18063003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/17/2022]
Abstract
The Korean National Health Insurance extended its coverage to reduce the economic burden of receiving dentures and implants for older adults in 2012 and 2014, respectively. We examined whether the new policy resulted in reduced out-of-pocket dental care expenditure in the eligible population, specifically focusing on low-income adults. We used interrupted time-series analysis (ITSA), a quasi-experimental design, to identify the effects of the policy among persons aged 65 or older. Data were extracted from the Korea Health Panel Survey (KHP; 2008–2017). The main outcome was out-of-pocket expenditures on dental care. The ITSA showed that expenditures decreased annually by 4.5% (RR: 0.96, 95% CI: 0.95–0.96) between 2012 and 2014. However, expenditure increased by 7.8% (RR: 1.08, 95% CI: 1.07–1.08) after 2014. Dental insurance coverage did not contribute to reducing the out-of-pocket expenses for dentures among low-income adults, while coverage of dental implants led to an increase in dental expenditure.
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Sadiq N, Probst JC, Martin AB, Khan MM, Merchant AT. Untreated Dental Caries May be Associated with Subsequent Mortality among Working-Age Adults: Evidence from NHANES III. Community Dent Oral Epidemiol 2020; 49:377-383. [PMID: 33341956 DOI: 10.1111/cdoe.12612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/21/2020] [Accepted: 11/29/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Poor oral health has been shown to be associated with selected adverse health outcomes. This study assessed the association between untreated dental caries and mortality and examined whether having dental insurance mitigates the risk of mortality among working-age US adults with dental caries. METHODS Analysis used the publicly available linked mortality file for NHANES III, an observational study conducted in 1988-1994, with follow-up through December 2015. Propensity score matching was conducted to create similar populations of insured and uninsured adults, resulting in a sample of 4420 matched observations. The Cox proportional hazard model was used to investigate the effect of untreated dental caries and that of dental insurance on risk of all-cause mortality. The descriptive and final outcome statistical analyses were adjusted for complex sampling technique using weights, strata and cluster variables. RESULTS Adults with untreated dental caries had a higher risk of mortality (HR: 1.33; 95% CI: 1.06-1.68) than those with no dental caries. Having dental insurance was associated with a lower risk of mortality (HR: 0.73; 95% CI: 0.59-0.92). An interaction between caries treatment status and dental insurance was not statistically significant. CONCLUSIONS Adults with untreated dental caries have a higher risk of mortality, even in the presence of dental insurance. Untreated caries may be an indicator for multiple risk factors, including personal attitudes regarding health and healthcare-seeking behaviour.
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Affiliation(s)
- Naveed Sadiq
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Janice C Probst
- Department of Health Services, Policy & Management, University of South Carolina, Columbia, SC, USA
| | - Amy B Martin
- Medical University of South Carolina, Columbia, SC, USA
| | - M Mahmud Khan
- Department of Health Policy & Management, University of Georgia, Athens, GA, USA
| | - Anwar T Merchant
- Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, SC, USA
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Karam I, Jaffa MA, Ghafari J. Barriers to the use of dental services by children in Lebanon and association with parental perception of oral health care. East Mediterr Health J 2020; 26:1420-1424. [PMID: 33226111 DOI: 10.26719/emhj.20.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 11/03/2019] [Indexed: 11/09/2022]
Abstract
Background Oral health is important to general health but use of dental services varies considerably, particularly for children. Aims We aimed to determine factors associated with parents' use of dental services for their children in Lebanon, and their perception of dental care relative to medical care. Methods A convenience sample of public and private schools in Beirut was selected between January and May 2013. Parents of children in grades 2-6 (aged 7-12 years) were invited to complete a questionnaire covering socioeconomic characteristics and use of dental services. Logistic regression analysis was used to assess the relationship between use of dental services, and parents' socioeconomic characteristics and awareness and perceptions of dental services. Results The parents of 316 children returned the questionnaire. Most children (72.8%) had been taken to the dentist in the past year, mainly for emergency care. Most parents (78.2%) considered dental care as important as or more important than medical care, and 89.9% were willing to contribute to dental insurance. Use of dental services was significantly associated with: older age of the parent (odds ratio, OR = 1.04; 95% confidence interval, CI: 1.02-1.06); awareness of dental care centres offering affordable treatment (OR = 3.18; 95% CI: 1.52-6.68); and children being in private schools (OR = 2.00, 95% CI: 1.08-3.95). It was negatively associated with > 4 children in the family compared with 1 child (OR = 0.18; 95% CI: 0.04-0.81). Conclusion Barriers to dental care for children were mostly related to economic factors.
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Affiliation(s)
- Ingrid Karam
- Division of Orthodontics and Dentofacial Orthopedics, Department of Otorhinolaryngology, Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Miran A Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Joseph Ghafari
- Division of Orthodontics and Dentofacial Orthopedics, Department of Otorhinolaryngology, Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Sadiq N, Probst JC, Merchant AT, Martin AB, Shrestha D, Khan MM. The role of dental insurance in mitigating mortality among working-age U.S. adults with periodontitis. J Clin Periodontol 2020; 47:1294-1303. [PMID: 32939782 DOI: 10.1111/jcpe.13366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 07/28/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022]
Abstract
AIM To assess the relationship of dental insurance with all-cause mortality and mortality due to cardiovascular diseases (CVD), diabetes mellitus (DM), and cerebrovascular diseases (CBD) among those with periodontitis. MATERIALS AND METHODS NHANES III and its associated mortality data set were used in this study. The outcome variables were "all-cause mortality" and "combined mortality" due to CVD, DM, and CBD. The independent variable was dental insurance stratified over periodontitis status. Unweighted frequencies with weighted column percentages were used for descriptive statistics, and chi-square test was applied for significance. Cox proportional hazard models were used for stratified multivariable analyses. All analyses were performed in SAS v9.4 accounting for survey data complexities. Significance level was kept at 5%. RESULTS The mortality was 14.58% for all-cause mortality and 4.06% for combined mortality among those with periodontitis in this study. Dental insurance significantly reduced the hazard of all-cause mortality among those with periodontitis (HR: 0.75; 95% CI: 0.61 - 0.93), adjusted for covariates. However, no association of dental insurance with combined mortality was observed among periodontitis group. CONCLUSIONS Dental insurance reduces hazard of all-cause mortality among those with periodontitis. Dental insurance ensures access to dentists and improves oral and dental health. Longitudinal study is needed to establish causality.
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Affiliation(s)
- Naveed Sadiq
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan.,Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, USA
| | - Janice C Probst
- Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, USA
| | - Anwar T Merchant
- Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Amy B Martin
- College of Dental Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Deepika Shrestha
- Data Management and Analysis Division, Center for Policy, Planning and Evaluation, DC Department of Health, Washington, DC, USA
| | - M Mahmud Khan
- Department of Health Policy & Management, University of Georgia, Athens, GA, USA
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Nasseh K, Bowblis JR, Vujicic M. Pricing in commercial dental insurance and provider markets. Health Serv Res 2020; 56:25-35. [PMID: 32844447 PMCID: PMC7839642 DOI: 10.1111/1475-6773.13544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 11/28/2022] Open
Abstract
Objective To examine the impact of commercial dental insurer and provider concentration on dentist reimbursement. Data Sources We utilized provider data from the American Dental Association, reimbursement data from IBM Watson MarketScan® Commercial Research Databases, submitted billed charges from FAIR Health®, dental insurance market concentration data from FAIR Health®, and county‐level demographic and economic data from the Area Health Resources File and the Council for Community and Economic Research. Study Design We used the Herfindahl‐Hirschman Index to separately measure commercial dental insurance concentration and dentist concentration. We studied the effect of provider and insurance concentration on dentist reimbursement. Using two‐stage least squares, we accounted for potential endogeneity in dental insurer and provider concentration. Principal Findings Across the dental procedures we examined, a 10 percent increase in dental insurance concentration is associated with a 1.95 percent (P‐value = .033) reduction in gross payments to dentists. Conversely, a 10 percent increase in dentist concentration is associated with a more modest 0.71 percent (P‐value = .024) increase in gross payments. A 10 percent increase in dental insurance concentration is associated with a 1.16 percentage point (P‐value = .016) decline in the allowed‐to‐list price ratio, while a 10 percent increase in dentist concentration is associated with a 0.56 percentage point (P‐value = .001) increase in the allowed‐to‐list price ratio. Similar patterns were found across dental procedure subcategories. Conclusions Dental provider markets are substantially less concentrated than insurance markets, which may limit the ability of dentists to garner higher reimbursement.
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Affiliation(s)
- Kamyar Nasseh
- American Dental Association, Health Policy Institute, Chicago, Illinois, USA
| | - John R Bowblis
- Department of Economics, Farmer School of Business, Miami University, Oxford, Ohio, USA
| | - Marko Vujicic
- American Dental Association, Health Policy Institute, Chicago, Illinois, USA
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Saeed SG, Bain J, Khoo E, Siqueira WL. COVID-19: Finding silver linings for dental education. J Dent Educ 2020; 84:1060-1063. [PMID: 32488877 PMCID: PMC7300654 DOI: 10.1002/jdd.12234] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Sophia G Saeed
- University of Texas School of Dentistry at Houston, Houston, Texas, USA
| | - Jennifer Bain
- The University of Mississippi Medical Center School of Dentistry, Jackson, Mississippi, USA
| | - Edmund Khoo
- Clinical Orthodontics, New York University College of Dentistry, New York, New York, USA
| | - Walter L Siqueira
- University of Saskatchewan College of Dentistry, Saskatoon, Saskatchewan, Canada
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Shane DM, Wehby GL. Were Patient Protection and Affordable Care Act spillover gains to private dental coverage for dependents widely shared?: An analysis using Medical Expenditure Panel Survey data. J Am Dent Assoc 2020; 151:182-189. [PMID: 32130947 DOI: 10.1016/j.adaj.2019.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/17/2019] [Accepted: 11/18/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND The dependent coverage mandate policy of the Patient Protection and Affordable Care Act led to spillover increases in private dental coverage among affected young adults. The authors investigate whether such gains were widely shared across racial or ethnic groups and shared across income levels. The authors further explore the relationship between dental coverage and dental services use stratified by race or ethnicity and income using the mandate as a natural experiment. METHODS Using nationally representative Medical Expenditure Panel Survey data from 2006 through 2015, the authors used a difference-in-difference regression approach comparing changes in private dental coverage and dental services use for 19- through 25-year-olds affected by the policy with those for unaffected 27- through 30-year-olds. The authors stratified the model by race or ethnicity and income to understand potential differences in the effects of the mandate across these groups. RESULTS The authors found significant increases in private dental coverage across all racial or ethnic groups as well as across higher- and lower-income young adults. However, despite notable increases in private dental coverage, the authors found little evidence of any overall effects on dental services use. The authors did find evidence suggesting an increased relative likelihood of dental visits for 19- through 25-year-old non-Hispanic blacks compared with slightly older non-Hispanic blacks. CONCLUSIONS The spillover effect of the dependent coverage mandate on private dental coverage was widely shared across racial or ethnic groups and across income levels. PRACTICAL IMPLICATIONS Among young adults aged 19 through 25 years, increases in private dental coverage may not be enough on its own to increase the use of preventive dental services and ultimately lead to improved oral health.
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Parish CL, Feaster DJ, Pereyra MR, Alcaide M, Cohen M, Levin S, Gustafson D, Merenstein D, Aouizerat B, Donohue J, Webster-Cyriaque J, Wingood G, Kempf M, Metsch LR. Dental insurance, dental care utilization, and perceived unmet dental needs in women living with HIV: Results from the Women's Interagency HIV Study. J Public Health Dent 2019; 79:343-351. [PMID: 31418877 PMCID: PMC10876047 DOI: 10.1111/jphd.12336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/16/2019] [Accepted: 07/22/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Dental care is the most commonly cited unmet health-care service due to cost. Previous research has highlighted the unmet dental needs of people living with HIV (PLWH). Understanding associations among dental insurance availability, dental care utilization, and the presence of unmet dental needs among PLWH is a public health priority. METHODS Oral health surveys were collected cross-sectionally (April-October 2016) among 1,442 women living with HIV (WLWH) in the Women's Interagency HIV Study. Logistic regression models were used to analyze the association between having versus not having dental insurance by type (Ryan White, private, Medicaid/Medicare) and two primary outcomes: a) typical frequency of dental visits (at least annually, less than annually) and b) reporting an unmet dental need in the past 6 months. RESULTS All dental insurance types were associated with higher odds of receiving annual dental care and, for those with either Medicare/Medicaid or private insurance, lower odds of having an unmet dental need. When WLWH were asked to describe their oral health, poor self-reported condition was associated with both an unmet dental need (odds ratio [OR]: 4.52, 95 percent Confidence Interval [CI] [3.29-6.20]) and lower odds of annual dental care utilization (OR: 0.44, 95 percent CI [0.34-0.57]). Self-reported depressive symptom burden was also linked to having an unmet dental need (OR: 2.10, 95 percent CI [1.46-3.01]). CONCLUSIONS Dental insurance coverage increases dental care utilization and is associated with better oral health among WLWH. In the era of health-care reform, dental insurance coverage may be instrumental for enhancing treatment outcomes.
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Affiliation(s)
- Carrigan Leigh Parish
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J. Feaster
- Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | | | - Maria Alcaide
- Medicine, University of Miami School of Medicine, Miami, FL, USA
- CORE Center, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Mardge Cohen
- Stroger Hospital Cook County Bureau of Health Services Department of Medicine, Chicago, IL, USA
| | - Susanna Levin
- Montefiore Hospital and Medical Center, Bronx, NY, USA
| | - Deborah Gustafson
- Neurology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Daniel Merenstein
- Family Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Bradley Aouizerat
- Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, USA
| | - Jessica Donohue
- WIHS Data Management and Analysis Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer Webster-Cyriaque
- Dental Ecology, University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, North Carolina, USA
| | - Gina Wingood
- Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mirjam Kempf
- Health Behavior, School of Nursing, Birmingham, Alabama, USA
| | - Lisa R. Metsch
- School of General Studies, Columbia University, New York, NY, USA
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Meyerhoefer CD, Zuvekas SH, Farkhad BF, Moeller JF, Manski RJ. The demand for preventive and restorative dental services among older adults. Health Econ 2019; 28:1151-1158. [PMID: 31264323 PMCID: PMC6706303 DOI: 10.1002/hec.3921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 06/09/2023]
Abstract
Many older Americans have poor access to dental care, resulting in a high prevalence of oral health problems. Because traditional Medicare does not include dental care benefits, only older Americans who are employed, have post-retirement dental benefits or spousal coverage, or enroll in certain Medicare Advantage plans are able to obtain dental care coverage. We seek to determine the extent to which poor access to dental insurance and high out-of-pocket costs affect dental service use by the elderly. Using the 2007-2015 Medical Expenditure Panel Survey and supplemental data on dental care prices, we estimate a demand system for preventive dental services and basic and major restorative services. Selection into dental and medical insurance is addressed using a correlated random effects panel data specification. Consistent with prior studies of the nonelderly population, dental service use was not sensitive to out-of-pocket prices. However, private dental insurance increased preventive service use by 25%, and dental coverage through Medicaid increased basic and major service use by 23% and 36%, respectively. The use of services was more responsive to dental insurance for women than men. These estimates suggest that a Medicare dental benefit could significantly increase dental service use by older Americans.
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Affiliation(s)
- Chad D Meyerhoefer
- Department of Economics, Lehigh University, National Bureau of Economic Research, Cambridge, Massachusetts
| | - Samuel H Zuvekas
- Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland
| | | | - John F Moeller
- University of Maryland School of Dentistry, Baltimore, Maryland
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Reynolds JC, Sukalski JMC, McKernan SC, Damiano PC. Member and dentist narratives about a dental programme for the Medicaid expansion population: A content analysis. Community Dent Oral Epidemiol 2019; 47:485-493. [PMID: 31441086 DOI: 10.1111/cdoe.12490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/13/2019] [Accepted: 07/18/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In the United States, the 2010 Affordable Care Act's Medicaid expansion improved financial access to dental care for new Medicaid enrollees in states with Medicaid dental benefits for adults. Using an existing theoretical framework, we explored dentist and Medicaid member narratives concerning a state's redesigned dental programme for the Medicaid expansion population. METHODS Data sources include two surveys conducted in 2016-one to a random sample of Medicaid members and one to private practice dentists in Iowa. A qualitative content analysis approach was used to quantify and describe themes present in open-ended comment data. RESULTS The most common themes among Medicaid member narratives were related to oral health needs and status, availability of dentists who accept Medicaid, and Medicaid coverage for dental care. Among dentists, the programme's administrative burden was the most common theme, with coverage and reimbursement commonly cited as well. An emergent theme among both member and dentist comments was patient confusion or lack of knowledge about programme enrolment and coverage. CONCLUSIONS Member awareness about enrolment and coverage in public dental benefit plans should be further explored to determine the impact on access to care. Effectively communicating the intent, programme design and expectations of a Medicaid programme to both providers and Medicaid members is important to the success of the programme.
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Affiliation(s)
- Julie C Reynolds
- University of Iowa Public Policy Center, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Jennifer M C Sukalski
- University of Iowa Public Policy Center, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Susan C McKernan
- University of Iowa Public Policy Center, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Peter C Damiano
- University of Iowa Public Policy Center, University of Iowa College of Dentistry, Iowa City, IA, USA
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Sohn M, Park S, Lim S, Park HJ. Children's Dental Sealant Use and Caries Prevalence Affected by National Health Insurance Policy Change: Evidence from the Korean National Health and Nutrition Examination Survey (2007-2015). Int J Environ Res Public Health 2019; 16:ijerph16152773. [PMID: 31382547 PMCID: PMC6695976 DOI: 10.3390/ijerph16152773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/16/2022]
Abstract
We evaluated the effect of the National Health Insurance (NHI) policy including dental sealant on changes in the prevalence of sealant and caries, and examined how NHI affected sealant utilization and untreated caries in children from diverse income groups in South Korea. We used a multivariate logistic regression analysis to explore the effects of three stages of dental sealant policy (pre-policy: 2007-2009, first post-policy: 2010-2012, and second post-policy: 2013-2015) on the prevalence of dental sealant and untreated caries. Participant data (N = 8161, aged 6-14 years) were derived from the Korea National Health and Nutrition Examination Survey (2007-2015). We also conducted subgroup analysis to determine the effects of the NHI policy on dental sealant and untreated caries by income level. Implementation of dental insurance coverage was associated with higher likelihood of using dental sealant (odds ratio (OR) = 1.39 (95% confidence interval (CI): 1.18-1.63) for the first period and OR = 1.58 (95% CI: 1.33-1.87) for the second period) and lower odds of having untreated caries (OR = 0.79 (95% CI: 0.64-0.98) for the first period and OR = 0.65 (95% CI: 0.51-0.83) for the second period) after controlling for covariates. Results revealed that there was a greater prevalence of dental sealant and a lower prevalence of untreated caries in both middle- and low-income households compared to high-income households. The higher prevalence of dental sealant and lower untreated caries after the policy implementation. Moreover, we demonstrated children from low-or middle-income households were more associated with increasing dental sealant use and a declining prevalence of caries.
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Affiliation(s)
- Minsung Sohn
- Department of Health and Care Administration, The Cyber University of Korea, 106 Bukchon-ro, Jongno-gu, Seoul 03051, Korea
| | - Sujin Park
- Division of Hospital Management Support, Seoul Health Foundation, 31 Maebongsan-ro, Mapo-gu, Seoul 03909, Korea
| | - Sungwon Lim
- School of Nursing, University of Washington, Health Sciences Building, Room T-507, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Hee-Jung Park
- Department of Dental Hygiene, College of Health Science, Kangwon National University, 346 Hwangjo-gil, Dogye-up, Samcheok-si, Gangwon-do 25945, Korea.
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Nieto V, Arnett M, Furgeson D. Attitudes and Access Patterns of Michigan Veterans Ineligible for Oral Healthcare Benefits: A cross-sectional study. J Dent Hyg 2019; 93:6-13. [PMID: 31409719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 03/14/2019] [Indexed: 06/10/2023]
Abstract
Purpose: Strict eligibility criteria exclude a majority of the veteran population from receiving oral healthcare benefits through the Veterans' Administration Dental Care program (VADC). The purpose of this study was to examine perceptions of oral health status, and access/barriers to dental care of veterans who are ineligible for VADC benefits.Methods: This cross-sectional study was conducted using a 24-item paper survey, disseminated in person to 227 veterans across the state of Michigan over a period of two months. Items included socio-demographic information, questions regarding perceptions of oral health, access to dental care, and perceived barriers. Descriptive statistics were collected to provide an overview of the data.Results: A response rate of 80% (n=182) was achieved. Veterans who perceived themselves as having a poor oral health status were less likely to have a dental home (p=.000) or receive dental care (p=.001). Respondents were more likely to report cost as a barrier (p=.000), and to report having had a toothache during the past 12-months (p=.000).Conclusion: Results from this study indicate that while veterans in general value the importance of oral healthcare, cost and time are significant barriers to accessing dental care for individual's ineligible for VADC benefits. Veterans who perceive themselves as having poor oral health are more likely to report oral health disparities. Further research is needed to impact Veterans Administration policy and decrease oral health disparities.
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Naavaal S, Brickhouse TH, Hafidh S, Smith K. Factors Associated with Preventive Dental Visits Before and During Pregnancy. J Womens Health (Larchmt) 2019; 28:1670-1678. [PMID: 31084459 DOI: 10.1089/jwh.2018.7509] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Poor prenatal oral health has implications for maternal, fetal, and infant health. Studies have shown an association between periodontal disease and adverse pregnancy outcomes, such as preterm delivery, low birth weight, and pre-eclampsia. The objective of this study was to identify the factors associated with preventive dental visits before and during pregnancy and examine the relationship of dental insurance with those visits among Virginia women. Methods: The Virginia Pregnancy Risk Assessment Monitoring System (2012-2014) cross-sectional data were used to explore the use of dental cleaning visit among women. The bivariate and multivariate analyses included sociodemographic variables, health risk factors, chronic conditions, oral health knowledge, and oral health promotion variables. All estimates were weighted; p < 0.05 was considered statistically significant. Results: A total of 1,344 weighted respondents represented ∼293,608 women in Virginia. Overall, 56% of women reported a before pregnancy dental cleaning visit, and 47% of women reported a during pregnancy dental cleaning visit. Nearly 60% of women were non-Hispanic white, 78% were between 20 and 34 years of age, and 67% reported having dental insurance. Dental insurance (odds ratio [OR] = 3.5; 95% confidence interval [95% CI] = 2.17-5.67) and oral health knowledge (OR = 2.8; 95% CI = 1.42-5.48) were associated with before pregnancy dental visit. During pregnancy dental visit was strongly associated with dental insurance (OR = 5.8; 95% CI = 2.80-11.97), before pregnancy dental visit (OR = 20.72, 95% CI = 11.14-38.54), and oral health promotion by health provider (OR = 12.37, 95% CI = 7.31-20.93). Conclusions: Overall, the use of a preventive dental visit before and during pregnancy was low among Virginia women. Improving the use of routine dental visits before pregnancy, increasing access to dental insurance, and engaging health care providers to promote oral health can impact the use of dental care during pregnancy.
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Affiliation(s)
- Shillpa Naavaal
- Department of Oral Health Promotion and Community Outreach, School of Dentistry, Oral Health in Childhood and Adolescence Core, Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, Virginia
| | - Tegwyn H Brickhouse
- Department of Oral Health Promotion and Community Outreach, School of Dentistry, Oral Health in Childhood and Adolescence Core, Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, Virginia
| | - Shahid Hafidh
- Division of Population Health Data, Office of Family Health Services, Virginia Department of Health, Richmond, Virginia
| | - Kenesha Smith
- Division of Population Health Data, Office of Family Health Services, Virginia Department of Health, Richmond, Virginia
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Abstract
OBJECTIVES Dental services in many countries are funded out-of-pocket by patients whose acceptance of a dental treatment depends on their valuation of it. Using a willingness-to-pay (WTP) strategy, this study aimed to determine how people who do not wear dentures value the benefits of dentures retained by implants and what factors explain variations in WTP among subjects. METHODS Telephone numbers of a representative Canadian sample were obtained from a consumer database provider. Respondents completed either an internet-based or telephone survey with 3 payment scenarios: paying oneself (out-of-pocket), coverage with private health insurance, and publicly financed through additional taxes. Personal information data (e.g., age, income) were used as independent variables in regression models to assess the determinants of WTP amounts. RESULTS Among 1,096 respondents, 317 participated in the survey (response rate, 28.9%). The mean WTP of participants (mean ± SD age: 41.2 ± 0.6 y; 54.3% male) who were dentate/partially edentate was $5,347 for implant overdentures. Considering a 1 in 5 chance of becoming edentate, they were willing to pay $26.93 as monthly payments for private insurance. They were also willing to pay an additional yearly tax of $103.63 to support a public program. WTP private payments increased substantially with increase in household income and dental needs. CONCLUSION This preference study provides information to dentists, insurance companies, and policy makers on what dentate people are willing to pay for implant overdentures, whether directly or with insurance/government coverage. KNOWLEDGE TRANSFER STATEMENT This study provides results of interest to many stakeholders. For clinicians, the results reveal what people are willing to pay for implant overdentures for themselves. It also provides information to employers and insurance companies on how people value having coverage for this kind of service. Furthermore, it provides public policy makers the value that people place on public funding of such treatments and how they would support a decision to publicly fund such a treatment.
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Affiliation(s)
- A Srivastava
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - S Esfandiari
- Faculty of Dentistry, University of Montreal, Montreal, QC, Canada
| | - S A Madathil
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - S Birch
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics, University of Manchester, Manchester, UK.,Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia
| | - J S Feine
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
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Abstract
OBJECTIVE To determine the impact of the inclusion of pediatric dental care in the Affordable Care Act's (ACA) core package of essential health benefits on dental coverage and utilization. DATA SOURCES Children aged 1-18 years included in the nationally representative 2010-2015 National Health Interview Survey (NHIS). STUDY DESIGN We used regression-adjusted difference-in-differences to examine changes in rates of dental coverage and visits pre- and post-ACA for children likely to be affected by the ACA (have a parent working for a small employer) to a comparison group of children who were unlikely to be affected (have a parent in a firm with ≥50 employees). Models adjusted for relevant health and sociodemographic measures. DATA COLLECTION NHIS is an annual household survey conducted by the National Center for Health Statistics. PRINCIPAL FINDINGS Comparing pre- and post-ACA periods, private dental insurance increased by 4.6 percentage points more (P = 0.013) and annual dental visits were unchanged (2.7 percentage points, P = 0.071) among children likely to be affected by the ACA compared to children unlikely to be affected by the ACA. CONCLUSION Inclusion of pediatric dental care as an ACA essential health benefit increased dental insurance coverage, but not dental visits among children likely to be affected by this policy.
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Sukalski JMC, McKernan SC, Avila-Ortiz G, Cunningham-Ford MA, Qian F, Damiano PC. Periodontal treatment needs in the Medicaid patient population: a retrospective study in a US dental school. J Public Health Dent 2018; 79:53-59. [PMID: 30516828 DOI: 10.1111/jphd.12294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/30/2018] [Accepted: 10/08/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to use electronic health records (EHRs) from a US dental school clinic to retrospectively investigate associations between periodontal treatment needs and insurance type in a newly insured adult Medicaid population. We hypothesized that newly insured Medicaid patients, covered by the Iowa Dental Wellness Plan (DWP), would display greater need for treatment than patients with other sources of financing. METHODS A retrospective chart review of EHRs of patients at the University of Iowa College of Dentistry and Dental Clinics (UI COD) from 2014 to 2016 was completed. The outcome of interest whether or not a new patient was indicated for scaling and root planing (SRP) based on clinical examination. Logistic regression models analyzed associations between treatment need and source of financing, adjusting for known periodontal disease risk indicators. RESULTS A total of 1,259 patient charts were evaluated. SRP was indicated for 56 percent of all patients. Patients with DWP coverage had significantly greater unadjusted odds of being indicated for SRP than privately insured individuals (OR = 1.47, P = 0.009). However, this association did not remain significant after adjusting for known risk indicators. CONCLUSIONS Although individuals enrolled in DWP were not significantly more likely to need treatment than individuals with other sources of financing when adjusting for risk indicators, their demonstrated clinical need was higher than privately insured adults. Public benefit programs could anticipate greater burden of periodontal need in low-income populations due to increased prevalence of risk factors in this population.
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Affiliation(s)
- Jennifer M C Sukalski
- Department of Preventive and Community Dentistry, University of Iowa, Iowa City, IA, USA.,Public Policy Center, University of Iowa, Iowa City, IA, USA
| | - Susan C McKernan
- Department of Preventive and Community Dentistry, University of Iowa, Iowa City, IA, USA.,Public Policy Center, University of Iowa, Iowa City, IA, USA
| | | | | | - Fang Qian
- Department of Preventive and Community Dentistry, University of Iowa, Iowa City, IA, USA
| | - Peter C Damiano
- Department of Preventive and Community Dentistry, University of Iowa, Iowa City, IA, USA.,Public Policy Center, University of Iowa, Iowa City, IA, USA
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Olsson SR, Pigg M, Isberg PE, Fransson H. Demographic factors in the choice of coronal restoration after root canal treatment in the Swedish adult population. J Oral Rehabil 2018; 46:58-64. [PMID: 30269335 DOI: 10.1111/joor.12723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/03/2018] [Accepted: 09/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND After root canal treatment, a choice is made between different coronal restorations which in the long run could affect the survival of the tooth. OBJECTIVE To compare demographic characteristics between individuals choosing an indirect coronal restoration (crown, inlay/onlay) and individuals choosing other restorations after completion of a root filling. METHODS The cohort consisted of all root-filled upper first molars that were reported to the tax-funded Swedish Social Insurance Agency (SSIA) during 2009. After registration of the root filling, any subsequent coronal restorations within 2 years were identified. The crown group consisted of individuals registered with an indirect coronal restoration and the restoration group was the remaining individuals with a direct coronal restoration or lacking registration. Demographic data (gender, disposable income, age, educational level, civil status and country of birth) were received from Statistics Sweden or the SSIA. Statistical analyses included chi-square test, t test and logistic regression analysis. P < 0.05 was considered statistically significant. RESULTS An indirect coronal restoration was received by 7806 individuals (21.9%), and 27 886 individuals (78.1%) received a direct restoration. All demographic variables except gender differed significantly between groups. Logistic regression analysis found significant associations for all demographic variables and the registration of an indirect restoration except for country of birth and gender. CONCLUSIONS The identified demographic differences between individuals choosing to restore their newly root-filled teeth with an indirect restoration compared to those receiving other restorations may indicate that the tax-funded Swedish dental insurance fails to provide dental care on equal terms for Swedish citizens.
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Affiliation(s)
- Sara R Olsson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Maria Pigg
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Per-Erik Isberg
- Department of Statistics, Lund University School of Economics and Management, Lund University, Lund, Sweden
| | | | - Helena Fransson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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30
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Abstract
Objective To examine the potential association between patients’ characteristics that experienced implant failure and those who had successful implant treatment. Materials and methods This retrospective case-control study is based on 186 dental records of implant failure and 186 age and gender matched successful treatments for a total of 372 patients. Age at the time of the procedure, gender, medical history, tobacco use, dental insurance status, ZIP code and type of treatment provided (implant failure/successful implant treatment) were recorded. Results The population consisted of 47.6% females, 48.9% individuals with dental insurance and 9.7% self-reported tobacco users. A statistically significant association (p≤0.05) was found between implant failure and successful implant treatment in regards to tobacco use, socio-economic status and medical history. Insurance status and implant location (region, arch) did not affect significantly (p>0.05) the outcome of implant therapy. Conclusions Within the limitation of this retrospective case-control study, individuals with high socio-economic status, no history of tobacco use and history of heart attack were more likely to have a successful implant treatment than those with a low socio-economic status, tobacco users and without history of heart attack.
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Affiliation(s)
- Georgios S Chatzopoulos
- Advanced Education Program in Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Larry F Wolff
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN USA
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31
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Abstract
The purpose of this study was to disclose the psychological meaning structure of dentistry as a free market within the context of leading Swedish policymaking. Following the criteria for the descriptive phenomenological psychological method data was collected from leading policy makers about the experiential aspects of dentistry as a free market within the context of a welfare state. The analysis showed that dentistry as a free market was experienced as a complex business relationship between buyers and sellers that transcended the traditional dentist and patient roles. The lived experience of the proposed business transaction was based on two inherently conflicting views: the belief in the individual’s ability to make a free choice versus the understanding that all individuals in a society do not have the ability or the means necessary to make a free choice. Dentistry as a free market within a welfare state, such as Sweden, can thus be seen as a persistent attempt to hold on to a compromise between two very distinctive political ideologies.
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Affiliation(s)
- Bengt Franzon
- a Faculty of Odontology, Department of Oral Diagnostics , Malmö University , Malmö , Sweden
| | | | - Björn Axtelius
- a Faculty of Odontology, Department of Oral Diagnostics , Malmö University , Malmö , Sweden
| | - Björn Klinge
- c Department of Odontology, Division of Oral Diseases, Karolinkska Institutet, Faculty of Odontology, Department of Periodontology , Malmö University , Malmö , Sweden
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Abstract
Oral and dental side effects of cancer treatment can be painful, impede function, and affect patients' quality of life. Inclusion of the dental team is important prior to, during, and after treatment to manage temporary, chronic, or permanent sequelae of treatment. Separation of medical and dental specialties and models of insurance reimbursement make obtaining medically necessary dental care unduly difficult. Nurses are at the front line of care and in a position to identify oral side effects of treatment, provide education, and advocate for proper dental care.
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Finlayson TL, Asgari P, Dougherty E, Tadese BK, Stamm N, Nunez-Alvarez A. Child, caregiver, and family factors associated with child dental utilization among Mexican migrant families in California. Community Dent Health 2018; 35:89-94. [PMID: 29645407 DOI: 10.1922/cdh_4201finlayson06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify associations between child, caregiver, and family-level factors and child dental utilization. RESEARCH DESIGN Cross-sectional oral health survey. PARTICIPANTS Caregivers and one study child (ages 0-17) from Mexican migrant families in northern San Diego county, CA (n=142). METHODS Caregivers reported on child's dental care utilization history and related factors, including: child (age, gender, dental insurance, source of care, believed to have cavities), caregiver (marital status, income, education, acculturation level, depressive symptoms), and family cohesion. Descriptive and logistic regression models identified predisposing, enabling, and need factors associated with child dental utilization during the past year. RESULTS Most (76%) children had visited the dentist in the past year, while 8.6% had never been. Child factors (gender, insurance), caregiver factors (education, depressive symptoms), and family cohesion were each associated with child dental utilization in the bivariate analyses. In the final adjusted model, uninsured children were less likely to have a past year dental visit compared to insured children (Odds Ratio (OR) = 0.23, 95% Confidence Interval (CI) = 0.06-0.96). Children whose caregivers visited the dentist were 4.29 times more likely to visit the dentist in the past year (CI=1.36-13.61). Higher caregiver education was positively associated with child dental utilization (OR=4.50, CI=1.50-13.55). CONCLUSION Child age and dental insurance, and caregiver education and dental utilization history were associated with whether or not a child had a past year dental visit. Ensuring child dental coverage and caregiver access to dental care may promote regular dental utilization by children.
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Affiliation(s)
- T L Finlayson
- Graduate School of Public Health, San Diego State University.,Institute for Behavioral and Community Health
| | - P Asgari
- Institute for Behavioral and Community Health.,Gary & Mary West Health Institute
| | - E Dougherty
- Graduate School of Public Health, San Diego State University.,Institute for Behavioral and Community Health
| | - B K Tadese
- Graduate School of Public Health, San Diego State University.,Institute for Behavioral and Community Health
| | - N Stamm
- Health Promotion Center, Vista Community Clinic
| | - A Nunez-Alvarez
- National Latino Research Center, California State University San Marcos
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34
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Naavaal S, Barker LK, Griffin SO. The effect of health and dental insurance on US children's dental care utilization for urgent and non-urgent dental problems - 2008. J Public Health Dent 2017; 77:54-62. [PMID: 27613222 PMCID: PMC10927192 DOI: 10.1111/jphd.12171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/15/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage. METHODS We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had four categories: none, private health no dental coverage (PHND), private health and dental (PHD), or Medicaid/State Children's Health Insurance Program (SCHIP). Predisposing variables included sociodemographic characteristics. We used bivariate and multivariate analyses to identify explanatory variables' association with utilization-DP. Using logistic regression, we obtained adjusted estimates of utilization-DP by urgency for each insurance category. RESULTS In bivariate analyses, utilization-DP was associated with both insurance and urgency. In multivariate analyses, the difference in percent utilizing care for an urgent versus non-urgent DP among children covered by Medicaid/SCHIP was 32 percentage points; PHD, 25 percentage points; PHND, 12 percentage points; and no insurance, 14 percentage points. The difference in utilization by DP urgency was higher for children with Medicaid/SCHIP compared with either PHND or uninsured children. CONCLUSION Expansion of Medicaid/SCHIP may permit children to receive care for urgent DPs who otherwise may not, due to lack of dental insurance.
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Affiliation(s)
- Shillpa Naavaal
- Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Laurie K Barker
- Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Susan O Griffin
- Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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35
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Gnanamanickam ES, Teusner DN, Arrow PG, Brennan DS. Dental insurance, service use and health outcomes in Australia: a systematic review. Aust Dent J 2017; 63:4-13. [PMID: 28543627 DOI: 10.1111/adj.12534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 11/29/2022]
Abstract
Private health insurance plays a key role in financing dental care in Australia. Having private dental insurance has been associated with higher levels of access to dental care, visiting for a check-up and receiving a favourable pattern of services. Associations with better oral health have also been reported. In the absence of any existing review, this paper aims to systematically review the relationship between dental insurance and dental service use and/or oral health outcomes in Australia. A systematic search of online databases and subsequent sifting resulted in 36 publications, 33 of which were cross sectional and three cohort analyses. Dental service outcomes were more commonly reported than oral health outcomes. There was considerable heterogeneity in the outcome measures reported, for both service use and health outcomes. Overall, the majority of the evidence was from cross sectional studies and few studies reported analyses adjusted for confounding factors. The consolidated evidence points towards a positive association between dental insurance and dental visiting. Dentally insured adults are likely to have more regular access to dental care and have a more favourable pattern of service use than the uninsured. However, evidence of associations between dental insurance and oral health are mixed.
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Affiliation(s)
- E S Gnanamanickam
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - D N Teusner
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - P G Arrow
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Health, Dental Health Services, Perth, Western Australia, Australia
| | - D S Brennan
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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36
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Huang RY, Lin YF, Kao SY, Shieh YS, Chen JS. Dental restorative treatment expenditure and resource utilization in patients with chronic kidney disease: A nationwide population-based study. J Dent Sci 2017; 12:275-282. [PMID: 30895062 PMCID: PMC6400004 DOI: 10.1016/j.jds.2016.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/08/2016] [Indexed: 12/12/2022] Open
Abstract
Background/purpose There is a variety of pathological alterations occurring in the oral cavity are strongly associated with chronic kidney disease (CKD) or CKD therapy. The aim of this study is to conduct a retrospective analysis to examine the possible correlation between the dental restorative treatment modalities and the progression of kidney disease in CKD population. Materials and methods A total of 10,457 individuals were divided into three groups: (HC) group (n = 1438), high risk (HR) group (n = 3392), and CKD group (n = 5627). HR group were defined for those with an eGFR ≥60 (mL/min/1.73 m2) in addition to fulfilling one of the following requirements: (1) being diagnosed diabetes mellitus (DM), hypertension, or cardiovascular disease; (2) having a family member diagnosed with CKD or receiving dialysis treatment. Demographic characteristics, dental restorative treatment utilization and expenditures, including amalgam filling, composite resin filling on anterior teeth or posterior teeth, were analyzed retrospectively (2000–2008) among these groups using a nationwide database. Results The utilization and expenditures for various restorative treatments were significantly different among investigated groups, and the health insurance usage exhibited an inverse relationship with CKD stages, especially at CKD stages 4 and 5. A sustained decline in utilization and expenditures for restorative treatment was associated with the deterioration of kidney function. The lowest usage of these restorative modalities was noted in the CKD group and a marked difference was noted among investigated groups. Conclusion The findings do, however, provide indirect evidence that if patients with progressive renal failure and receive less dental care.
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Affiliation(s)
- Ren-Yeong Huang
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Yuh-Feng Lin
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Shuang Ho Hospital, New Taipei City, Taiwan.,Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sen-Yeong Kao
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Shing Shieh
- School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Jin-Shuen Chen
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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37
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Abstract
BACKGROUND Oral health problems are the leading chronic conditions among children and younger adults. Lack of dental coverage is thought to be an important barrier to care but little empirical evidence exists on the causal effect of private dental coverage on use of dental services. We explore the relationship between dental coverage and dental services utilization with an analysis of a natural experiment of increasing private dental coverage stemming from the Affordable Care Act's (ACA)-dependent coverage mandate. OBJECTIVES To evaluate whether increased private dental insurance due to the spillover effect of the ACA-dependent coverage health insurance mandate affected utilization of dental services among a group of affected young adults. DATA 2006-2013 Medical Expenditure Panel Surveys. STUDY DESIGN We used a difference-in-difference regression approach comparing changes in dental care utilization for 25-year olds affected by the policy to unaffected 27-year olds. We evaluate effects on dental treatments and preventive services RESULTS:: Compared to 27-year olds, 25-year olds were 8 percentage points more likely to have private dental coverage in the 3 years following the mandate. We do not find compelling evidence that young adults increased their use of preventive dental services in response to gaining insurance. We do find a nearly 5 percentage point increase in the likelihood of dental treatments among 25-year olds following the mandate, an effect that appears concentrated among women. CONCLUSIONS Increases in private dental coverage due to the ACA's-dependent coverage mandate do not appear to be driving significant changes in overall preventive dental services utilization but there is evidence of an increase in restorative care.
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Affiliation(s)
- Dan M Shane
- Assistant Professor, University of Iowa College of Public Health, Department of Health Management and Policy, 145 N. Riverside Drive, N244 CPHB, Iowa City, IA 52242
| | - George Wehby
- Associate Professor, University of Iowa College of Public Health, Department of Health Management and Policy, 145 N. Riverside Drive, Iowa City, IA 52242
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Reynolds JC, McKernan SC, Sukalski JMC, Damiano PC. Evaluation of enrollee satisfaction with Iowa's Dental Wellness Plan for the Medicaid expansion population. J Public Health Dent 2017; 78:78-85. [PMID: 28771746 DOI: 10.1111/jphd.12243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/07/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dental coverage for Iowa's Medicaid expansion population is provided through the Dental Wellness Plan (DWP), implemented in May 2014. The plan targets healthy behavior incentives via an earned benefits structure, whereby additional services are covered if enrollees return every 6-12 months for routine dental visits. This study examines enrollee satisfaction with the DWP. METHODS We surveyed a random sample of DWP enrollees 1 year after program implementation about their experiences. Survey items covered dental plan satisfaction, self-rated measures of health, and knowledge and attitudes toward the earned benefits approach. RESULTS Dental plan satisfaction was rated as low by 38 percent of respondents (n = 416), moderate by 25 percent (n = 276), and high by 37 percent (n = 402). A majority of respondents (66 percent) did not know about the earned benefits structure. Regression analysis indicated that respondents most likely to have low plan satisfaction were those who felt it was difficult to earn benefits (OR 3.66, P < 0.001) and those who were unable to find (OR 3.17, P < 0.001), or did not try to find (OR 3.51, P < 0.001), a regular dentist in the plan. CONCLUSIONS Satisfaction with a new model of dental insurance was influenced by whether enrollees had a regular source of care and their perceived ability to return for regular checkups in order to earn covered benefits.
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Affiliation(s)
- Julie C Reynolds
- Preventive and Community Dentistry and Public Policy Center, University of Iowa, Iowa City, IA, USA
| | - Susan C McKernan
- Preventive and Community Dentistry and Public Policy Center, University of Iowa, Iowa City, IA, USA
| | - Jennifer M C Sukalski
- Preventive and Community Dentistry and Public Policy Center, University of Iowa, Iowa City, IA, USA
| | - Peter C Damiano
- Preventive and Community Dentistry and Public Policy Center, University of Iowa, Iowa City, IA, USA
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39
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Hau KPH, Currie BL, Ng SPY, Le N, Poh CFY. Oral health status and possible explanatory factors of an inner-city low-income community. J Dent Sci 2017; 12:49-55. [PMID: 30895023 PMCID: PMC6395230 DOI: 10.1016/j.jds.2016.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/06/2016] [Indexed: 11/19/2022] Open
Abstract
Background/purpose Individuals with low income bear a number of health challenges to healthcare services. Vancouver's Downtown Eastside (DTES) is known to be a low-income community in a metropolitan city. Because it is difficult to reach, the oral health (OH) status of these residents is unknown. The objectives of this study are (1) to design a tool and strategy to collect OH information in a low-income community, (2) to characterize the OH status and related factors among low-income adults, and (3) to identify the explanatory factors for their OH status. Materials and methods Mobile screening clinics were established in the gathering centers of the DTES, and those of 19 years of age or older were recruited. Data were collected through survey interviews and clinical examinations. Potential explanatory factors were investigated by regression analysis. Results The 356 screened participants were mostly males, middle-aged, less educated, and living with low income (≤CAD$20,000/y). About 80% had dental coverage, mostly from public programs (94%). Many (86%) perceived a dental need. Among dentate participants (n = 306), on average, 3.8 decayed, 8.6 missing, 4.9 filled teeth, and a care index of 41.5% were observed. Social factors (barriers to care and length of DTES residence), dental hygiene (brushing/flossing), and personal (hepatitis C virus infection/methadone usage) factors contributed to their care index level. Conclusion This is the first time that comprehensive information regarding OH status has been collected from a low-income, inner-city community in Canada. Further investigations in the challenges and needs in accessing dental care may develop solutions for better OH in similar communities.
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Affiliation(s)
- Keith Pak-Hei Hau
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Brenda Lee Currie
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Samson Pak-Yan Ng
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Nhu Le
- Integrative Oncology and Cancer Control Research, British Columbia Cancer Agency Research Centre, Vancouver, BC, Canada
| | - Catherine Fang-Yeu Poh
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
- Integrative Oncology and Cancer Control Research, British Columbia Cancer Agency Research Centre, Vancouver, BC, Canada
- Corresponding author. Faculty of Dentistry, Department of Oral Medical and Biological Sciences, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, Canada V6T 1Z3.
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Manski R, Moeller J, Chen H, Widström E, Listl S. Disparity in dental out-of-pocket payments among older adult populations: a comparative analysis across selected European countries and the USA. Int Dent J 2017; 67:157-171. [PMID: 28213893 DOI: 10.1111/idj.12284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The current study addresses the extent to which diversity exists in dental out-of-pocket (OOP) payments across population subgroups within and between the USA and selected European countries. This represents the final paper in a series in which the previous two papers addressed diversity in dental coverage and dental utilisation, respectively, using similar data and methods. METHOD We used data from the 2006/2007 Health and Retirement Study (HRS) and from the 2004-2006 Survey of Health, Ageing and Retirement in Europe (SHARE) for respondents ≥51 years of age. We estimated the impacts of dental-care coverage and of demographic, socio-economic and health status on the likelihood and amount of dental OOP payments. RESULTS In the USA, older persons with the least education, lowest income and worst health are most likely to pay nothing OOP for their dental care and, for persons with an OOP payment, the amount of this payment increases with income and education and is higher for persons who are uninsured and in fair or poor health. However, these results were not consistently found in the 10 European countries we studied. CONCLUSIONS European countries classified according to social welfare state or the presence of social health insurance (SHI) showed no effect on the likelihood of making payments OOP for dental care nor, when OOP payments were made, on the amounts paid. Variation in generosity of coverage and procedures reimbursed by insurance, even within countries with SHI, as well as differing needs, tastes and access to care across countries, contribute to this finding.
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Affiliation(s)
- Richard Manski
- Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - John Moeller
- Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Haiyan Chen
- Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Eeva Widström
- National Institute for Health and Welfare, Helsinki, Finland
| | - Stefan Listl
- Translational Health Economics Group, Department of Conservative Dentistry, Heidelberg University, Heidelberg, Germany.,Munich Center for the Economics of Aging, Max-Planck-Institute for Social Law and Social Policy, Munich, Germany
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Fingar KR, Smith MW, Davies S, McDonald KM, Stocks C, Raven MC. Medicaid dental coverage alone may not lower rates of dental emergency department visits. Health Aff (Millwood) 2017; 34:1349-57. [PMID: 26240249 DOI: 10.1377/hlthaff.2015.0223] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medicaid was expanded to millions of individuals under the Affordable Care Act, but many states do not provide dental coverage for adults under their Medicaid programs. In the absence of dental coverage, patients may resort to costly emergency department (ED) visits for dental conditions. Medicaid coverage of dental benefits could help ease the burden on the ED, but ED use for dental conditions might remain a problem in areas with a scarcity of dentists. We examined county-level rates of ED visits for nontraumatic dental conditions in twenty-nine states in 2010 in relation to dental provider density and Medicaid coverage of nonemergency dental services. Higher density of dental providers was associated with lower rates of dental ED visits by patients with Medicaid in rural counties but not in urban counties, where most dental ED visits occurred. County-level Medicaid-funded dental ED visit rates were lower in states where Medicaid covered nonemergency dental services than in other states, although this difference was not significant after other factors were adjusted for. Providing dental coverage alone might not reduce Medicaid-funded dental ED visits if patients do not have access to dental providers.
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Affiliation(s)
- Kathryn R Fingar
- Kathryn R. Fingar is a research leader at Truven Health Analytics in Sacramento, California
| | - Mark W Smith
- Mark W. Smith is a director in the Federal Government Division of Truven Health Analytics in Bethesda, Maryland
| | - Sheryl Davies
- Sheryl Davies is a research associate in the Center for Health Policy and the Center for Primary Care and Outcomes Research at Stanford University, in California
| | - Kathryn M McDonald
- Kathryn M. McDonald is executive director of and a senior scholar at the Center for Health Policy and the Center for Primary Care and Outcomes Research at Stanford University
| | - Carol Stocks
- Carol Stocks is a senior research analyst in the Center for Delivery, Organization, and Markets at the Agency for Healthcare Research and Quality, in Rockville, Maryland
| | - Maria C Raven
- Maria C. Raven is an associate professor of emergency medicine at the University of California, San Francisco
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Manski RJ, Hyde JS, Chen H, Moeller JF. Differences Among Older Adults in the Types of Dental Services Used in the United States. Inquiry 2016; 53:53/0/0046958016652523. [PMID: 27284127 PMCID: PMC4905592 DOI: 10.1177/0046958016652523] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/29/2016] [Indexed: 11/24/2022]
Abstract
The purpose of this article is to explore differences in the socioeconomic, demographic characteristics of older adults in the United States with respect to their use of different types of dental care services. The 2008 Health and Retirement Study (HRS) collected information about patterns of dental care use and oral health from individuals aged 55 years and older in the United States. We analyze these data and explore patterns of service use by key characteristics before modeling the relationship between service use type and those characteristics. The most commonly used service category was fillings, inlays, or bonding, reported by 43.6% of those with any utilization. Just over one third of those with any utilization reported a visit for a crown, implant, or prosthesis, and one quarter reported a gum treatment or tooth extraction. The strongest consistent predictors of use type are denture, dentate, and oral health status along with dental insurance coverage and wealth. Our results provide insights into the need for public policies to address inequalities in access to dental services among an older US population. Our findings show that lower income, less wealthy elderly with poor oral health are more likely to not use any dental services rather than using only preventive dental care, and that cost prevents most non-users who say they need dental care from going to the dentist. These results suggest a serious access problem and one that ultimately produces even worse oral health and expensive major procedures for this population in the future.
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Abstract
OBJECTIVES To assess whether the Affordable Care Act's (ACA) dependent coverage health insurance mandate had a spillover impact on young adult dental insurance coverage and whether any observed effects varied by household income. DATA Medical Expenditure Panel Surveys from 2006 through 2011. STUDY DESIGN We employed a difference-in-difference regression approach comparing changes in insurance rates for young adults ages 19-25 years to changes in insurance rates for adults ages 27-30 years. Separate regressions were estimated by categories of household income as a percentage of the Federal Poverty Level (FPL) to understand whether the mandate had heterogeneous spillover effects. RESULTS Private dental insurance increased by 6.7 percentage points among young adults compared to a control group of 27-30-year olds. Increases were concentrated at middle-income levels (125-400 percent FPL). CONCLUSIONS The dependent coverage mandate provision of the Affordable Care Act has not only increased health insurance rates among young adults but also dental insurance coverage rates.
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Affiliation(s)
- Dan M Shane
- Padmaja Ayyagari, Ph.D., is also with the Department of Health Management and Policy, University of Iowa, Iowa City, IA
| | - Padmaja Ayyagari
- Padmaja Ayyagari, Ph.D., is also with the Department of Health Management and Policy, University of Iowa, Iowa City, IA
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Kreider B, Moeller J, Manski RJ, Pepper J. The effect of dental insurance on the use of dental care for older adults: a partial identification analysis. Health Econ 2015; 24:840-58. [PMID: 24890257 PMCID: PMC4247826 DOI: 10.1002/hec.3064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 02/11/2014] [Accepted: 04/24/2014] [Indexed: 05/16/2023]
Abstract
We evaluate the impact of dental insurance on the use of dental services using a potential outcomes identification framework designed to handle uncertainty created by unknown counterfactuals-that is, the endogenous selection problem-and uncertainty about the reliability of self-reported insurance status. Using data from the health and retirement study, we estimate that utilization rates of adults older than 50 years would increase from 75% to around 80% under universal dental coverage.
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Affiliation(s)
| | - John Moeller
- Division of Health Services Research University of Maryland Dental School
| | - Richard J. Manski
- Division of Health Services Research University of Maryland Dental School
| | - John Pepper
- Department of Economics University of Virginia
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Abstract
OBJECTIVE We analyze correlates of the direction and magnitude of changes in out-of-pocket (OOP) payments for dental care by older Americans over a recent 4-year period. METHODS We analyzed data from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of the direction and linear regression models of the amounts of OOP changes over survey periods. RESULTS Financial-based factors were more strongly associated with the direction and magnitude of changing self-payments for dental care than were health factors. DISCUSSION Findings suggested that dental coverage, income, and wealth and changes in these financial factors were more strongly correlated with the persistence of and changes in OOP payments for dental care over time than were health status and changes in health status. The sensitivity to dental coverage changes should be considered as insurance and retirement policy reforms are deliberated.
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Affiliation(s)
- Richard J Manski
- Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - John F Moeller
- Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Haiyan Chen
- Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | | | - John V Pepper
- Department of Economics, University of Virginia, Charlottesville, VA, USA
| | - Patricia A St Clair
- RAND Corporation, Center for the Study of Aging, Santa Monica, CA, USA University of Southern California, Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA
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Moeller JF, Manski RJ, Mathiowetz NA, Campbell N, Pepper JV. Response error in reporting dental coverage by older Americans in the health and retirement study. Inquiry 2014; 51:51/0/0046958014561325. [PMID: 25428430 PMCID: PMC4283597 DOI: 10.1177/0046958014561325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this research was to analyze the inconsistency in responses to survey questions within the Health and Retirement Study (HRS) regarding insurance coverage of dental services. Self-reports of dental coverage in the dental services section were compared with those in the insurance section of the 2002 HRS to identify inconsistent responses. Logistic regression identified characteristics of persons reporting discrepancies and assessed the effect of measurement error on dental coverage coefficient estimates in dental utilization models. In 18% of cases, data reported in the insurance section contradicted data reported in the dental use section of the HRS by those who said insurance at least partially covered (or would have covered) their (hypothetical) dental use. Additional findings included distinct characteristics of persons with potential reporting errors and a downward bias to the regression coefficient for coverage in a dental use model without controls for inconsistent self-reports of coverage. This study offers evidence for the need to validate self-reports of dental insurance coverage among a survey population of older Americans to obtain more accurate estimates of coverage and its impact on dental utilization.
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Affiliation(s)
- John F Moeller
- University of Maryland School of Dentistry, Baltimore, USA
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Manski RJ, Vargas CM, Brown E, Carper KV, Macek MD, Cohen LA. Dental procedures among children age birth to 20, United States, 1999 and 2009. J Public Health Dent 2014; 75:10-6. [PMID: 24964135 DOI: 10.1111/jphd.12065] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/23/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe dental procedures received by US children and adolescents by poverty status and dental insurance coverage. METHODS Data for this analysis came from the 1999 and 2009 Medical Expenditure Panel Surveys. The primary outcome variable represented the types of dental procedures that were received during dental visits in the preceding year. Descriptive variables included dental insurance and poverty status. Analysis was restricted to children from birth to 20 years. RESULTS Overall, diagnostic (41.2 percent) and preventive (35.8 percent) procedures accounted for most of the procedures received by children from birth to 20 years of age, while restorative procedures accounted for just 5 percent. Children from low-income families received a higher proportion of restorative procedures than children in higher-income families. The proportion of diagnostic and preventive services was lower among uninsured children than among publicly insured children. Orthodontic services, on the other hand, represented a greater percentage of these procedures among uninsured children than among publicly insured children. DISCUSSION The vast majority of procedures received by children from birth to 20 years were diagnostic and preventive. Most children with at least one dental visit received a diagnostic or preventive service. Between 1999 and 2009, the proportion of all services received accounted for by diagnostic or preventive services increased. However, the proportion in which each type of procedure was received by children who made at least one visit who received did not change.
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Affiliation(s)
- Richard J Manski
- Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
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Abstract
BACKGROUND While dental service use in Australia has been extensively reported, little is known about associated costs. The aim of this article was to describe the annual individual dental expenditure of Australian adults. METHODS Self-reported service use and expenditure data were sourced from a sample of 3000 adults aged 30 to 61 years who were randomly selected from the electoral roll. Bivariate associations between total individual dental expenditure and out-of-pocket expenditure (fees less insurance rebate) and a range of participant characteristics were explored. RESULTS Response rate for the baseline questionnaire was 39.4% and of these, 53.1% responded at 12-month follow-up. The mean total dental expenditure was $702 and mean out-of-pocket expenditure was $489. Toothache was associated with total dental expenditure; adults experiencing toothache had higher median expenditure ($445) than adults who hardly ever/never had toothache ($308) (p < 0.05). Dental insurance status was not associated with total expenditure, but insured had lower median out-of-pocket expenditure ($146) than uninsured adults ($320) (p < 0.01). CONCLUSIONS Affordability variables typically associated with access to dental care, such as insurance status, were not associated with total expenditure, while poorer oral health was associated with higher total expenditures.
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Affiliation(s)
- D N Teusner
- Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, South Australia
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Bhagavatula P, Xiang Q, Eichmiller F, Szabo A, Okunseri C. Racial/ethnic disparities in provision of dental procedures to children enrolled in Delta Dental insurance in Milwaukee, Wisconsin. J Public Health Dent 2012; 74:50-6. [PMID: 22970893 PMCID: PMC4121860 DOI: 10.1111/j.1752-7325.2012.00366.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Most studies on the provision of dental procedures have focused on Medicaid enrollees known to have inadequate access to dental care. Little information on private insurance enrollees exists. This study documents the rates of preventive, restorative, endodontic, and surgical dental procedures provided to children enrolled in Delta Dental of Wisconsin (DDWI) in Milwaukee. METHODS We analyzed DDWI claims data for Milwaukee children aged 0-18 years between 2002 and 2008. We linked the ZIP codes of enrollees to the 2000 U.S. Census information to derive racial/ethnic estimates in the different ZIP codes. We estimated the rates of preventive, restorative, endodontic, and surgical procedures provided to children in different racial/ethnic groups based on the population estimates derived from the U.S. Census data. Descriptive and multivariable analysis was done using Poisson regression modeling on dental procedures per year. RESULTS In 7 years, a total of 266,380 enrollees were covered in 46 ZIP codes in the database. Approximately, 64 percent, 44 percent, and 49 percent of White, African American, and Hispanic children had at least one dental visit during the study period, respectively. The rates of preventive procedures increased up to the age of 9 years and decreased thereafter among children in all three racial groups included in the analysis. African American and Hispanic children received half as many preventive procedures as White children. CONCLUSION Our study shows that substantial racial disparities may exist in the types of dental procedures that were received by children.
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Affiliation(s)
| | - Qun Xiang
- Division of Biostatistics, Medical College of Wisconsin
| | | | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin
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Abstract
For low-income mothers of children aged 3-6 years, we estimate whether social gradients exist between mothers' income, education, and employment status and mothers' perceptions of self and child dental and general health, and whether these relationships differ by racial/ethnic group. Disproportionate stratified sampling by racial/ethnic group selected 10,909 eligible children aged 3 to 6 in Medicaid in Washington State. Mothers (n=4,373) completed a mixed-mode (web, mail, telephone) survey. Mothers' education had a strong, gradient relationship with mother ratings of self and child dental health that was not explained by other measures. Similar gradients were found for mothers' employment status and income, but some associations were no longer significant (p>.05) after adjusting for oral health beliefs and behaviors, dental insurance, and regular dental care. Associations did not differ significantly by racial/ethnic group.
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Affiliation(s)
- David Grembowski
- Department of Oral Health Sciences, University of Washington, Seattle, WA 98195-7660, USA.
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