The effects of the financial crisis on the general and dental health status of Greek citizens.

PURPOSE: To present the impact of the financial crisis on health status and dental health in Greece and compare it to the European Union and Finland and to identify any changes in health-related expenditure focusing on pharmaceutical expenditure and generic medicines. DESIGN/METHODOLOGY/APPROACH: Databases as Scopus, Pubmed, Google Scholar, World Health Organization, Eurostat, and Elstat were used. FINDINGS: Indicators, such as mortality and life expectancy, show that there is no clear correlation between health deterioration and financial crisis while dental health has deteriorated. Out-of-pocket expenses were found to be catastrophic, and the use of generic medicines is still limited. PRACTICAL IMPLICATIONS: Proper prescribing of medicines, coverage of health care costs by the government, and cost savings from the use of generic medicines were implemented. As regards dental care, the state should focus on prevention as well as reinforcement of public dental care services. ORIGINALITY/VALUE: The break through idea is to compare the impact of the financial crisis on health indexes in Greece with the European Union and Finland, to focus on pharmaceutical expenditure, generic medicines, and dental health.

Do Patients With More Education Receive More Subsidized Dental Care? Evidence From a Natural Experiment Using the Introduction of a School Reform in Norway as an Instrumental Variable.

BACKGROUND: In Norway, for several dental conditions, a substantial part of treatment costs are reimbursed by the National Insurance Scheme. Ideally, the probability of receiving subsidized dental care (SDC) should be independent of social determinants of health, such as education, so that dental services are accessible to everyone independent of their social status. OBJECTIVE: The main objective of this study was to estimate the causal effect of education on the probability of receiving SDC in the adult Norwegian population. RESEARCH DESIGN: During the period 1960-1972, all municipalities in Norway were required to increase the number of compulsory years of education from 7 to 9 years. This education reform was used to create exogenous variation in the education variable. Since municipalities implemented the reform at different times, we have both cross-sectional and time series variation in the reform instrument. Thus we were able to estimate the effect of education on the probability of receiving SDC by controlling for municipality fixed effects and trend variables. SUBJECTS: This study included all Norwegian adults, born during the period of 1947-1958. MEASURES: Information about education (number of years), whether the individuals had received SDC, place of residence (municipality) was collected. RESULTS: The probability of receiving SDC was found to increase by 2 percentage points per additional year of education. CONCLUSION: People with the most resources benefit the most from a universal welfare scheme that is addressed to reach everybody. We suggest providing information about the subsidy scheme in a way that is easily available and understandable to all individuals, independent of their level of education.

Health needs and economics in Oklahoma.

A review of government and private agency reports document many of the health issues, including the low comparative oral health ranking as compared to the standing in other states, faced by the residents of Oklahoma. The complex issues of funding oral health services are considered in terms of the potential for increasing services to individuals with disabilities who are "aging out" of the Medicaid dental program.

The orthodontic treatment in Lithuania: accessibility survey.

UNLABELLED: The objective of the present study was to assess the public accessibility of orthodontic care in Lithuania. MATERIAL AND METHODS: In 2008, a request for the information about various aspects of public orthodontic care during 2000-2007 in Lithuania was submitted to the State Patients' Fund at the Ministry of Health. The data on the demographic distribution of orthodontists in Lithuania were received from the Lithuanian Dental Chamber. The authors of the paper also analyzed the national legislation regulating the State Patients' Fund expenditure on orthodontic care and treatment. RESULTS: In 2007, there were 73 orthodontists-practitioners in Lithuania, most of them highly concentrated in major cities and towns: most of them were practicing in Vilnius (22) and Kaunas (20), while there were only 5 orthodontists in Klaipeda, 4 in Siauliai, 3 in each of Panevezys and Marijampole. The public orthodontic treatment is rendered only to patients suffering from most severe pathologies. With the constantly increasing expenditure of the State Patients' Fund, the national public orthodontic care system definitely undergoes significant development: the number of patients who received the treatment with removable and with fixed orthodontic appliances was gradually increasing during 2002-2007, with however, a very small number of new facilities for ambulatory treatment facilities of orthodontists (consultations included). The number of patients who received treatment with removable orthodontic appliances was specifically higher in Siauliai and Telsiai, Panevezys and Utena districts, with fixed orthodontic appliances - in Vilnius and Alytus, Kaunas and Marijampole, Panevezys and Utena regions. The analysis of the availability of public orthodontic treatment showed a marked increase in the number highly-specialized ambulatory facilities in Vilnius and Alytus district in 2002-2007. CONCLUSIONS: Specialists providing orthodontic treatment in the country are highly concentrated, while in general public orthodontic treatment undergoes development at the moment. The accessibility of orthodontic treatment in Lithuania, especially in the regions distant from Vilnius and Kaunas, remains inadequate.

Dental erosion amongst 13- and 14-year-old Brazilian schoolchildren.

OBJECTIVES: To assess the prevalence of dental erosion in a sample of 13- and 14-year-old Brazilian schoolchildren and to assess the relationship of dental erosion and socio-demographic characteristics. METHODS: A convenience sample of 458 children (190 boys and 268 girls) from 14 schools in Três Corações, south east Brazil, was examined. Socio-demographic data were collected by self-completion questionnaires. RESULTS: Dental erosion was observed in 34.1% of subjects, involving enamel only and showing a symmetrical distribution. The palatal surfaces of the upper incisors were the most commonly affected surfaces. Erosion experience was higher in boys; pupils from Government funded schools; those resident in rural areas and those from the high economic class, but none of these were statistically significant. CONCLUSION: These data are the first to show that in a cohort of 13-14-year old Brazilian schoolchildren, approximately one third of those examined showed mild erosion, requiring clinical preventive counselling. No statistically significant association was observed between erosion, gender and socioeconomic factors.

Periodontal treatment needs in Central and Eastern Europe.

The aim of the present review is to evaluate the periodontal conditions and treatment needs in Central and Eastern Europe and to compare these data to the epidemiological data from the industrialised and developing countries. The recent prevalence and severity data provided by national surveys based on the CPITN methods are summarised. The periodontal conditions in the age groups 15-19 and 35-44 are discussed in detail. The CPITN data show no major differences in the extent and severity of destructive periodontal disease in different countries. In the age group 15-19 just a few European surveys reported 'score 4 sextant' and the prevalence of 'score 3' sextants was also below 10% in each survey. However calculus formation and bleeding on probing were very frequent findings both in Western and Eastern Europe. In the age group 35-44 the average prevalence of 'score 4 sextant' in Western and Eastern Europe were comparable while the proportion of periodontally absolutely healthy individuals was lower in Eastern Europe than in the Western part of the Continent. Five to 20% of the populations are affected by destructive periodontitis at the age of 40. This indicates the magnitude of the disease as a public health problem both in the industrialised West and the Eastern European countries. The same 10-15% prevalence rate of destructive periodontitis imposes a great challenge to the health authorities of these post-communist countries amid social and economic transition, because the nationwide preventive and basic periodontal therapeutic measures should be managed and financed from a substantially lower GDP than in the industrialised West.

Dental public health postdoctoral education: a survey on the status of funding and career opportunities.

OBJECTIVES: This paper reports the results of a survey to determine the consequences of budget reductions on the status of dental public health postdoctoral training in the United States, and opinions of experts in education and practice regarding career opportunities in dental public health. METHODS: A survey was mailed to 154 dental and public health education and service institutions. RESULTS: Most respondents (74 of 103; 72%) agreed that training opportunities depend on funding, and 73 percent (n = 75) expressed the view that more dental public health specialists are needed. Respondents reported that funding for current dental public health master's degree and residency programs is less than satisfactory. Respondents involved in training of dental public health professionals held marginally statistically significant different opinions regarding career opportunities than those who were not involved. No significant differences in opinions of respondents existed by type of institution. CONCLUSION: With decreased numbers of dental graduates, improved funding for dental public health programs will be critical, particularly at the specialty entry level, to ensure that adequate numbers of specialists are trained and available to meet the oral health needs of all the US population.

Charges for oral health care during a period of economic growth in the US: 1987-96.

OBJECTIVES: This study aimed to provide estimates of amounts charged for dental care during 1996 for the US adult population and its major sociodemographic subgroups, and to evaluate whether charges had increased since 1987. METHODS: We used data from the 1996 Medical Expenditures Panel Survey and report results for 12,931 adults aged 19-64 years. For comparison with previously published charges, we converted 1987 charges to their 1996 "constant dollar" value to control for inflation. Data were analyzed using SUDAAN and the results can be generalized to the US adult population. RESULTS: In 1996, 43.7 percent (95% CI=42.7%, 44.6%) of the US population incurred dental care charges, which did not differ significantly from the 1987 estimate of 44.5 percent. In 1996, mean per capita charge for dental care was 182 dollars (95% CI=171 dollars, 192 dollars), which did not differ significantly from the inflation-adjusted 1987 estimate of 174 dollars. The average charge per patient who incurred charges in 1996 was 416 dollars (95% CI=394 dollars, 438 dollars), which was only 7 percent greater than the inflation-adjusted 1987 estimate of 389 dollars (P=.08). Sociodemographic variations were observed in per capita charges, but were less apparent in mean charge per patient who incurred charges. CONCLUSIONS: During a period when economic growth and other market forces were expected to increase delivery of dental services, there was little or no change in percentage of US adults incurring charges or in mean per capita charges. The booming US economy did not raise dental charges significantly and did not increase utilization of dental care services.

The funding of dental services among U.S. children 2 to 17 years old: recent trends in expenditures and sources of funding.

BACKGROUND: This article is the first of two that focus on recent changes in the funding of dental services in the United States. METHODS: This study is based on analyses of data regarding dental expenditures among children 2 to 17 years of age from the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Panel Survey. Both of these surveys were designed to produce national estimates of annual medical expenditures in the United States. RESULTS: Overall, real per capita dental expenditures among 2- to 17-year-old children who had had a dental visit fell from $578.05 in 1987 to $498.57 in 1996. Large increases per patient were reported for the poorest children, while decreases were reported for children from families with higher incomes. CONCLUSIONS: Much of the increase from 1987 to 1996 in dental expenditures among economically disadvantaged children who had had a dental visit was due to an increase in care provided by dentists that was not reimbursed. PRACTICE IMPLICATIONS: More needs to be done to increase the number of economically disadvantaged children who visit a dentist. All segments of society must cooperate to achieve this result.

The funding of dental services among U.S. adults aged 18 years and older: recent trends in expenditures and sources of funding.

BACKGROUND: This article is the second in a series of two that focus on recent changes in the funding of dental services in the United States. METHODS: This study is based on the analyses of data regarding dental expenditures among adults aged 18 years and older from the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Panel Survey. Both of these surveys were designed to produce national estimates of annual medical expenditures in the United States. RESULTS: Overall, real per-patient dental expenditures among adults aged 18 years and older who had had a dental visit fell from $529.93 in 1987 to $467.29 in 1996. CONCLUSIONS: Recent decreases in dental expenditures may be related to a shift from restorative to diagnostic and preventive services. PRACTICE IMPLICATIONS: In the future, dentists' gross revenues may grow more from an increase in the number of patients seen than from an increase in the average revenue per patient.

A macroeconomic review of dentistry in Canada in the 1990s.

OBJECTIVES: To document the trends in expenditures on dental health care services and the number of dental health care professionals in Canada from 1990 to 1999. METHODS: Information on dental and health expenditures, numbers of dentists, hygienists and dental therapists, and the population of Canada and the provinces were obtained from the Canadian Institute for Health Information; data on numbers of denturists were obtained from regional bodies and from Health Canada. Information on the costs of other disease categories was taken from studies by Health Canada (1993 and 1998). International comparisons were made on the basis of data published by the Organisation for Economic Co-operation and Development (OECD). Indices of change over the decade (in which the 1990 value served as the baseline [100]) were calculated. RESULTS: By 1999, the supply of all types of dental care providers had increased to 1 for every 904 people. Dental expenditures during the 1990s increased by 64% overall and by 49% per capita, a rate of increase that exceeded both inflation and costs of health care. Although the public share of dental costs decreased from 9.2% to 5.8%, the direct costs of dental care increased to rank second (6.30 billion dollars) after those for cardiovascular diseases (6.82 billion dollars). Among the OECD nations, Canada had the fourth highest per capita dental expenditures and the second lowest per capita public dental expenditures. CONCLUSIONS: The direct economic costs of dental conditions increased during the 1990s from 4.13 billion dollars to 6.77 billion dollars. Over the same period, the public share for expenditures on dental health care services declined.

General dentistry grant program: 1976-1996.

The federal general dentistry grant program supports the development of new programs and first-year positions in postdoctoral general dentistry (PGD) education. One hundred and fifteen institutions have participated in the grant program since awards were first made in 1978. The grant program assisted in establishing 59 new PGD programs and 560 new positions. Eighty-eight percent of the new programs are still in operation; 69 percent of the positions are still being filled. These retained programs and positions represent 72 percent and 77 percent of the net growth in PGD programs and positions, respectively, that has occurred since 1977.

State financing of dental education: impact on supply of dentists.

In 2000, the thirty-six states with public dental schools provided an average subsidy of 49,347 dollars per dental student. In contrast, nineteen states provided little or no subsidy. Since states invest in dental education, in part, to ensure an adequate supply of dentists, we examined the factors that explain dentist variation among states. We found that population size, per capita income, and the number of students from the state enrolled in dental school had a significant and positive impact. The level of state support for dental education and the presence of a dental school had a negative or nonsignificant effect, respectively. Apparently, dentists locate based primarily on the demand for their services and, to a lesser extent, on where they were raised. The states' investment in dental education had little impact on number of dentists because some states had many dentists but invested little in dental education. We identified two states that collectively account for 15 percent of enrolled students even though they provide minimal subsidy for dental education. We discuss the implications of these findings for states that do not have dental schools and need more dentists. This research was supported in part by grants from the Connecticut Health Foundation (Dental Workforce in Connecticut: Issues and Options), the Robert Wood Johnson Foundation, and the California Endowment (Pipeline, Profession, and Practice: Community-Based Dental Education).

The growth of postdoctoral general dentistry programs.

From 1972 to 1990, the number of Postdoctoral General Dentistry (PGD) programs increased by 57% and enrollment increased by 57% and enrollment increased by 131% for a total of 118 PGD programs and 1,367 positions. Although there has been some increase in military and Veterans Affairs (VA) programs, the major increase was in civilian programs. From 1972-78, the major impetus for growth was hospital sponsorship of General Practice Residency (GPR) programs. With federal funding of PGD programs, civilian GPR programs continued to be the main source of growth until the accreditation of Advanced Education in General Dentistry (AEGD) programs in 1981. Subsequently, almost all increases were in AEGD programs. Over the 12-year period of federal funding (1978-90), there was an increase of 406 civilian PGD positions to make a total of 925 positions. The increase in enrollment directly attributable to federal funding was 242. The "unmet demand" for PGD programs was estimated to be approximately 300 positions for 1990, from data derived from the Survey of Dental Seniors and the Matching Program. Assuming that the number of PGD positions continues to increase by 35 positions a year, as it has in the past 12 years, the unmet demand would be met in slightly less than 10 years. If, however, a postdoctoral year was mandated for licensure, the increase in the number of positions would be far short of projected need.

Medicare eventually may cover dental costs--but what about the children?

Government programs, particularly Medicare, provide extremely limited funds for dental services. As a result, the government absorbs fewer dental costs than the costs for other health services. Despite the need for support of dental services for children, it may become politically expedient to support the expansion of Medicare to include dental care for the increasing numbers of dentate baby boomers. The economic case for Medicare dentistry is presented as a harbinger for continued underfunding by the federal government for dental care for children.

Uvulopalatopharyngoplasty funded by the Australian government's Medicare scheme (1995-2007).

OBJECTIVE: To describe the provision, through the Australian state-funded Medicare system, of uvulopalatopharyngoplasty (UPPP) and its laser-assisted variation (LAUP) to the population of Australia between 1995 and 2007. STUDY DESIGN: Case series using a comprehensive national administrative database. SETTING: The Commonwealth of Australia. SUBJECTS AND METHODS: Subjects comprised the population of Australia. The raw numbers of procedures, reimbursement amounts in Australian dollars, and per capita adjustment nationwide and in each state/territory for UPPP and LAUP for each calendar year from 1995 to 2007 were downloaded from a publicly accessible database run by Medicare. RESULTS: The Australian federal government paid AUD 8.2 million for 19,534 UPPP procedures and AUD 1.1 million for 3270 LAUP procedures in the calendar years 1995 to 2007, inclusive. There is substantive variability between states in provision. Over time, provision of UPPP has declined slightly compared with population growth and overall Medicare provision. LAUP provision has declined markedly. CONCLUSION: Provision of UPPP under Medicare in Australia has declined slowly relative to population growth and overall growth in Medicare per capita provision. Laser-assisted UPPP (LAUP) has steadily declined and is now rarely used compared with the peak in its provision in the mid 1990s.