Dental service utilization in the very old: an insurance database analysis from northeast Germany

Abstract

Objectives We assessed dental service utilization in very old Germans. Methods A comprehensive sample of 404,610 very old (≥ 75 years), insured at a large statutory insurer (Allgemeine Ortskrankenkasse Nordost, active in the federal states Berlin, Brandenburg, Mecklenburg-Western Pomerania), was followed over 6 years (2012–2017). Our outcome was the utilization of dental services, in total (any utilization) and in five subgroups: (1) examinations and associated assessment or advice, (2) restorations, (3) surgery, (4) prevention, (5) outreach care. Association of utilization with (1) sex, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses, and (6) German modified diagnosis-related groups (GM-DRGs) was explored. Results The mean (SD) age of the sample was 81.9 (5.4) years. The utilization of any dental service was 73%; utilization was highest for examinations (68%), followed by prevention (44%), surgery (33%), restorations (32%), and outreach care (13%). Utilization decreased with age for nearly all services except outreach care. Service utilization was significantly higher in Berlin and most cities compared with rural municipalities, and in individuals with common, less severe, and short-term conditions compared with life-threatening and long-term conditions. In multi-variable analysis, social hardship status (OR: 1.14; 95% CI: 1.12-1.16), federal state (Brandenburg 0.85; 0.84–0.87; Mecklenburg-Western Pomerania: 0.80; 0.78–0.82), and age significantly affected utilization (0.95; 0.95–0.95/year), together with a range of co-morbidities according to ICD-10 and DRG. Conclusions Social, demographic, regional, and general health aspects were associated with the utilization of dental services in very old Germans. Policies to maintain access to services up to high age are needed. Clinical significance The utilization of dental services in the very old in northeast Germany showed significant disparities within populations. Policies to allow service utilization for sick, economically disadvantaged, rural and very old populations are required. These may include incentives for outreach servicing, treatment-fee increases for specific populations, or referral schemes between general medical practitioners and dentists.

Underscreening and undertreatment? Periodontal service provision in very old Germans

“…In our population, a nearly identical treatment-related utilization (1.6%) and an only minimally higher overall utilization (29.2%) was found over 6 years; i.e., the annual utilization is likely much smaller in the elderly in the northeast than in the national average. Note that this is also extremely low when comparing it with the overall utilization of dental services in this population, which we estimated at 73% for this cohort over the observational period [ 6 ]. Given that the PSI is allowed to be provided on a two-yearly basis for dentate patients, whose share in the very old is > 65% [ 16 ], and given that > 80% of the dentate very olds are (at least mild) periodontitis patients [ 3 ], it is clear that screening and, much more so, treatment are by far underutilized in the population of interest.…”

“…From a health services perspective, it can be questioned, then, why screening is performed at all. Given our previous findings that outreach care is increasing with age, and assuming periodontal care being one of the therapies which can be provided during outreach visits [ 6 ], it is notable that periodontal therapy does not seem to be provided during outreach visits; these visits seem to be rather focused on minimal care (including alleviation of pain or refitting/rebasing/repairing of removable dentures) than on regular tooth-retaining care.…”

“…These may encompass age, general health, financial means, and place of living, all of which affect the accessibility of services. In a previous study and building on claims data, we found both prosthetic [ 5 ] and operative or surgical services utilization in older individuals to be affected by these aspects [ 6 ]. Moreover, we demonstrated that both the overall consumption of any service and the consumption of specific services are associated with such factors.…”

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

“…The underlying dataset has been used to assess the utilization of general, operative and surgical [ 16 ], periodontal [ 17 ] and prosthetic [ 18 ] dental services by older Germans. The dataset contained claims data from a statutory (public) health insurance in Germany, the AOK Nordost, with a cohort of elderly followed over 6 years (2012 to 2017).…”

“…In a recent series of studies, we evaluated the utilization of general, operative, surgical, periodontal and prosthetic dental services in the very old (geriatric), defined as 75 years or older, in Germany [ 16 , 17 , 18 ]. In the present evaluation, using claims data from one large statutory insurer, we translate utilization into costs.…”