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1.
PLoS One ; 15(12): e0244446, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382762

RESUMO

OBJECTIVES: Oral potentially malignant disorders (OPMDs) encompass histologically benign, dysplastic, and cancerous lesions that are often indistinguishable by appearance and inconsistently managed. We assessed the potential impact of test-and-treat pathways enabled by a point-of-care test for OPMD characterization. MATERIALS AND METHODS: We constructed a decision-analytic model to compare life expectancy of test-treat strategies for 60-year-old patients with OPMDs in the primary dental setting, based on a trial for a point-of-care cytopathology tool (POCOCT). Eight strategies of OPMD detection and evaluation were compared, involving deferred evaluation (no further characterization), prompt OPMD characterization using POCOCT measurements, or the commonly recommended usual care strategy of routine referral for scalpel biopsy. POCOCT pathways differed in threshold for additional intervention, including surgery for any dysplasia or malignancy, or for only moderate or severe dysplasia or cancer. Strategies with initial referral for biopsy also reflected varied treatment thresholds in current practice between surgery and surveillance of mild dysplasia. Sensitivity analysis was performed to assess the impact of variation in parameter values on model results. RESULTS: Requisite referral for scalpel biopsy offered the highest life expectancy of 20.92 life-years compared with deferred evaluation (+0.30 life-years), though this outcome was driven by baseline assumptions of limited patient adherence to surveillance using POCOCT. POCOCT characterization and surveillance offered only 0.02 life-years less than the most biopsy-intensive strategy, while resulting in 27% fewer biopsies. When the probability of adherence to surveillance and confirmatory biopsy was ≥ 0.88, or when metastasis rates were lower than reported, POCOCT characterization extended life-years (+0.04 life-years) than prompt specialist referral. CONCLUSION: Risk-based OPMD management through point-of-care cytology may offer a reasonable alternative to routine referral for specialist evaluation and scalpel biopsy, with far fewer biopsies. In patients who adhere to surveillance protocols, POCOCT surveillance may extend life expectancy beyond biopsy and follow up visual-tactile inspection.


Assuntos
Técnicas de Apoio para a Decisão , Assistência Odontológica/organização & administração , Neoplasias Bucais/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Lesões Pré-Cancerosas/diagnóstico , Biópsia/economia , Biópsia/estatística & dados numéricos , Tomada de Decisão Clínica , Simulação por Computador , Análise Custo-Benefício , Procedimentos Clínicos/economia , Procedimentos Clínicos/organização & administração , Assistência Odontológica/economia , Clínicas Odontológicas/economia , Clínicas Odontológicas/organização & administração , Clínicas Odontológicas/estatística & dados numéricos , Diagnóstico Diferencial , Feminino , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Neoplasias Bucais/mortalidade , Neoplasias Bucais/patologia , Neoplasias Bucais/prevenção & controle , Sistemas Automatizados de Assistência Junto ao Leito/economia , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/terapia , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Medição de Risco/métodos
2.
Med Care ; 58(8): 749-755, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32692142

RESUMO

BACKGROUND: Low-income adults in the United States have historically had poor access to dental services largely due to limited dental coverage. OBJECTIVE: We examined the effects of recent Medicaid income-eligibility expansions under the Affordable Care Act on dental visits separately for preventive care and treatments. RESEARCH DESIGN: We used restricted data from the 2011 to 2016 Medical Expenditure Panel Survey with state geocodes. The main analytical sample included nearly 21,000 individuals who were newly eligible for Medicaid. We employed a quasi-experimental difference-in-differences design to identify the impact of the state Medicaid expansions effective in 2014 on dental services use by the level of state Medicaid dental benefit for the newly eligible. RESULTS: Expanding Medicaid in 2014 with extensive or limited dental coverage increased preventive dental visits and use of major dental treatments by over 5 percentage-points in 2014 and 2015. The increase in preventive visits continued in 2016 in expanding states with extensive coverage, while increase in major dental treatments continued in 2016 in expanding states with limited coverage. There is some but less consistent evidence of an increase in dental treatment with emergency-only coverage. CONCLUSIONS: Medicaid expansions with dental coverage beyond emergency-only services have increased access of the newly eligible low-income adults to dental treatments and preventive services, with extensive coverage showing continuing increase in preventive services use 3 years after the expansion. With limited coverage, there is some evidence of individuals needing to stretch treatments over a longer period. Providing comprehensive dental coverage can address unmet dental needs and improve oral health among low-income adults.


Assuntos
Assistência Odontológica/economia , Medicaid/tendências , Patient Protection and Affordable Care Act/tendências , Adulto , Assistência Odontológica/métodos , Assistência Odontológica/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
3.
PLoS One ; 15(6): e0234459, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32526770

RESUMO

INTRODUCTION: As total health and dental care expenditures in the United States continue to rise, healthcare disparities for low to middle-income Americans creates an imperative to analyze existing expenditures. This study examined health and dental care expenditures in the United States from 1996 to 2016 and explored trends in spending across various population subgroups. METHODS: Using data collected by the Medical Expenditure Panel Survey, this study examined health and dental care expenditures in the United States from 1996 to 2016. Trends in spending were displayed graphically and spending across subgroups examined. All expenditures were adjusted for inflation or deflation to the 2016 dollar. RESULTS: Both total health and dental expenditures increased between 1996 and 2016 with total healthcare expenditures increasing from $838.33 billion in 1996 to $1.62 trillion in 2016, a 1.9-fold increase. Despite an overall increase, total expenditures slowed between 2004 and 2012 with the exception of the older adult population. Over the study period, expenditures increased across all groups with the greatest increases seen in older adult health and dental care. The per capita geriatric dental care expenditure increased 59% while the per capita geriatric healthcare expenditure increased 50% across the two decades. For the overall US population, the per capita dental care expenditure increased 27% while the per capita healthcare expenditure increased 60% over the two decades. All groups except the uninsured experienced increased dental care expenditure over the study period. CONCLUSIONS: Healthcare spending is not inherently bad since it brings benefits while exacting costs. Our findings indicate that while there were increases in both health and dental care expenditures from 1996 to 2016, these increases were non-uniform both across population subgroups and time. Further research to understand these trends in detail will be helpful to develop strategies to address health and dental care disparities and to maximize resource utilization.


Assuntos
Assistência Odontológica/economia , Gastos em Saúde/tendências , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
4.
Artigo em Inglês | MEDLINE | ID: mdl-32397465

RESUMO

The aim of this study was to measure the magnitude and distribution of a Korean's lifetime dental expenses depending on age and sex, by constructing a hypothetical lifetime and life table of survival. Additionally, we estimated the difference in life expectancy between men and women and its impact on dental expenses. We used the 2015 Korea Health Panel Survey to calculate the total dental expenditure, including expenses paid directly by patients and those paid by insurers. We generated survival profiles to simulate dental expenses during a typical lifetime (from birth to age 95) using the abridged life table (five-year intervals for age groups) in 2015 from the South Korean Statistical Information Service. We independently calculated the remaining dental expenses for survivors of all ages. The results showed that an estimate of average lifetime dental expenditure was $31,851 per capita: $31,587 for men and $32,318 for women. Nearly 33% of the average per capita lifetime dental expenditure was attributable to the longer life expectancy of women, with no statistically significant difference in lifetime dental expenditure between men and women. Many survivors incurred 70% of their lifetime dental expenses before age 65. The results highlighted the need for policymakers to address spending on age-specific dental care owing to extended life expectancy, given the disproportionate share of healthcare resources supporting the elderly.


Assuntos
Assistência Odontológica , Gastos em Saúde , Expectativa de Vida , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Assistência Odontológica/economia , Feminino , Humanos , Lactente , Recém-Nascido , Tábuas de Vida , Masculino , Pessoa de Meia-Idade , República da Coreia , Adulto Jovem
5.
J Dent ; 99: 103387, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32473182

RESUMO

OBJECTIVES: To combat SARS-CoV2 (Covid-19), policy makers worldwide have adopted different policy alternatives, often including mitigation/suppression policies. We assessed the economic impact of such policies on dental practices in Germany using a modelling approach. METHODS: A providers' perspective within German healthcare was taken, with two provider scenarios (low/high volume practice, low/high proportion of non-statutory insurance revenue, low/high staff pool and costs; S1 and S2 scenarios) being modelled. Providers' costs were estimated in different blocks (staff, material, laboratory, others). A telephone-based survey was conducted on 24th March to 2nd April 2020 on a random sample of 300 German dentists (response: n = 146) to determine the experienced dental services utilization changes in these service blocks. A Markov model was constructed, following 100 practices in each scenario for a total of 365 days. Different Covid-19 mitigation/suppression periods (90 days: base-case, 45, 135 days: sensitivity analyses) were modelled. Monte-Carlo micro-simulation was performed and uncertainty introduced via probabilistic and univariate sensitivity analyses. RESULTS: Mitigation/suppression reduced utilization of all services, the most severe for prevention (-80 % in mean), periodontics (-76 %) and prosthetics (-70 %). Within the base-case, mean revenue reductions were 18.7 %/15.7 % from the public insurance, 18.7/18.6 % from private insurers and 19 %/19 % for out-of-pocket expenses in S1/S2, respectively. If the mitigation/suppression was upheld for 135 days, overall revenue decreased by 31 %/30 % in S1/S2, respectively. In this case, 29 %/12 % S1/S2 would have a negative net profit over the course of one year. CONCLUSIONS: Covid-19 and associated policies have profound economic effect on dental practices. CLINICAL SIGNIFIANCE: Policy makers will want to consider our findings when designing governmental subsidy and safety nets with immediate and midterm economic relieve effects. Dentists may consider practice re-organization to reduce costs and maintain minimum profitability.


Assuntos
Betacoronavirus , Infecções por Coronavirus/economia , Assistência Odontológica/economia , Consultórios Odontológicos/economia , Consultórios Odontológicos/estatística & dados numéricos , Odontólogos , Pandemias , Pneumonia Viral/economia , Infecções por Coronavirus/epidemiologia , Análise Custo-Benefício , Alemanha , Humanos , Cadeias de Markov , Pneumonia Viral/epidemiologia , Salários e Benefícios , Síndrome Respiratória Aguda Grave
6.
Artigo em Inglês | MEDLINE | ID: mdl-32213882

RESUMO

Given the widespread lack of access to dental care for many vulnerable Americans, there is a growing realization that integrating dental and primary care may provide comprehensive care. We sought to model the financial impact of integrating dental care provision into a primary care practice. A microsimulation model was used to estimate changes in net revenue per practice by simulating patient visits to a primary dental practice within primary care practices, utilizing national survey and un-identified claims data from a nationwide health insurance plan. The impact of potential changes in utilization rates and payer distributions and hiring additional staff was also evaluated. When dental care services were provided in the primary care setting, annual net revenue changes per practice were -$92,053 (95% CI: -93,054, -91,052) in the first year and $104,626 (95% CI: 103,315, 105,316) in subsequent years. Net revenue per annum after the first year of integration remained positive as long as the overall utilization rates decreased by less than 25%. In settings with a high proportion of publicly insured patients, the net revenue change decreased but was still positive. Integrating primary dental and primary care providers would be financially viable, but this viability depends on demands of dental utilization and payer distributions.


Assuntos
Assistência Odontológica/economia , Atenção Primária à Saúde/economia , Humanos , Estados Unidos
7.
Rev Epidemiol Sante Publique ; 68(2): 91-98, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32089349

RESUMO

BACKGROUND: People with chronic disease often have dental (especially periodontal) disorders. Nevertheless, people with chronic disease seek dental care less often than others. We wanted to know if there is a relationship between the consumption of medical care and the consumption of dental care, and if so if the relationship is especially strong for people with chronic disease. METHODS: We conducted a longitudinal study that combined two data-sets: consumption data from the French National Health Insurance Fund and health and socioeconomic welfare data collected with a dedicated national survey. We studied healthcare expenditure and analyzed the association between healthcare consumption, health status and healthcare expenditure over a four-year period (2010-2013). RESULTS: People who did not seek medical or dental care in 2010 exhibited irregular consumer behavior thereafter. This pattern was particularly evident among those with chronic disease whose healthcare expenditures did not stabilize during the study period compared with the rest of the study population. Among people who did not seek medical care in 2010, variation in average dental care expenditure was 91% in people with chronic disease versus 42% for those without chronic disease. Lack of medical care during the first year of the study was also associated with greater expenditure-delay in people with chronic disease (77%) compared with 15% in people without chronic disease. CONCLUSION: The lack of medical or dental care in 2010 for people with chronic disease did not lead to an increase in medical and dental consumption in the following years. The catch-up delay was longer than four years. This highlights a problem of monitoring and identifies a marginalized population within the healthcare system.


Assuntos
Doença Crônica , Assistência Odontológica/economia , Gastos em Saúde , Acesso aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde/economia , Adulto , Idoso , Doença Crônica/economia , Doença Crônica/epidemiologia , Doença Crônica/terapia , Conjuntos de Dados como Assunto/estatística & dados numéricos , Assistência Odontológica/normas , Assistência Odontológica/estatística & dados numéricos , Feminino , França/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doenças da Boca/economia , Doenças da Boca/epidemiologia , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Saúde Bucal/economia , Saúde Bucal/normas , Saúde Bucal/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto Jovem
8.
BMC Oral Health ; 20(1): 45, 2020 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041605

RESUMO

BACKGROUND: A three-arm parallel group, randomised controlled trial set in general dental practices in England, Scotland, and Wales was undertaken to evaluate three strategies to manage dental caries in primary teeth. Children, with at least one primary molar with caries into dentine, were randomised to receive Conventional with best practice prevention (C + P), Biological with best practice prevention (B + P), or best practice Prevention Alone (PA). METHODS: Data on costs were collected via case report forms completed by clinical staff at every visit. The co-primary outcomes were incidence of, and number of episodes of, dental pain and/or infection avoided. The three strategies were ranked in order of mean cost and a more costly strategy was compared with a less costly strategy in terms of incremental cost-effectiveness. Costs and outcomes were discounted at 3.5%. RESULTS: A total of 1144 children were randomised with data on 1058 children (C + P n = 352, B + P n = 352, PA n = 354) used in the analysis. On average, it costs £230 to manage dental caries in primary teeth over a period of up to 36 months. Managing children in PA was, on average, £19 (97.5% CI: -£18 to £55) less costly than managing those in B + P. In terms of effectiveness, on average, there were fewer incidences of, (- 0.06; 97.5% CI: - 0.14 to 0.02) and fewer episodes of dental pain and/or infection (- 0.14; 97.5% CI: - 0.29 to 0.71) in B + P compared to PA. C + P was unlikely to be considered cost-effective, as it was more costly and less effective than B + P. CONCLUSIONS: The mean cost of a child avoiding any dental pain and/or infection (incidence) was £330 and the mean cost per episode of dental pain and/or infection avoided was £130. At these thresholds B + P has the highest probability of being considered cost-effective. Over the willingness to pay thresholds considered, the probability of B + P being considered cost-effective never exceeded 75%. TRIAL REGISTRATION: The trial was prospectively registered with the ISRCTN (reference number ISRCTN77044005) on the 26th January 2009 and East of Scotland Research Ethics Committee provided ethical approved (REC reference: 12/ES/0047).


Assuntos
Assistência Odontológica/organização & administração , Cárie Dentária/prevenção & controle , Criança , Análise Custo-Benefício , Assistência Odontológica/economia , Cárie Dentária/economia , Cárie Dentária/epidemiologia , Inglaterra/epidemiologia , Humanos , Incidência , Odontopediatria , Estudos Prospectivos , Escócia/epidemiologia , País de Gales/epidemiologia
9.
Ciênc. Saúde Colet ; 24(12): 4427-4436, dez. 2019. tab
Artigo em Português | LILACS | ID: biblio-1055736

RESUMO

Resumo O presente estudo analisou os efeitos da austeridade e crise econômica sobre o financiamento da saúde bucal, oferta e utilização de serviços públicos e acesso a planos exclusivamente odontológicos no Brasil, no período de 2003 a 2018. Foi realizado um estudo retrospectivo, descritivo, com abordagem quantitativa. Foram coletados dados da base do Fundo Nacional de Saúde, da Agência Nacional de Saúde Suplementar, da Sala de Apoio à Gestão Estratégica, do Sistema e-gestor. Observou-se que o repasse federal fundo a fundo apresentou tendência crescente de 2003 a 2010 e estável de 2011 a 2018. A oferta decresceu ao final do período com redução da cobertura da primeira consulta odontológica programática, média da escovação dental supervisionada e número de tratamentos endodônticos. Na contramão da crise financeira pública, as empresas de planos exclusivamente odontológicos expandiram o mercado de 2,6 milhões de usuários em 2000 para 24,3 milhões em 2018, com lucro de mais de R$240 milhões. A austeridade fiscal tem forte influência sobre a utilização de serviços públicos odontológicos no Brasil, que pode beneficiar o mercado privado e ampliar as desigualdades.


Abstract The present study analyzed the effects of austerity and economic crisis on the financing of oral health, provision and use of public services and access to exclusively dental plans in Brazil, from 2003 to 2018. A retrospective, descriptive study was carried out, with a quantitative approach. Data were collected from the National Health Funding database, the National Supplementary Health Agency, the Strategic Management Support Room, and from the e-manager system. The federal fund-to-fund transfer was increasing from 2003 to 2010 and remained stable from 2011 to 2018. The supply decreased at the end of the period, with reduced coverage of the first programmatic dental appointment, average supervised tooth brushing and number of endodontic treatments. Against the background of the public financial crisis, exclusively dental plan companies expanded the market from 2.6 million users in 2000 to 24.3 million in 2018, with a profit of more than R$ 240 million. Fiscal austerity has a strong influence on the use of public dental services in Brazil, which can benefit the private market and widen inequalities.


Assuntos
Humanos , Alocação de Recursos para a Atenção à Saúde/economia , Assistência Odontológica/economia , Alocação de Recursos/economia , Recessão Econômica , Financiamento Governamental/economia , Acesso aos Serviços de Saúde/economia , Saúde Bucal/economia , Saúde Bucal/tendências , Estudos Retrospectivos , Setor Público , Setor Privado , Alocação de Recursos , Financiamento Governamental/tendências
10.
Cien Saude Colet ; 24(12): 4427-4436, 2019 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31778493

RESUMO

The present study analyzed the effects of austerity and economic crisis on the financing of oral health, provision and use of public services and access to exclusively dental plans in Brazil, from 2003 to 2018. A retrospective, descriptive study was carried out, with a quantitative approach. Data were collected from the National Health Funding database, the National Supplementary Health Agency, the Strategic Management Support Room, and from the e-manager system. The federal fund-to-fund transfer was increasing from 2003 to 2010 and remained stable from 2011 to 2018. The supply decreased at the end of the period, with reduced coverage of the first programmatic dental appointment, average supervised tooth brushing and number of endodontic treatments. Against the background of the public financial crisis, exclusively dental plan companies expanded the market from 2.6 million users in 2000 to 24.3 million in 2018, with a profit of more than R$ 240 million. Fiscal austerity has a strong influence on the use of public dental services in Brazil, which can benefit the private market and widen inequalities.


Assuntos
Assistência Odontológica/economia , Recessão Econômica , Financiamento Governamental/economia , Alocação de Recursos para a Atenção à Saúde/economia , Acesso aos Serviços de Saúde/economia , Alocação de Recursos/economia , Financiamento Governamental/tendências , Humanos , Saúde Bucal/economia , Saúde Bucal/tendências , Setor Privado , Setor Público , Estudos Retrospectivos
11.
BMJ Open ; 9(10): e031886, 2019 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-31585977

RESUMO

OBJECTIVE: This study aimed to describe stakeholder perspectives of a new service delivery model in primary care dentistry incorporating incentives for access, quality and health outcomes. DESIGN: Data were collected through observations, interviews and focus groups. SETTING: This was conducted under six UK primary dental care practices, three working under the incentive-driven contract and three working under the traditional activity-based contract. PARTICIPANTS: Observations were made of 30 dental appointments. Eighteen lay people, 15 dental team staff and a member of a commissioning team took part in the interviews and focus groups. RESULTS: Using a qualitative framework analysis informed by Andersen's model of access, we found oral health assessments influenced patients' perceptions of need, which led to changes in preventive behaviour. Dentists responded to the contract, with greater emphasis on prevention, use of the disease risk ratings in treatment planning, adherence to the pathways and the utilisation of skill-mix. Participants identified increases in the capacity of practices to deliver more care as a result. These changes were seen to improve evaluated and perceived health and patient satisfaction. These outcomes fed back to shape people's predispositions to visit the dentist. CONCLUSION: The incentive-driven contract was perceived to increase access to dental care, determine dentists' and patients' perceptions of need, their behaviours, health outcomes and patient satisfaction. Dentists face challenges in refocusing care, perceptions of preventive dentistry, deployment of skill mix and use of the risk assessments and care pathways. Dentists may need support in these areas and to recognise the differences between caring for individual patients and the patient-base of a practice.


Assuntos
Assistência Odontológica/economia , Assistência Odontológica/normas , Acesso aos Serviços de Saúde/economia , Qualidade da Assistência à Saúde , Reembolso de Incentivo , Contratos , Inglaterra , Grupos Focais , Acesso aos Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde , Humanos , Entrevistas como Assunto , Modelos Econômicos , Aceitação pelo Paciente de Cuidados de Saúde , Satisfação do Paciente , Padrões de Prática Odontológica , Pesquisa Qualitativa , Remuneração
12.
Int J Equity Health ; 18(1): 161, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640703

RESUMO

PURPOSE: Socioeconomic inequalities in dental care utilization in Iran are rarely documented. This study aimed to provide insight into socioeconomic inequalities in dental care utilization and its main contributing factors among Iranian households. DESIGN/METHODOLOGY/APPROACH: A total of 37,860 households from the 2017 Household Income and Expenditure Survey (HIES) were included in the study. Data on dental care utilization, age, gender and education attainment of the head of household, socioeconomic status of households, health insurance coverage, living areas and provinces were obtained for the survey. The concentration curve and the normalized concentration index (Cn) was used to illustrate and quantify socioeconomic inequalities in dental care utilization among Iranian households. The Cn was decomposed to identify the main determinants of the observed socioeconomic inequality in dental care utilization in Iran. FINDINGS: The study indicated that the prevalence of dental care utilization among Iranian's households was 4.67% (95% confidence interval [CI]: 4.46 to 4.88%). The results suggested a higher concentration of dental care utilization among socioeconomically advantaged households (Cn = 0.2522; 95% CI: 0.2258 to 0.2791) in Iran. Pro-rich inequality in dental care utilization also found in rural (Cn = 0.2659; 95%CI: 0.2221 to 0.3098) and urban (Cn = 0.0.2504; 95% CI: 0.0.2159 to 0.2841) areas. The results revealed socioeconomic status of households, age and education status of head of households and residing provinces as the main contributing factors to the concentration of dental care utilization among the wealthy households. ORIGINALITY/VALUE: This study revealed pro-rich inequalities in dental care utilization among households in Iran and its provinces. Thus, health policymakers should focus on designing effective evidence-based interventions to improve healthcare utilization among household with the older head of households, lower education status, and living in relatively poor provinces to reduce socioeconomic inequality in dental care utilization in Iran.


Assuntos
Assistência Odontológica/economia , Assistência Odontológica/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Características da Família , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
13.
Orv Hetil ; 160(38): 1503-1509, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31537092

RESUMO

Introduction: The compromise effect is a well-known phenomenon in the world of marketing, but it is rarely examined in medical settings. In dental setting, the patient often has to make treatment-related decisions with price as the only available and comprehensible information to help informed choice. Aim: We sought to determine if the compromise effect plays a role in dental treatment choices, and if yes, how the effect is modified by factors such as perceived quality, professional jargon in the explanations, or the importance of keeping one's own teeth intact. Method: 676 volunteers participated in this questionnaire-based study. The questionnaires were filled in anonymously. Altogether 8 versions of the same questionnaire were generated, in which the following information was given in varying combinations: the names of five different dental treatments from cheap to expensive, their possible prices, and additional information about the treatment. Statistical analysis: The significance of the relationship between the relative frequency of responses and the available additional information was determined by chi-square test and Fisher's exact test. Results: The respondents did not approach dental treatment-related decisions on a heuristic basis by default, most probably because of their preconceptions and previous experiences in connection with dental treatments. Esthetics turned out to be of utmost importance and expectable lifespan was also information that significantly influenced the choices. Conclusion: Extra information can and does influence informed dental treatment choice on the patient side, provided it is offered in a clear, proper, and intelligible form, which points out the importance of professional communication. Orv Hetil. 2019; 160(38): 1503-1509.


Assuntos
Tomada de Decisões , Assistência Odontológica/economia , Voluntários , Humanos , Hungria , Consentimento Livre e Esclarecido , Projetos Piloto , Inquéritos e Questionários
14.
BMJ Open ; 9(8): e030934, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31420398

RESUMO

OBJECTIVES: The aim of this study was to conduct a cost-effectiveness analysis (CEA) of a high-intensity and a low-intensity smoking cessation treatment programme (HIT and LIT) using long-term follow-up effectiveness data and to validate the cost-effectiveness results based on short-term follow-up. DESIGN AND OUTCOME MEASURES: Intervention effectiveness was estimated in a randomised controlled trial as numbers of abstinent participants after 1 and 5-8 years of follow-up. The economic evaluation was performed from a societal perspective using a Markov model by estimating future disease-related costs (in Euro (€) 2018) and health effects (in quality-adjusted life-years (QALYs)). Programmes were explicitly compared in an incremental analysis, and the results were presented as an incremental cost-effectiveness ratio. SETTING: The study was conducted in dental clinics in Sweden. PARTICIPANTS: 294 smokers aged 19-71 years were included in the study. INTERVENTIONS: Behaviour therapy, coaching and pharmacological advice (HIT) was compared with one counselling session introducing a conventional self-help programme (LIT). RESULTS: The more costly HIT led to higher number of 6-month continuous abstinent participants after 1 year and higher number of sustained abstinent participants after 5-8 years, which translates into larger societal costs avoided and health gains than LIT. The incremental cost/QALY of HIT compared with LIT amounted to €918 and €3786 using short-term and long-term effectiveness, respectively, which is considered very cost-effective in Sweden. CONCLUSION: CEA favours the more costly HIT if decision makers are willing to spend at least €4000/QALY for tobacco cessation treatment.


Assuntos
Aconselhamento/economia , Assistência Odontológica/economia , Padrões de Prática Odontológica/estatística & dados numéricos , Abandono do Hábito de Fumar/economia , Adulto , Idoso , Atitude do Pessoal de Saúde , Terapia Comportamental/economia , Análise Custo-Benefício , Assistência Odontológica/métodos , Serviços de Saúde Bucal/economia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Suécia , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-31349691

RESUMO

The objective of this study was to evaluate the clinical effectiveness and cost-effectiveness of oral-health promotion programs (OHPPs) aiming to improve children's knowledge of favorable oral health behavior to lower decayed/-missing/-filled teeth (DMFT) while reducing the financial cost on health institutions. An electronic search was performed in seven databases. Studies were restricted to human interventions published in English. The search study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and the risk of bias was assessed based on the Drummonds Checklist. A total of 1072 references were found. Among these, 19 full texts were included. Most studies had a strong quality. The overall pooled impact of OHPPs estimates children suffering from DMFT/S to have 81% lower odds of participating in OHPP (95% CI 61-90%, I2: 98.3%, p = 0). Furthermore, the program was shown to be effective at lowering the cost in 97 out of 100 OHPPs (95% CI 89-99%, I2: 99%, p = 0). Three subgroups analyses (age groups, study countries, studies of the last five years) were performed to evaluate the influence modification on the pooled effect. A comprehensive analysis of the OHPPs confirmed a reduction effect on child DMFT, hence, lowering the financial burden of dental-care treatment on health institutions.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Assistência Odontológica/economia , Cárie Dentária/prevenção & controle , Promoção da Saúde/economia , Promoção da Saúde/métodos , Saúde Bucal/economia , Saúde Bucal/educação , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Resultado do Tratamento
17.
Artigo em Inglês | MEDLINE | ID: mdl-31195612

RESUMO

Aim: The objective of this study was to estimate the Out-Of-Pocket Expenditures (OOPEs) incurred by households on dental care, as well as to analyze the sociodemographic, economic, and oral health factors associated with such expenditures. Method: A cross-sectional study was conducted among 763 schoolchildren in Mexico. A questionnaire was distributed to parents to determine the variables related to OOPEs on dental care. The amounts were updated in 2017 in Mexican pesos and later converted to 2017 international dollars (purchasing power parities-PPP US $). Multivariate models were created: a linear regression model (which modeled the amount of OOPEs), and a logistic regression model (which modeled the likelihood of incurring OOPEs). Results: The OOPEs on dental care for the 763 schoolchildren were PPP US $53,578, averaging a PPP of US $70.2 ± 123.7 per child. Disbursements for treatment were the principal item within the OOPEs. The factors associated with OOPEs were the child's age, number of dental visits, previous dental pain, main reason for dental visit, educational level of mother, type of health insurance, household car ownership, and socioeconomic position. Conclusions: The average cost of dental care was PPP US $70.2 ± 123.7. Our study shows that households with higher school-aged children exhibiting the highest report of dental morbidity-as well as those without insurance-face the highest OOPEs. An array of variables were associated with higher expenditures. In general, higher-income households spent more on dental care. However, the present study did not estimate unmet needs across the socioeconomic gradient, and thus, future research is needed to fully ascertain disease burden.


Assuntos
Assistência Odontológica/economia , Países em Desenvolvimento/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Seguro Saúde , Masculino , México , Fatores Socioeconômicos , Inquéritos e Questionários
18.
Community Dent Health ; 36(2): 118-125, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31070875

RESUMO

OBJECTIVE: To collate the body of evidence in economic studies of different dental interventions. METHODS: Eligible English studies after 1980 were sourced from MEDLINE using MeSH terms and reviewed independently by 4 teams. Studies were grouped according to the type of dental intervention and their quality appraised using Drummond's Checklist. RESULTS: The number of dental economic studies increased from 1980 to 2016. A total of 91 studies were identified following the search strategy. Most studies were conducted in the United States (n=23), followed by Germany (n=14), Australia (n=10) and the United Kingdom (n=9). Preventative dental interventions comprised 37% of included studies (n=34), followed by restorative (n=14), prosthodontic (n=13) and periodontal interventions (n=12). Cost effectiveness analyses (n=68) comprise 75% of full economic evaluation (EE) studies, followed by cost-utility (n=17) and cost-benefit (n=6). Quality assessment checklists identified 60 studies as good, 23 as moderate and 8 as poor. Common methodological limitations were identified in EE studies. Comparison of studies identified trends and common findings within each dental intervention. CONCLUSION: High quality economic studies are important in directing resources and funding by policy makers. Standardisation of reporting outcome measures will improve the potential for interpretation and comparison between studies. Research adhering to recommended quality assessment checklists will improve the overall quality of evidence to better identify cost-effective treatments for different dental interventions.


Assuntos
Assistência Odontológica , Austrália , Análise Custo-Benefício , Assistência Odontológica/economia , Alemanha , Humanos , Reino Unido
19.
Prim Dent J ; 8(1): 34-37, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31122329

RESUMO

This study was carried out to evaluate the difference in prices for dental treatments carried out privately in general dental practice within the Birmingham area. Ten different practices were chosen at random, which were spread across Birmingham, in order to get a better insight into the differences across the districts. Their prices for pre-determined dental procedures were procured off the practices' respective websites or through telephoning. The findings of this study have shown a wide variation in prices for each dental procedure, with the greatest variation in prices between practices being ?850 for dental implants. The procedures with the lowest average cost were fissure sealants at ?23.14. The procedure with the highest average cost was dental implants at ?2,261.11. This study also showed that as more dental treatment was required, the mean cost for the dental intervention increased, regardless of the tooth being treated.


Assuntos
Assistência Odontológica , Cárie Dentária , Odontologia Geral , Selantes de Fossas e Fissuras , Custos e Análise de Custo , Assistência Odontológica/economia , Odontologia Geral/economia , Humanos , Selantes de Fossas e Fissuras/economia , Prática Privada
20.
BMJ Open ; 9(3): e022436, 2019 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-30928921

RESUMO

OBJECTIVES: This study was designed to evaluate whether employment status is associated with the experience of unmet dental care needs. METHODS: A total of 4620 workers were retrieved from Korea Health Panel data (2010-2013), and potential relationships were explored among their income levels, changes in employment and unmet dental care needs. RESULTS: Among the 4620 workers, 17.3% said they had failed at least once to get dental treatment or check-up, despite their needs. Precarious workers and those not in employment were more likely to experience unmet dental care needs due to economic burden compared with permanent workers (OR 1.36, 1.40, respectively). In addition, people in low-income group were 4.46 times more likely to experience unmet dental care needs caused by economic burden, compared with those with the highest income. CONCLUSION: This disparity means that precarious workers and those not in employment are more likely to face barriers in obtaining needed health services. Given the insecure employment status of low income people, meeting their healthcare needs is an important consideration.


Assuntos
Assistência Odontológica/estatística & dados numéricos , Emprego/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Adulto , Assistência Odontológica/economia , Feminino , Acesso aos Serviços de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , República da Coreia/epidemiologia , Fatores Socioeconômicos , Adulto Jovem
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