Affordable False Teeth: The Effects of Patient Cost Sharing on Denture Utilization and Subjective Chewing Ability

Ando, Michihito; Takaku, Reo

doi:10.1515/bejeap-2015-0194

Cited by 9 publications

(14 citation statements)

References 54 publications

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“…Finally, we chose not to undertake sex stratified analysis due to the limited sample size and instead performed pooled analyses controlling for sex. Previous research reported that denture utilisation with respect to the reduction of the co-payment in Japan was high for women but close to zero for men (Ando and Takaku 2016). However, our analyses suggested that although women utilised significantly more dental services than men, the effect of co-payment reduction was consistent among both sexes, further supporting the aforementioned analytical choice.…”

Section: Discussionsupporting

confidence: 79%

“…Although dental treatments are at high demand among older adults, neither of these studies investigated the utilisation of dental services. Ando and Takaku (2016) used a similar methodology to show the effect of copayment reduction on denture use and subjective chewing ability. However, the data were prior to the implementation of the implementation of current co-payments rates in 2014 and they did not examine the impact of co-payment on dental attendance.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Copayment on Dental Visits: A Regression Discontinuity Analysis

et al. 2020

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Despite their prevalence and burdens, oral diseases are neglected in universal health coverage. In Japan, a 30% copayment (out of pocket) by the user and a 70% contribution by Japan’s universal health insurance (JUHI) are required for dental and medical services. From the age of 70 y, an additional 10% is offered by JUHI (copayment, 20%; JUHI, 80%). This study aimed to investigate the effect of cost on dental service use among older adults under the current JUHI system. A regression discontinuity quasi-experimental method was used to investigate the causal effect of the JUHI discount policy on dental visits based on cross-sectional data. Data were derived from the 2016 Japan Gerontological Evaluation Study. This analysis contained 7,161 participants who used JUHI, were aged 68 to 73 y, and responded to questions regarding past dental visits. Analyses were controlled for age, sex, number of teeth, and equalized household income. Mean ± SD age was 72.1 ± 0.79 y for the discount-eligible group and 68.9 ± 0.78 y for the noneligible group. During the past 12 mo, significantly more discount-eligible participants had visited dental services than noneligible participants (66.0% vs. 62.1% for treatment visits, 57.7% vs. 53.1% for checkups). After controlling for covariates, the effect of discount eligibility was significant on dental treatment visits (odds ratio [OR], 1.36; 95% CI, 1.32 to 1.40) and dental checkups (OR, 1.49; 95% CI, 1.44 to 1.54) in the regression discontinuity analysis. Similar findings were observed in triangular kernel-weighted models (OR, 1.38 [95% CI, 1.34 to 1.44]; OR, 1.52 [95% CI, 1.47 to 1.56], respectively). JUHI copayment discount policy increases oral health service utilization among older Japanese. The price elasticity for dental checkup visits appears to be higher than for dental treatment visits. Hence, reforming the universal health coverage system to improve the affordability of relatively inexpensive preventive care could increase dental service utilization in Japan.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Effect of Copayment on Dental Visits: A Regression Discontinuity Analysis

et al. 2020

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“…It is necessary to consider indicators that assess social well-being outcomes in addition to oral health. Chewing difficulty is a very subjective indicator 2,15 . It not only depends on the intraoral status (dental caries, periodontal disease, number of teeth, prosthodontics, dentures, and/or dry mouth, etc.…”

Section: Discussionmentioning

confidence: 99%

“…Reports on dental insurance focus on the need for coverage, implementation, disparities in accessibility, and inequalities 7 , 9 – 14 . Cost reduction is also one of the main foci of dental insurance studies 7 , 8 , 15 , 16 . For example, within the Korean context, after the expansion of dental insurance, the accessibility of dental care improved 10 , 11 , 14 .…”

Section: Introductionmentioning

confidence: 99%

“…In the USA, reports using a difference-in-difference design showed that insurance expansion under the Affordable Care Act of 2010 increased dental visits 20 but did not reduce income-based inequalities in oral health 21 . A single report focused on the elderly and used a regression discontinuity (RD) design to evaluate the impact of cost sharing on the use of dentures 15 . Even though the utilization of dentures increased, no improvement in chewing ability was found.…”

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confidence: 99%

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Did expanded access to denture services improve chewing ability in the Korean older population? Results of a regression discontinuity analysis

Kim

Kawachi

2020

Sci Rep

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The Korean National Health Insurance expanded the dental insurance in 2012 to cover denture services for older adults. We analyzed whether the new policy improved of chewing ability in the eligible population. We used regression discontinuity (RD), a quasi-experimental design, to analyze the effects of the expanded dental insurance. We analyzed data from the Korea National Health and Nutrition Examination Survey conducted in 2010 and 2015. The study population consisted of two groups: the treatment group, aged 65 and above who were eligible; and the control group, under 65 years of age who were not eligible for the dental insurance benefit. The main outcome evaluated was self-reported chewing difficulty. The RD analysis showed that in 2015, the chewing difficulty in aged above 65 was 2.2% lower than in those aged under 65. However, the difference was not statistically significant (P = 0.76). The results from the falsification testing of predetermined covariates, placebo cutoffs , and bandwidths validated our main conclusion. The expansion of dental insurance benefits to include dentures for the older adults did not improve the chewing ability in the eligible population. future studies should evaluate long-term outcomes of oral health as well as the social impacts on the elderly. An important global goal related to oral health, as set forth by the World Health Organization (WHO), is the reduction of chewing difficulties in the older adults 1. Consequently, national strategies have been launched to achieve this goal. In 2012, the Korean government expanded dental insurance for the older adults to include coverage for removable complete and partial dentures. Furthermore, in 2014, dental implant services were included in the National Health Insurance scheme. The expansion of insurance coverage for geriatric dental care ensures the well-being of an aging society and specifically aims to improve oral health outcomes for the older adults. Discomfort when eating food, which is measured as chewing difficulty, is the most frequently reported dental issue in the older adults 1-4. Denture treatment is a common rehabilitation procedure used to enhance chewing ability in the older adults, in order to improve nutrition intake and quality of life 3-5. In Korea and other developed countries, as much as one-third to a half of all elderly people wear complete dentures, and up to three-quarters wear removable complete or partial dentures 6. We expected that there is increasing interest globally in assessing the impact of dental insurance coverage for dentures on oral health. However, in contrast to studies on medical insurance, there is limited evidence on the effect of dental insurance on oral health. This may be a reflection of the lower priority accorded to dental care compared to medical care, which is indicated by the late introduction of dental insurance, fewer benefits, and limited coverage, all of which leads to out-of-pocket expenditure for beneficiaries 7,8. In turn, due to these limitations, there is a lack of evidence su...

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The effects of patient cost-sharing on health expenditure and health among older people: Heterogeneity across income groups

et al. 2021

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Despite rapidly rising health expenditure associated with population aging, empirical evidence on the effects of cost-sharing on older people is still limited. This study estimated the effects of cost-sharing on the utilization of healthcare and health among older people, the most intensive users of healthcare. We employed a regression discontinuity design by exploiting a drastic reduction in the coinsurance rate from 30 to 10% at age 70 in Japan. We used large administrative claims data as well as income information at the individual level provided by a municipality. Using the claims data with 1,420,252 person-month observations for health expenditure, we found that reduced cost-sharing modestly increased outpatient expenditure, with an implied price elasticity of – 0.07. When examining the effects of reduced cost-sharing by income, we found that the price elasticities for outpatient expenditure were almost zero, – 0.08, and – 0.11 for lower-, middle-, and higher-income individuals, respectively, suggesting that lower-income individuals do not have more elastic demand for outpatient care compared with other income groups. Using large-scale mail survey data with 3404 observations for self-reported health, we found that the cost-sharing reduction significantly improved self-reported health only among lower-income individuals, but drawing clear conclusions about health outcomes is difficult because of a lack of strong graphical evidence to support health improvement. Our results suggest that varying cost-sharing by income for older people (i.e., smaller cost-sharing for lower-income individuals and larger cost-sharing for higher-income individuals) may reduce health expenditure without compromising health.

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Affordable False Teeth: The Effects of Patient Cost Sharing on Denture Utilization and Subjective Chewing Ability

Cited by 9 publications

References 54 publications

Effect of Copayment on Dental Visits: A Regression Discontinuity Analysis

Effect of Copayment on Dental Visits: A Regression Discontinuity Analysis

Did expanded access to denture services improve chewing ability in the Korean older population? Results of a regression discontinuity analysis

The effects of patient cost-sharing on health expenditure and health among older people: Heterogeneity across income groups

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