The demand for dental care: evidence from a randomized trial in health insurance

Manning, Willard G.; Bailit, Howard L.; Benjamin, Bernadette; Newhouse, Joseph P.

doi:10.14219/jada.archive.1985.0031

Cited by 152 publications

(139 citation statements)

References 6 publications

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“…The specificity of plaque in gingivitis and periodontitis was described earlier (Löe et 292,185,17,16,1BO,197,60,284,274,202,137,195,60,2O7,12,294,186,219,161,192,143,.185,.f 61,45,45,27,161,202,45,161,192,143,45,202,223,202,180, 163,83,168,31,72,251 Consistency 27, 174,26,185,i37,35,1Og,94,297,97,117,.t47,236,266,33,…”

Section: Temporality -mentioning

confidence: 72%

“…Differences may also be related to the dental care delivery system's attitude toward lower sES groups (Blaikie 1979). some studies show that even when frnancial barriers are eliminated, preventive dental visiting is less frequent among the lower sES (Manning et al 1986 (Barnett et al 1984). This lack of consistency may be due to differences in populations studied and methods of measuring both Ap and diabetic status.…”

Section: Ft-ossingmentioning

confidence: 99%

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Factors associated with adult periodontitis in a dental teaching clinic population

Gelskey

Young

Singer

1998

Comm Dent Oral Epid

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– Exposure to a number of environmental, behavioral and sociodemographic variables has been associated with increased prevalence and severity of adult periodontitis. However, it is not possible easily to identify the individuals most susceptible to this chronic disease. A case control study was conducted among a population of adults to determine what factors were associated with increased prevalence of moderate to advanced periodontitis. Clinical and radio‐graphic data were obtained from dental charts and structured interviews were conducted by telephone to collect sociodemographic and behavioral data. Statistical modeling was completed for the total study population (35–87‐year‐olds) and for two age‐stratified subpopulations. Significant crude disease associations were observed between periodontitis and numerous explanatory variables. However, after adjustment for age and gender, few variables remained significant. Age stratification indicated that young adults (35–54 years) were affected differently from older adults (≧55 years) by exposures to certain variables. Young moderate smokers had a 3.15 times increased risk of periodontitis and young heavy smokers had a 7.33 times increased risk compared to never‐smokers. Older single adults had a 3.07 times increased risk compared to those with partners.

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Section: Temporality -mentioning

confidence: 72%

Section: Ft-ossingmentioning

confidence: 99%

Factors associated with adult periodontitis in a dental teaching clinic population

Gelskey

Young

Singer

1998

Comm Dent Oral Epid

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“…15 The RAND health insurance experiment supported this argument by showing that dental expenditure increased as the generosity of insurance cover increased. 16 In addition, dental insurance has been associated with visit type (check-up versus emergency) and with the type of services received. Insured adults receive more preventive care and fewer extractions.…”

Section: Discussion Key Findingsmentioning

confidence: 99%

Individual dental expenditure by Australian adults

2013

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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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“…Copayments via Patient Charge Revenue have also been a fundamental component of the NHS dental contract since the 1950s. In the USA, Manning et al 111 found that dental service use increased as copayments decreased in a randomised trial of alternative insurance plans, whereas Parkin and Yule 112 found a negative relationship between price and dental care use in Scotland. Little is known about the impact of remuneration systems on the efficiency of NHS practices and how they might influence outputs such as access.…”

Section: Organisation Of Nhs Dentistry In Primary Carementioning

confidence: 99%

Determining the optimal model for role substitution in NHS dental services in the UK: a mixed-methods study

Brocklehurst

Birch

McDonald

et al. 2016

Health Serv Deliv Res

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BackgroundMaximising health gain for a given level and mix of resources is an ethical imperative for health-service planners. Approximately half of all patients who attend a regular NHS dental check-up do not require any further treatment, whereas many in the population do not regularly attend. Thus, the most expensive resource (the dentist) is seeing healthy patients at a time when many of those with disease do not access care. Role substitution in NHS dentistry, where other members of the dental team undertake the clinical tasks previously provided by dentists, has the potential to increase efficiency and the capacity to care and lower costs. However, no studies have empirically investigated the efficiency of NHS dental provision that makes use of role substitution.Research questionsThis programme of research sought to address three research questions: (1) what is the efficiency of NHS dental teams that make use of role substitution?; (2) what are the barriers to, and facilitators of, role substitution in NHS dental practices?; and (3) how do incentives in the remuneration systems influence the organisation of these inputs and production of outputs in the NHS?DesignData envelopment analysis was used to develop a productive efficiency frontier for participating NHS practices, which were then compared on a relative basis, after controlling for patient and practice characteristics. External validity was tested using stochastic frontier modelling, while semistructured interviews explored the views of participating dental teams and their patients to role substitution.SettingNHS ‘high-street’ general dental practices.Participants121 practices across the north of England.InterventionsNo active interventions were undertaken.Main outcome measuresRelative efficiency of participating NHS practices, alongside a detailed narrative of their views about role substitution dentistry. Social acceptability for patients.ResultsThe utilisation of non-dentist roles in NHS practices was relatively low, the most common role type being the dental hygienist. Increasing the number of non-dentist team members reduced efficiency. However, it was not possible to determine the relative efficiency of individual team members, as the NHS contracts only with dentists. Financial incentives in the NHS dental contract and the views of practice principals (i.e. senior staff members) were equally important. Bespoke payment and referral systems were required to make role substitution economically viable. Many non-dentist team members were not being used to their full scope of practice and constraints on their ability to prescribe reduced efficiency further. Many non-dentist team members experienced a precarious existence, commonly being employed at multiple practices. Patients had a low level of awareness of the different non-dentist roles in a dental team. Many exhibited an inherent trust in the professional ‘system’, but prior experience of role substitution was important for social acceptability.ConclusionsBetter alignment between the financial incentives within the NHS dental contract and the use of role substitution is required, although professional acceptability remains critical.Study limitationsOutput data collected did not reflect the quality of care provided by the dental team and the input data were self-reported.Future workFurther work is required to improve the evidence base for the use of role substitution in NHS dentistry, exploring the effects and costs of provision.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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The demand for dental care: evidence from a randomized trial in health insurance

Cited by 152 publications

References 6 publications

Factors associated with adult periodontitis in a dental teaching clinic population

Factors associated with adult periodontitis in a dental teaching clinic population

Individual dental expenditure by Australian adults

Determining the optimal model for role substitution in NHS dental services in the UK: a mixed-methods study

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