Costs for Statutorily Insured Dental Services in Older Germans 2012–2017

Abstract

Objectives: We assessed the costs of dental services in statutorily insured, very old (geriatric) Germans. Methods: A comprehensive sample of very old (≥75 years) people insured at a large Northeastern statutory insurer was followed over 6 years (2012–2017). We assessed dental services costs for: (1) examination, assessments and advice, (2) operative, (3) surgical, (4) prosthetic, (5) periodontal, (6) preventive and (7) outreach services. Association of utilization with: (1) sex, (2) age, (3) region, (4) social hardship status, (5) International Disease Classification (ICD-10) diagnoses and (6) Diagnoses Related Groups (DRGs) was explored. Results: 404,610 individuals with a mean (standard deviation, SD) age 81.9 (5.4 years) were followed, 173,733 did not survive follow-up. Total mean costs were 129.61 (310.97) euro per capita; the highest costs were for prosthetic (54.40, SD 242.89 euro) and operative services (28.40, SD 68.38 euro), examination/advice (21.15, SD 28.77 euro), prevention (13.31, SD 49.79 euro), surgery (5.91, SD 23.91 euro), outreach (4.81, SD 28.56 euro) and periodontal services (1.64, SD 7.39 euro). The introduction of new fee items for outreach and preventive services between 2012 and 2017 was reflected in costs. Total costs decreased with increasing age, and this was also found for all service blocks except outreach and preventive services. Costs were higher in those with social hardship status, and in Berlin than Brandenburg and Mecklenburg-Western Pomerania. Certain general health conditions were associated with increased or decreased costs. Conclusions: Costs were associated with sex, social hardship status, place of living and general health conditions. Clinical significance: Dental services costs for the elderly in Germany are unequally distributed and, up to a certain age or health status, generated by invasive interventions mainly. Policy makers should incentivize preventive services earlier on and aim to distribute expenses more equally.

Chewing ability and associated factors in older adults in Germany. Results from GEDA 2019/2020-EHIS

“…However, it is unclear what kind of dental treatment the respondents could not afford. This would be important information, as in Germany the amount of costs for these treatments can certainly vary [ 80 ]. Moreover, it is important to note that functional limitations such as reduced chewing ability are an integral component of the broader concept of oral health-related quality of life (OHRQoL) [ 81 ] that can be assessed, for example, with the OHIP-5 (Oral Health Impact Profile) [ 82 ].…”

Financial Burden of Medical Care, Dental Care, and Medicines among Older-Aged Population in Slovenia, Serbia, and Croatia

“…Previous studies found that several factors were associated with the financial burden of healthcare, such as household size, presence of family members aged over 65, household members with a chronic disease, income, absence of health insurance, and education level [ 1 , 5 , 6 ]. The financial burden of healthcare is widely spread among older people in European countries, and the cross-country differences in the distribution of financial burden highlighted the importance of identifying people who are vulnerable [ 4 , 7 , 8 ]. This was mainly due to medicines, medical products, outpatient and inpatient care, and diagnostic tests [ 2 , 4 ].…”

“…The population is aging all over the world, and it is estimated that in European countries, the share of people over 65 years will grow from 19.1% in 2020 to 30.4% of the total population by 2100, or even more, such as in Slovenia (31.4%,), Serbia (34.4%), and Croatia (35.1%) [ 20 ]. Among persons aged over 65, multimorbidity and frailty increase the risk of the financial burden of healthcare as well as the presence of some chronic disease or cancer does, when in need of more contact with the health system and prescribed medicines [ 4 , 6 , 7 , 8 , 21 , 22 , 23 , 24 ]. There appears to be no research that has evaluated the older-aged population’s experiences related to the financial burden of medical care, dental care, and medicines in Slovenia, Serbia, and Croatia using specific and comparable data.…”