RESUMO
BACKGROUND: Dental utilization patterns and costs of providing comprehensive oral healthcare for older adults in different settings have not been examined. METHODS: Retrospective longitudinal cohort data from Apple Tree Dental (ATD) were analyzed (N = 1,159 total; 503 outpatients, 656 long-term care residents) to describe oral health status at presentation, service utilization patterns, and care costs. Generalized estimating equation (GEE) repeated measures analysis identified significant contributors to service cost over the three-year study period. RESULTS: Cohort mean age was 74 years (range = 55-104); the outpatient (OP) group was younger compared to the long-term care (LTC) group. Half (56%) had Medicaid, 22% had other insurance, and 22% self-paid. Most (72%) had functional dentitions (20+ teeth), 15% had impaired dentitions (9-19 teeth), 6% had severe tooth loss (1-8 teeth), and 7% were edentulous (OP = 2%, LTC = 11%). More in the OP group had functional dentition (83% vs. 63% LTC). The number of appointments declined from 5.0 in Year 1 (OP = 5.7, LTC = 4.4) to 3.3 in Year 3 (OP = 3.6, LTC = 3.0). The average cost to provide dental services was $1,375/year for three years (OP = $1,427, LTC = $1,336), and costs declined each year, from an average of $1,959 (OP = $2,068, LTC = $1,876) in Year 1 to $1,016 (OP = $989, LTC = $1,037) by Year 3. Those with functional dentition at presentation were significantly less costly than those with 1-19 teeth, while edentulous patients demonstrated the lowest cost and utilization. Year in treatment, insurance type, dentition type, and problem-focused first exam were significantly associated with year-over-year cost change in both OP and LTC patients. CONCLUSION: Costs for providing comprehensive dental care in OP and LTC settings were similar, modest, and declined over time. Dentate patients with functional dentition and edentulous patients were less costly to treat. LTC patients had lower utilization than OP patients. Care patterns shifted over time to increased preventive care and decreased restorative care visits.
Assuntos
Assistência Odontológica Integral/economia , Assistência Odontológica Integral/estatística & dados numéricos , Assistência Odontológica para Idosos/economia , Assistência Odontológica para Idosos/estatística & dados numéricos , Assistência de Longa Duração/normas , Pacientes Ambulatoriais/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Minnesota , Estudos RetrospectivosRESUMO
OBJECTIVE: To estimate premium and out-of-pocket costs for child dental care services under various dental coverage options offered within the federally facilitated marketplace. STUDY DESIGN: We estimated premium and out-of-pocket costs for child dental care services for 12 patient profiles, which vary by dental care use and spending. We did this for 1039 medical plans that include child dental coverage, 2703 medical plans that do not include child dental coverage, and 583 stand-alone dental plans for the 2015 plan year. Our analysis is based on plan data from the Center for Consumer Information and Insurance Oversight and Data.HealthCare.Gov. RESULTS: On average, expected total financial outlays for child dental care services were lower when dental coverage was embedded within a medical plan compared with the alternative of a stand-alone dental plan. The difference, however, in average expected out-of-pocket spending varied significantly for our 12 patient profiles. Older children who are very high users of dental care, for example, have lower expected out-of-pocket costs under a stand-alone dental plan. For the vast majority of other age groups and dental care use profiles, the reverse holds. CONCLUSIONS: Our results show that embedding dental coverage within medical plans, on average, results in lower total financial outlays for child beneficiaries. Although our results are specific to the federally facilitated marketplace, they hold lessons for both state-based marketplaces and the general private health insurance and dental benefits market, as well.
Assuntos
Assistência Odontológica/economia , Gastos em Saúde/estatística & dados numéricos , Cobertura do Seguro/economia , Seguro Odontológico/economia , Criança , Assistência Odontológica Integral/economia , Bases de Dados Factuais , Feminino , Humanos , Seguro/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Odontológico/tendências , Seguro Saúde/organização & administração , Masculino , Avaliação das Necessidades , Patient Protection and Affordable Care Act/economia , Estudos de Amostragem , Estados UnidosAssuntos
Odontologia/tendências , Administração da Prática Odontológica/tendências , Corporações Profissionais/tendências , Assistência Odontológica Integral/economia , Assistência Odontológica Integral/normas , Relações Dentista-Paciente , Previsões , Humanos , Prática Privada/tendências , Qualidade da Assistência à SaúdeRESUMO
Determinar los gastos de atención odontológica de niños con Caries de la Infancia Temprana (CIT) que ocasionan a sus familias y al Estado Peruano, representado por el Instituto Nacional de Salud del Nino (INSN) Lima-Perú. Material y Métodos: Estudio de tipo descriptivo, observacional y transversal. La muestra escogida aleatoriamente estuvo formada por 629 niños menores de 71 meses de edad atendidos en el Servicio de Atención del Infante del INSN, en el año 2009, dicha muestra fue estratificada según condición clínica (sanos o con CIT) y procedimiento realizado (tratamiento preventivo y tratamiento restaurador: con manejo de conducta, sedación, o anestesia general). Para determinar los gastos ocasionados a las familias se entrevistaron a las madres de los niños, y los gastos del hospital fueron calculados según el reporte económico del mismo. Para el análisis estadístico se utilizó el software Stata v12, aplicando las pruebas U. Mann-Whitney y Kruskal-Wallis para comparar y encontrar las diferencias en las variables estudiadas. Resultados: La frecuencia de CIT en la muestra evaluada fue de 82.19%. Según mediana: las familias de pacientes sanos gastan por encima de S/.30.00 (min=12, max=84) en procedimientos de prevención y las familias de los pacientes enfermos gastan por encima de S/.113.00 (min=26, max=761) en tratamientos restaurativos ocasionados por CIT, (Relación de 1:4). De acuerdo al tipo de tratamiento realizado, según la mediana, lo más resaltante se encontró en el rubro de anestesia general, donde las familias gastan por encima de S/.639.00 (min=440, max=761); es decir, 20 veces más que en procedimientos de prevención. Del gasto total, la mayor parte es asumida o subvencionada por el INSN, siendo estos gastos aún mayores. Conclusiones: La CIT, ocasiona importantes gastos directos e indirectos a las familias y al Estado representado por el INSN. Las medidas preventivas son altamente costo efectivas...
Objective: To determine the cost of dental care for children with Early Childhood Caries (ECC) that causes to their families and the Peruvian State, represented by the National Institute of Child Health (INSN) LimaPeru. Methods: A descriptive, observation and transversal study. The randomly selected sample consisted of 629 children under 71 months of age, treated at the Infant Care Service of the INSN in 2009, the sample was stratified according to clinical condition (healthy or Early Childhood Caries) and procedure performed (preventive and restorative treatment: with behavior management, sedation or general anesthesia). To determine the costs incurred by families, mothers of children were asked and hospital costs were calculated according to the economic report. For statistical analysis software was used Stata v12, applying the Mann-Whitney U test and Kruskal-Wallis test to compare and find the differences in the studied variables. Results: The frequency of ECC in the evaluated sample was 82.19%. According to the median, families of healthy patients spend over to S / .30.00 (min = 12, max = 84) in methods of prevention and families of sick patients spend over to S / .113.00 (min = 26, max = 761) in restorative treatments caused by CIT, (ratio 1: 4). According the type of treatment performed, as reported by the median, most interesting observation was found under general anesthesia; families spend over to S / .639.00 (min = 440, max = 761), ie 20 times more than in methods of prevention. The biggest part of total spending is taken or subsidized by the hospital, and these costs are even higher. Conclusions: ECC, cause significant direct and indirect costs to families and the State, represented by the hospital. Preventive measures are highly cost effective...
Assuntos
Humanos , Criança , Assistência Odontológica Integral/economia , Cárie Dentária , Gastos em Saúde , Epidemiologia Descritiva , Estudo Observacional , Estudos Transversais , PeruAssuntos
Aceitação pelo Paciente de Cuidados de Saúde , Planejamento de Assistência ao Paciente , Anestesiologia/educação , Comunicação , Assistência Odontológica Integral/classificação , Assistência Odontológica Integral/economia , Sedação Consciente , Assistência Odontológica/classificação , Assistência Odontológica/economia , Relações Dentista-Paciente , Recessão Econômica , Educação Continuada em Odontologia , Humanos , Planejamento de Assistência ao Paciente/classificação , Planejamento de Assistência ao Paciente/economia , Equipe de Assistência ao Paciente , Educação de Pacientes como Assunto , Resultado do Tratamento , Estados UnidosRESUMO
California children suffer more from dental disease than any other chronic childhood disease. Disparities in access and oral health are disproportionately represented among children from minority and low-income families. A comprehensive school-based/linked dental program is one essential ingredient in addressing these problems. Described here are the goals, program elements, and challenges of building a seamless dental services system that could reduce barriers care, maximize resources, and employ best practices to improve oral health.
Assuntos
Assistência Odontológica Integral , Assistência Odontológica para Crianças , Acessibilidade aos Serviços de Saúde , Serviços de Odontologia Escolar , Adolescente , California , Criança , Defesa da Criança e do Adolescente , Serviços de Saúde da Criança/economia , Serviços de Saúde da Criança/organização & administração , Proteção da Criança/economia , Proteção da Criança/legislação & jurisprudência , Pré-Escolar , Redes Comunitárias , Assistência Odontológica Integral/economia , Assistência Odontológica Integral/organização & administração , Assistência Odontológica para Crianças/economia , Assistência Odontológica para Crianças/organização & administração , Cárie Dentária/prevenção & controle , Organização do Financiamento/economia , Organização do Financiamento/legislação & jurisprudência , Educação em Saúde Bucal/organização & administração , Prioridades em Saúde , Recursos em Saúde , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Lactente , Grupos Minoritários , Objetivos Organizacionais , Doenças Periodontais/prevenção & controle , Pobreza , Odontologia Preventiva/economia , Odontologia Preventiva/legislação & jurisprudência , Desenvolvimento de Programas , Serviços de Odontologia Escolar/economia , Serviços de Odontologia Escolar/organização & administraçãoRESUMO
To develop a long-term, sustainable partnership with dental schools, federally qualified health centers (FQHCs) need to assess the financial impact of dental students on their financial operations. Primary concerns are that students will not cover their marginal costs and will reduce the productivity of clinic dentists. This study uses data from Asian Health Services, an FQHC in Oakland, California, to examine revenues generated by senior dental students and by FQHC dentists when students are and are not present. The analysis of ten months of electronic record data showed that two full-time equivalent students generated $420,549 in gross revenues and reduced dentist output by only $29,000. While the results are from just one FQHC, they strongly suggest that students make a significant contribution to clinic productivity and finances.
Assuntos
Odontologia Comunitária/educação , Serviços de Saúde Comunitária/economia , Clínicas Odontológicas/economia , Educação em Odontologia/economia , Faculdades de Odontologia/economia , California , Odontologia Comunitária/economia , Serviços de Saúde Comunitária/organização & administração , Relações Comunidade-Instituição , Assistência Odontológica Integral/economia , Assistência Odontológica Integral/organização & administração , Assistência Odontológica Integral/estatística & dados numéricos , Custos e Análise de Custo , Clínicas Odontológicas/organização & administração , Registros Odontológicos , Odontólogos/economia , Eficiência Organizacional , Registros Eletrônicos de Saúde , Apoio Financeiro , Humanos , Renda , Medicaid/economia , Preceptoria/economia , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Estudantes de Odontologia , Estados UnidosRESUMO
The authors surveyed parent-leaders about aspects of a dental home for children with special health care needs (CSHCN). State leaders in two advocacy groups completed the survey; the response rate was 70.6% of all states. Two of the most highly rated aspects of a dental home, endorsed as "essential" by 89% of respondents, pertained to dentist-parent interactions: the dentist listens carefully to the family, and the dentist helps the family feel like a partner in treatment decisions. Likewise, 89% said it was essential that insurance coverage allows the child to see needed providers. Dentists' lack of knowledge or willingness to treat CSHCN and refusal of Medicaid insurance coverage were identified as major barriers to care. More than 84% of respondents reported that parents were unaware of the recommendation to establish dental care by 1 year of age. Establishing policy and educational strategies should help parents meet this dental health goal.
Assuntos
Atitude Frente a Saúde , Assistência Odontológica para Crianças/psicologia , Assistência Odontológica para a Pessoa com Deficiência/psicologia , Acessibilidade aos Serviços de Saúde , Pais/psicologia , Criança , Participação da Comunidade , Assistência Odontológica Integral/economia , Defesa do Consumidor , Informação de Saúde ao Consumidor , Assistência Odontológica para Crianças/economia , Assistência Odontológica para a Pessoa com Deficiência/economia , Recursos Humanos em Odontologia , Odontólogos , Educação em Saúde Bucal , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Seguro Odontológico , Medicaid/economia , Pais/educação , Defesa do Paciente , Assistência Centrada no Paciente , Atenção Primária à Saúde/economia , Relações Profissional-Família , Recusa em Tratar , Estados UnidosAssuntos
Assistência Odontológica Integral , Planejamento de Assistência ao Paciente , Assistência Odontológica Integral/economia , Assistência Odontológica Integral/organização & administração , Tomada de Decisões , Relações Dentista-Paciente , Estética Dentária , Prioridades em Saúde , Humanos , Saúde Bucal , Educação de Pacientes como Assunto , Participação do PacienteRESUMO
BACKGROUND: Patients enrolled in Medicaid have limited access to orthodontic services in the United States. No studies are available, to the authors' knowledge, regarding the clinical and psychosocial burdens of malocclusion on these patients from an economic perspective. METHODS: The authors conducted a systematic review of the relevant economic literature. They identified issues from the perspectives of the various stakeholders (dentists, patients and parents, Medicaid programs) and developed a conceptual model for studying decision making focused on the strategy of providing early interceptive and preventive treatment rather than, or in addition to, comprehensive care in the patient's permanent dentition. RESULTS: Medicaid coverage and reimbursement amounts vary nationwide, and decision making associated with obtaining care can be complex. The perspectives of all relevant stakeholders deserve assessment. A conceptual framework of the cost-effectiveness of interceptive orthodontic treatment compared with comprehensive treatment illustrates the issues to be considered when evaluating these strategies. CONCLUSIONS: Policymakers and the dental community should identify creative solutions to addressing low-income families' limited access to orthodontic services and compare them from various perspectives with regard to their relative cost-effectiveness. CLINICAL IMPLICATIONS: Dentists should be aware of the multiple problems faced by low-income families in obtaining orthodontic services and the impact of stakeholder issues on access to care; they also should be proactive in helping low-income patients obtain needed orthodontic services.
Assuntos
Efeitos Psicossociais da Doença , Má Oclusão/economia , Medicaid , Qualidade de Vida , Assistência Odontológica Integral/economia , Análise Custo-Benefício , Humanos , Má Oclusão/psicologia , Medicaid/economia , Ortodontia Corretiva/economia , Ortodontia Interceptora/economia , Ortodontia Preventiva/economia , Estados UnidosRESUMO
Many individuals who have disabilities or complex health conditions do not have adequate access to comprehensive oral health care. An examination of the literature indicates a variety of contributing factors. This study reports on cost of care as a barrier to oral health care. Data from the 2007 Florida Behavioral Risk Factor Surveillance System (BRFSS) were used (n = 33,777). Respondents who reported activity limitation or the use of special equipment were considered to have a disability. Lack of access to dental care due to cost during the past year was assessed. More individuals with a disability reported not seeing a dentist due to cost versus people without disabilities (30% vs. 16%). After adjusting for confounding variables, Floridians with disabilities were 60% more likely to report cost as a barrier to dental care (OR = 1.60, 95% CI 1.32-1.94). Cost of dental care is an access to oral health barrier for Floridians with disabilities. Improving access to dental care for this population will require consideration of financial issues.
Assuntos
Sistema de Vigilância de Fator de Risco Comportamental , Assistência Odontológica para a Pessoa com Deficiência/economia , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Atividades Cotidianas , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Assistência Odontológica Integral/economia , Escolaridade , Emprego , Etnicidade , Feminino , Florida , Custos de Cuidados de Saúde , Humanos , Renda , Seguro Saúde , Masculino , Estado Civil , Pessoa de Meia-Idade , Qualidade de Vida , Fatores Sexuais , Adulto JovemRESUMO
The University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco established a comprehensive dental care program at Laguna Honda Hospital, a public, skilled nursing facility. The program had three goals: (1) to provide dental students and residents an opportunity to provide oral health care for adults who were frail and medically compromised who could not come into the clinics, (2) to increase students' access to patients who needed removable prosthodontics, and (3) to fulfill Pacific's commitment to public service. Laguna Honda and Pacific pooled their resources to bring comprehensive dental care to patients who were not able to access the dental school clinics. The long-term goals are to restore and maintain the oral health of those who reside in the facility, and to educate future dentists to provide oral health care for similar populations.
Assuntos
Doença Crônica , Relações Comunidade-Instituição , Assistência Odontológica Integral , Hospitais Públicos , Área Carente de Assistência Médica , Faculdades de Odontologia , Instituições de Cuidados Especializados de Enfermagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Odontológica Integral/economia , Assistência Odontológica Integral/organização & administração , Custos e Análise de Custo , Atenção à Saúde/economia , Atenção à Saúde/organização & administração , Educação em Odontologia , Feminino , Apoio Financeiro , Odontologia Geral/educação , Recursos em Saúde , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Hospitais Públicos/economia , Hospitais Públicos/organização & administração , Humanos , Internato e Residência , Masculino , Pessoa de Meia-Idade , Objetivos Organizacionais , Equipe de Assistência ao Paciente , Prostodontia/educação , São Francisco , Faculdades de Odontologia/economia , Faculdades de Odontologia/organização & administração , Instituições de Cuidados Especializados de Enfermagem/economia , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Cirurgia Bucal/educaçãoRESUMO
BACKGROUND: The authors investigate the relationship of preventive dental treatment to subsequent receipt of comprehensive treatment among Medicaid-enrolled children. METHODS: The authors analyzed Medicaid dental claims data for 50,485 children residing in Wayne County, Mich. The study sample included children aged 5 through 12 years in 2002 who had been enrolled in Medicaid for at least one month and had had at least one dental visit each year from 2002 through 2005. The authors assessed dental care utilization and treatment patterns cross-sectionally for each year and longitudinally. RESULTS: Among the Medicaid-enrolled children in 2002, 42 percent had had one or more dental visits during the year. At least 20 percent of the children with a dental visit in 2002 were treated by providers who billed Medicaid exclusively for diagnostic and preventive (DP) services. Children treated by DP care providers were less likely to receive restorative and/or surgical services than were children who were treated by dentists who provided a comprehensive mix of dental services. The logistic model showed that children who visited a DP-care provider were about 2.5 times less likely to receive restorative or surgical treatments than were children who visited comprehensive-care providers. Older children and African-American children were less likely to receive restorative and surgical treatments from both types of providers. CONCLUSIONS: The study results show that the type of provider is a significant determinant of whether children received comprehensive restorative and surgical services. The results suggest that current policies that support preventive care-only programs may achieve increased access to preventive care for Medicaid-enrolled children in Wayne County, but they do not provide access to adequate comprehensive dental care.
Assuntos
Assistência Odontológica Integral/estatística & dados numéricos , Assistência Odontológica para Crianças/estatística & dados numéricos , Restauração Dentária Permanente/estatística & dados numéricos , Medicaid , Odontologia Preventiva/estatística & dados numéricos , Criança , Pré-Escolar , Assistência Odontológica Integral/economia , Estudos Transversais , Assistência Odontológica para Crianças/economia , Restauração Dentária Permanente/economia , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Odontologia Preventiva/economia , Estados UnidosRESUMO
Preservation or alteration of the natural dentition to an optimal state of health, function, comfort, and esthetics remains the primary goal of dentistry. However, referral of patients by general dentists to orthodontic specialists may be complex as it involves the interaction of the two dental professionals and the patient. Because there is a marked variation in referral rates between the dentists and many patients may be referred inappropriately, a clear understanding of what is known about current orthodontic treatment possibilities, limitations and inherent risks is necessary. The purpose of this article is to outline the existing orthodontic therapeutic possibilities for adjunctive dental work and to emphasize the importance of teamwork among the general dentist, the orthodontic specialist and possibly other dental specialists during treatment planning.
Assuntos
Odontologia Geral , Relações Interprofissionais , Ortodontia , Anodontia/terapia , Assistência Odontológica Integral/economia , Análise Custo-Benefício , Implantes Dentários , Restauração Dentária Permanente , Relações Dentista-Paciente , Humanos , Saúde Bucal , Ortodontia Corretiva , Planejamento de Assistência ao Paciente , Equipe de Assistência ao Paciente , Doenças Periodontais/terapia , Encaminhamento e Consulta , Fatores de Risco , Especialidades Odontológicas , Fatores de Tempo , Resultado do TratamentoAssuntos
Desenho Assistido por Computador , Administração da Prática Odontológica , Atitude Frente a Saúde , Assistência Odontológica Integral/economia , Desenho Assistido por Computador/economia , Desenho Assistido por Computador/instrumentação , Materiais Dentários/química , Relações Dentista-Paciente , Dentística Operatória/educação , Educação Continuada em Odontologia , Desenho de Equipamento , Previsões , Humanos , Laboratórios Odontológicos , Administração da Prática Odontológica/economia , Administração da Prática Odontológica/organização & administração , Administração da Prática Odontológica/tendências , Qualidade da Assistência à Saúde , Software , Tecnologia Odontológica/educaçãoRESUMO
OBJECTIVES: Previous research shows increased dental decay among immigrants, but little is known about the oral health of the growing population of children of immigrants. We compared the children of immigrants to the children of US-born caregivers in their caries experience at enrollment and their new caries increments during the 5-year New England Children's Amalgam Trial (NECAT). METHODS: NECAT recruited 283 Boston-area children aged 6 to 10 with untreated caries and offered free semiannual preventive and restorative dental care during the trial. Sociodemographic factors and caregiver immigrant status were assessed through interviews. Multivariate negative binomial models evaluated the association between caregiver immigrant status and clinically assessed carious surfaces. RESULTS: Forty percent of these Boston-area children had immigrant caregivers. At baseline, the children of immigrants had more carious surfaces (11.5 versus 9.4, adjusted for race/ethnicity, age, gender, and caregiver smoking status). Caregiver language preference explained some of this association. Immigrant status and language preference were not associated with 5-year caries increments. CONCLUSIONS: Prevalent disparities in the unmet dental needs of the immigrants' children were quickly ameliorated during participation in NECAT Dental initiatives that target neighborhoods and are sensitive to acculturation levels may help improve and maintain the oral health of immigrant families.