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1.
Int Dent J ; 71(1): 76-84, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33616056

RESUMO

OBJECTIVES: This study explored trends in self-rated poor oral health (SRPOH) from 2007 to 2015 among all age groups to monitor changes after the expansion of dental insurance. METHODS: Repeated cross-sectional data from 2007 to 2015 Korea National Health and Nutrition Examination Surveys were collected and analysed. The respondents (n = 20,199) were categorised into four age groups: 0-19, 20-44, 45-64, and ≥65 years. The outcome variable was SRPOH, with independent variables being socioeconomic factors, sex, household income, and education. The age-sex standardised prevalence rate was calculated to determine trends, and complex samples logistic regression analysis was performed to confirm the factors affecting SRPOH. RESULTS: Self-rated poor oral health prevalence decreased significantly from 2007 to 2009 (25%) to 2013 to 2015 (14%) in the age groups of 0-19 and 20-44 years (P < 0.05), whereas the SRPOH prevalence in the age groups of 45-64 and ≥65 years did not undergo any significant changes. Although the prevalence decreased by 6% among older adults, over 40% older women still experienced SRPOH. A sex gap increased with age but did not change over time. SRPOH was strongly associated with sex, income, and education across all age groups; the association did not notably change from 2007 to 2015. CONCLUSIONS: Self-rated poor oral health improved among younger people in Korea. The gender gap in the prevalence increased with age and persisted over time. However, income was the strongest determinant of SRPOH among all age groups, regardless of dental insurance expansion. Further studies should aim to draw causal inferences to explore the policy impact of dental insurance benefits.


Assuntos
Seguro Odontológico , Saúde Bucal , Idoso , Estudos Transversais , Feminino , Humanos , República da Coreia/epidemiologia , Fatores Socioeconômicos
3.
Artigo em Inglês | MEDLINE | ID: mdl-32751843

RESUMO

Countries with different oral health care systems may have different levels of oral health related inequalities. We compared the socioeconomic inequalities in oral health among older adults in Japan and England. We used the data for adults aged 65 years or over from Japan (N = 79,707) and England (N = 5115) and estimated absolute inequality (the Slope Index of Inequality, SII) and relative inequality (the Relative Index of Inequality, RII) for edentulism (the condition of having no natural teeth) by educational attainment and income. All analyses were adjusted for sex and age. Overall, 14% of the Japanese subjects and 21% of the English were edentulous. In both Japan and England, lower income and educational attainment were significantly associated with a higher risk of being edentulous. Education-based SII in Japan and England were 9.9% and 26.7%, respectively, and RII were 2.5 and 4.8, respectively. Income-based SII in Japan and England were 9.2% and 14.4%, respectively, and RII were 2.1 and 1.9, respectively. Social inequalities in edentulous individuals exist in both these high-income countries, but Japan, with wider coverage for dental care, had lower levels of inequality than England.


Assuntos
Assistência Odontológica , Disparidades nos Níveis de Saúde , Seguro Odontológico , Saúde Bucal , Idoso , Idoso de 80 Anos ou mais , Inglaterra/epidemiologia , Feminino , Humanos , Japão/epidemiologia , Estudos Longitudinais , Masculino , Fatores Socioeconômicos
4.
Artigo em Inglês | MEDLINE | ID: mdl-32679717

RESUMO

A cross-sectional, self-administered survey was used to gather information about dental outcomes, sugar-containing food behaviors and intake, and sociodemographic characteristics of adults of Mexican and Central-American (Guatemala, El Salvador, Honduras) origin (n = 517). Bivariate and multiple-variable logistic regressions were used to examine the associations of behaviors related to added sugar-containing foods/beverages (overall intake and consumption before bed) with dental outcomes. Outcome measures involved dental outcomes, dental self-care practices, and added sugar intake. Estimated daily added sugar intake among all participants was 98 (SD = 99) g, with no difference in consumption among participants from different countries. The majority of added sugar (63 (SD = 74) g) was provided by sugar-sweetened beverages. Participants who reported consuming sugar-containing foods or beverages within an hour before bed were more likely to report having a fair/poor/very poor condition of teeth and gums and having felt dental pain (p < 0.05 for all). The amount of sugar intake was associated with being prescribed medication for oral or dental problems (p = 0.008) and dental pain (p = 0.003). Findings support the association between sugar containing food-related behaviors and dental problems among Hispanic immigrants to the U.S. Health promotion and preventive interventions for this population should consider these behaviors as modifiable contributors to adverse dental outcomes.


Assuntos
Sacarose na Dieta/administração & dosagem , Emigrantes e Imigrantes , Hispano-Americanos , Saúde Bucal , Adulto , Bebidas , Estudos Transversais , El Salvador , Ingestão de Energia , Feminino , Honduras , Humanos , Seguro Odontológico , Masculino , México/epidemiologia , Açúcares
5.
Aust Dent J ; 65 Suppl 1: S71-S78, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32583584

RESUMO

BACKGROUND: This study examines last dental visit (visiting within the last 12 months, having a last visit 5 or more years ago, attending a private dental practice) and usual visit (usually visiting for a check-up, having a dentist they usually attend). METHODS: Explanatory variables include age, gender, region, income, area-based SES and dental insurance. The data were collected in the Interview in NSAOH 2017-18. RESULTS: There was a dental visiting gradient by region, with lower percentages visiting in the last 12 months in remote (44.9%) and regional areas (50.8%) than major cities (58.7%). A higher percentage of the higher-income tertile made visits (63.8%) than the middle (53.7%) and lower tertiles (49.9%). There was a visiting gradient by area-based SES, with higher percentages in the higher (63.8%) and middle SES tertiles (55.2%) than the lower tertile (50.2%). Uninsured persons had lower percentages visiting (43.3%) than insured (69.7%). CONCLUSIONS: Persons in remote locations, those with low socioeconomic status and those uninsured were disadvantaged in terms of access. They had lower percentages visiting in the last 12 months, usually visiting for a check-up, having a dentist they usually attend and higher percentages visiting 5 or more years ago.


Assuntos
Seguro Odontológico , Saúde Bucal , Adulto , Austrália/epidemiologia , Assistência Odontológica , Humanos , Renda
6.
Ned Tijdschr Tandheelkd ; 127(2): 119-125, 2020 Feb.
Artigo em Holandês | MEDLINE | ID: mdl-32271329

RESUMO

This fifth and final in a series of 5 articles in the context of the 2017 Kies-voor-Tanden study presents the results for 23-year-olds. 21% of the 23-year-olds had flawless permanent teeth. In 2017, there were still differences in oral health among the socio-economic (SES) groups, to the advantage of the high SES group. The oral health of the low SES group had shown some improvement in the previous 6 years, while this was not the case within the high SES group. The preventive dental behaviour of 23-year-olds was not optimal and the knowledge about the dental insurance system was poor. Conclusion: the oral health of 23-year-olds had partly improved, partly stagnated. Since not everyone will be able to access information through oral care professionals, other ways of providing information to them must be considered. In the context of public health, to be able to follow trends in oral health and dental preventive behaviour of (young) adults, research monitoring oral health is of great importance.


Assuntos
Cárie Dentária , Adulto , Índice CPO , Humanos , Seguro Odontológico , Países Baixos , Saúde Bucal , Prevalência
7.
J Endod ; 46(5): 584-595, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32273156

RESUMO

The recent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated coronavirus disease has gripped the entire international community and caused widespread public health concerns. Despite global efforts to contain the disease spread, the outbreak is still on a rise because of the community spread pattern of this infection. This is a zoonotic infection, similar to other coronavirus infections, that is believed to have originated in bats and pangolins and later transmitted to humans. Once in the human body, this coronavirus (SARS-CoV-2) is abundantly present in nasopharyngeal and salivary secretions of affected patients, and its spread is predominantly thought to be respiratory droplet/contact in nature. Dental professionals, including endodontists, may encounter patients with suspected or confirmed SARS-CoV-2 infection and will have to act diligently not only to provide care but at the same time prevent nosocomial spread of infection. Thus, the aim of this article is to provide a brief overview of the epidemiology, symptoms, and routes of transmission of this novel infection. In addition, specific recommendations for dental practice are suggested for patient screening, infection control strategies, and patient management protocol.


Assuntos
Infecções por Coronavirus , Coronavirus , Assistência Odontológica , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Assistência Odontológica/métodos , Assistência Odontológica/tendências , Humanos , Controle de Infecções/métodos , Seguro Odontológico , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
8.
BMC Health Serv Res ; 20(1): 124, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066434

RESUMO

BACKGROUND: Universal coverage for dental care is a topical policy debate across Canada, but the impact of dental insurance on improving oral health-related outcomes remains empirically unexplored in this population. METHODS: We used data on individuals 12 years of age and older from the Canadian Community Health Survey 2013-2014 to estimate the marginal effects (ME) of having dental insurance in Ontario, Canada's most populated province (n = 42,553 representing 11,682,112 Ontarians). ME were derived from multi-variable logistic regression models for dental visiting behaviour and oral health status outcomes. We also investigated the ME of insurance across income, education and age subgroups. RESULTS: Having dental insurance increased the proportion of participants who visited the dentist in the past year (56.6 to 79.4%, ME: 22.8, 95% confidence interval (CI): 20.9-24.7) and who reported very good or excellent oral health (48.3 to 57.9%, ME: 9.6, 95%CI: 7.6-11.5). Compared to the highest income group, having dental insurance had a greater ME for the lowest income groups for dental visiting behaviour: dental visit in the past 12 months (ME highest: 17.9; 95% CI: 15.9-19.8 vs. ME lowest: 27.2; 95% CI: 25.0-29.3) and visiting a dentist only for emergencies (ME highest: -11.5; 95% CI: - 13.2 to - 9.9 vs. ME lowest: -27.2; 95% CI: - 29.5 to - 24.8). CONCLUSIONS: Findings suggest that dental insurance is associated with improved dental visiting behaviours and oral health status outcomes. Policymakers could consider universal dental coverage as a means to support financially vulnerable populations and to reduce oral health disparities between the rich and the poor.


Assuntos
Seguro Odontológico/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Cobertura Universal do Seguro de Saúde , Adulto Jovem
9.
J Am Dent Assoc ; 151(1): 6-7, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31902401
10.
PLoS One ; 15(1): e0227233, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945098

RESUMO

OBJECTIVES: Dental caries is the most common chronic childhood disease that occurs in a continuum and can be prevented by children and their parents' adherence to recommended oral health behaviors. Theory-driven tools help practitioners to identify the causes for poor adherence and develop effective interventions. This study examined the Expanded Theory of Planned Behaviour (TPB) Model by adding the concept of Sense of Coherence (SOC) to predict parental adherence to preschooler's preventive dental visits. METHODS: Data regarding socio-economic demographics were collected from parents of children aged 2-6 years. Constructs of TPB including parental attitudes, subjective norms (SN), Perceived Behavioural Control (PBC), and intention to attend preventive dental visits for their preschoolers were collected by questionnaire, alongside parents' sense of coherence (SOC). Dental attendance was measured by asking if the child had a regular dental visit during the last year. Structural Equation Modeling Analysis (SEMA) was carried out to identify significant direct and indirect (mediated) pathways in the extended TPB model. RESULTS: Three hundred and seventy-eight mothers (mean age = 34.41 years, range 22-48) participated in the study. The mean age of children was 3.92 years, range: 2-6), and 75.9% had dental insurance. Results of the final model showed that predisposing factors (child's birthplace and mother's birthplace) significantly predicted enabling resources (family monthly income and child's dental insurance status); both predicted the TPB components (PBC, SN, and attitude). TPB components, in turn, predicted behavioural intention. However, contrary to expectation, intention did not significantly predict dental attendance in the past 12 months. Parent's SOC significantly predicted TPB components and dental attendance. Overall, 56% of the variance in dental attendance was explained by the expanded TPB model. CONCLUSIONS: The expanded TPB model explained a great deal of variance in preschooler's dental attendance. These findings suggest that the expanded model could be used as the framework for designing interventions or strategies to enhance dental attendance among preschoolers; in particular, such strategies should focus specifically on enhancing parental SOC including empowerment.


Assuntos
Educação em Saúde Bucal , Odontologia Preventiva , Doenças Dentárias/prevenção & controle , Adulto , Atitude Frente a Saúde , Criança , Pré-Escolar , Feminino , Humanos , Seguro Odontológico , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
11.
Health Serv Res ; 55(3): 367-374, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31943200

RESUMO

OBJECTIVES: To estimate the effect of Medicaid expansion under the Affordable Care Act (ACA) on the frequency and payment source for Emergency Department (ED) visits for dental care. STUDY DESIGN: Retrospective, quasi-experimental study. DATA SOURCES/STUDY SETTING: We used the State Emergency Department Database to compare changes in ED visit rates and payment source for dental conditions among patients from 33 states. These states represent four distinct policy environments, based on whether they expanded Medicaid and whether their Medicaid programs provide dental benefits. We first assessed the number of ED dental visits before (2012) and after (2014) the ACA. Then, we used differences-in-differences regression to estimate changes in insurance for dental visits by nonelderly adults. PRINCIPAL FINDINGS: Our sample contained 375 944 dental ED visits. In states that expanded Medicaid and offered dental coverage, dental ED visits decreased by 14.1 percent (from 19 443 to 16 709, for a net difference of 2734). By contrast, in the remaining three state groups, dental ED visits rose. Meanwhile, the expansion significantly increased Medicaid coverage and decreased the rate of self-pay for ED dental visits. CONCLUSIONS: Medicaid expansion, combined with adult dental coverage in Medicaid, was associated with a reduction in ED utilization for dental visits.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Doenças Dentárias/terapia , Adulto , Feminino , Humanos , Masculino , Medicaid/legislação & jurisprudência , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/legislação & jurisprudência , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
12.
J Immigr Minor Health ; 22(1): 96-101, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30820732

RESUMO

Ontario has the largest Indigenous population in Canada. This study aims to examine the prevalence and factors associated with poor dental care use amongst the Indigenous in Ontario. Data from the 2014 cycle of the Canadian Community Health Survey was used. The main outcome was defined as visiting the dentist only for emergency care. Stepwise multivariable logistic regression was performed to assess the association between socio-demographic, socio-economic, and the health related factors and emergency dental care use. 28% of the participants reported visiting the dentist only for emergencies. First Nations people were at increased odds of having poor dental care (OR 2.01, CI 1.12-3.95). Additionally, being male, a smoker, having fair/poor health and lacking dental insurance puts the Indigenous Ontarians at increased odds of having the outcome. Improvements to the current social benefit programs could help better cater to the needs of this population.


Assuntos
Assistência Odontológica/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Índios Norte-Americanos/estatística & dados numéricos , Saúde Bucal/etnologia , Adulto , Fatores Etários , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Nível de Saúde , Humanos , Seguro Odontológico/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ontário , Prevalência , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
13.
Clin Oral Investig ; 24(7): 2331-2339, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31664593

RESUMO

OBJECTIVE: Early dental monitoring contributes substantially to good oral health in children. However, little is known on whether children from different geographical regions and gender are equally reached with current preventive and curative oral health strategies. The aim of our study therefore was to explore regional and gender differences in a population-based oral health dataset of Austrian children up to the age of 14. MATERIALS AND METHODS: We extracted the first electronically available health insurance data of children aged up to 14 years on dental services within a 4-year observation period in Austria and performed a separate analysis in up to 6-year-old children. In addition, we used a smaller randomly selected sample dataset of 3000 children as the large numbers would result in significant, but very small effects. RESULTS: In a total of 130,895 children, of whom 77,173 children (59%) were up to the age of six, we detected an east-west gradient: The eastern regions of Austria showed an older age at first contact and a higher number of dental services. A child aged up to 6 years who needed more than four dental services had a likelihood of 40% to be from Vienna, Austria's capital city located in the east. The smaller random sample did not show significant gender differences. CONCLUSIONS: Even in regions with a high density of dentists, such as Vienna, we obviously did not reach young children in the same extent as in other regions. CLINICAL RELEVANCE: Stratified interventions could be developed to overcome regional inequalities.


Assuntos
Cárie Dentária , Seguro Odontológico , Saúde Bucal , Adolescente , Áustria/epidemiologia , Criança , Pré-Escolar , Cárie Dentária/epidemiologia , Cárie Dentária/prevenção & controle , Humanos , Cobertura do Seguro , Seguro Odontológico/estatística & dados numéricos , Fatores Sexuais , Fatores Socioeconômicos
14.
BMC Health Serv Res ; 19(1): 678, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533819

RESUMO

BACKGROUND: This study aimed to investigate the relationship between complementary health insurance and frequency of dental visits. METHODS: The present study was performed using the Urban Health Equity Assessment and Response Tool (Urban HEART). A cross-sectional study was conducted in Tehran (Iran) to assess inequalities in health status among different socioeconomic and ethnic groups, genders, geographical areas, and social determinants of health. Out of 20,320 records retrieved from the original study with dental information, 17,252 had both dental insurance and dental visit information. Complementary health insurance as the main independent variable had three categories (i.e., basic insurance, with complementary medical coverage, and with dental coverage). The frequency of dental visits during the last year as a dependent variable had also three categories (i.e., no visit, one, and two, or more dental visits in the last year). In this study, in addition to investigating the relationship between complementary health insurance and frequency of dental visits, potential covariates that may affect the mentioned relationship were evaluated in the regression model. Statistical analyses included simple and multiple multinomial logistic regression considering the sampling method and sampling weights. RESULTS: The meanage of 17,252 participants (Tehran citizens) was 39.36 years; 49.4%were women, 86.0%hadonly basicinsurance, 7.2% had complementary medical insurance, and 6.8% had complementary dental insurance. Of all subjects, 43.8% reported no dental visit, 26.1% reported one, and 30.1% reportedtwoor more dental visits during the lastyear. The frequency of dental visits was lower in people who had basic insurance than others such that that odds ratio (OR) was 0.73 (p-value < 0.001) for one visit and 0.68 (p-value< 0.001) for two or more visits in the last year. The frequency of dental visits was also positively associated with dental brushing, toothpaste use, high educational level, being married, having more than 20 teeth, and having dental pain. CONCLUSION: Having dental insurance increases the frequency of dental visits but the association between dental insurance and dental visits was independently influenced by other predictors.


Assuntos
Serviços de Saúde Bucal/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Análise de Dados , Utilização de Instalações e Serviços , Feminino , Nível de Saúde , Humanos , Irã (Geográfico) , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Saúde da População Urbana/estatística & dados numéricos , Adulto Jovem
15.
Artigo em Inglês | MEDLINE | ID: mdl-31382547

RESUMO

We evaluated the effect of the National Health Insurance (NHI) policy including dental sealant on changes in the prevalence of sealant and caries, and examined how NHI affected sealant utilization and untreated caries in children from diverse income groups in South Korea. We used a multivariate logistic regression analysis to explore the effects of three stages of dental sealant policy (pre-policy: 2007-2009, first post-policy: 2010-2012, and second post-policy: 2013-2015) on the prevalence of dental sealant and untreated caries. Participant data (N = 8161, aged 6-14 years) were derived from the Korea National Health and Nutrition Examination Survey (2007-2015). We also conducted subgroup analysis to determine the effects of the NHI policy on dental sealant and untreated caries by income level. Implementation of dental insurance coverage was associated with higher likelihood of using dental sealant (odds ratio (OR) = 1.39 (95% confidence interval (CI): 1.18-1.63) for the first period and OR = 1.58 (95% CI: 1.33-1.87) for the second period) and lower odds of having untreated caries (OR = 0.79 (95% CI: 0.64-0.98) for the first period and OR = 0.65 (95% CI: 0.51-0.83) for the second period) after controlling for covariates. Results revealed that there was a greater prevalence of dental sealant and a lower prevalence of untreated caries in both middle- and low-income households compared to high-income households. The higher prevalence of dental sealant and lower untreated caries after the policy implementation. Moreover, we demonstrated children from low-or middle-income households were more associated with increasing dental sealant use and a declining prevalence of caries.


Assuntos
Cárie Dentária/epidemiologia , Política de Saúde , Programas Nacionais de Saúde/organização & administração , Selantes de Fossas e Fissuras/uso terapêutico , Adolescente , Criança , República Democrática Popular da Coreia/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Renda , Seguro Odontológico/estatística & dados numéricos , Masculino , Inquéritos Nutricionais , Prevalência , República da Coreia/epidemiologia
16.
Med Care ; 57(10): 781-787, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31433313

RESUMO

BACKGROUND: Low-income adults in the United States have historically had limited access to dental coverage and poor dental health outcomes. OBJECTIVE: We examined the effects of the Affordable Care Act Medicaid expansions on dental visits among low-income adults focusing on the generosity of dental coverage and heterogeneity in effects by dentist supply. RESEARCH DESIGN: We used data from 2012, 2014, and 2016 Behavioral Risk Factor Surveillance System surveys. The main analytical sample included nearly 117,000 individuals <138% federal poverty level. We employed a quasi-experimental difference-in-differences design to identify the impact of the state Medicaid expansions on having a dental visit in the past 12 months by the generosity of dental coverage and dentist supply. RESULTS: Medicaid expansions were associated with a nearly 6 percentage-point increase in the likelihood of any dental visits in 2016 (over 10% increase from preexpansion rate) for individuals in Medicaid expanding states with extensive dental benefits. This increase, however, was concentrated in states with high dentist supply with no evidence of improvement in utilization in states with limited dental coverage or low dentist supply. CONCLUSIONS: Expanding Medicaid with generous dental coverage improved dental care use only in areas with high dentist supply with no evidence of benefits with low dentist supply or less generous coverage. Improving access to dental care may require both generous coverage and supply-side interventions to increase dentist availability.


Assuntos
Assistência Odontológica/estatística & dados numéricos , Odontólogos/provisão & distribução , Cobertura do Seguro/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Medicaid/legislação & jurisprudência , Patient Protection and Affordable Care Act , Pobreza/estatística & dados numéricos , Estados Unidos
17.
J Public Health Dent ; 79(4): 343-351, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31418877

RESUMO

OBJECTIVES: Dental care is the most commonly cited unmet health-care service due to cost. Previous research has highlighted the unmet dental needs of people living with HIV (PLWH). Understanding associations among dental insurance availability, dental care utilization, and the presence of unmet dental needs among PLWH is a public health priority. METHODS: Oral health surveys were collected cross-sectionally (April-October 2016) among 1,442 women living with HIV (WLWH) in the Women's Interagency HIV Study. Logistic regression models were used to analyze the association between having versus not having dental insurance by type (Ryan White, private, Medicaid/Medicare) and two primary outcomes: a) typical frequency of dental visits (at least annually, less than annually) and b) reporting an unmet dental need in the past 6 months. RESULTS: All dental insurance types were associated with higher odds of receiving annual dental care and, for those with either Medicare/Medicaid or private insurance, lower odds of having an unmet dental need. When WLWH were asked to describe their oral health, poor self-reported condition was associated with both an unmet dental need (odds ratio [OR]: 4.52, 95 percent Confidence Interval [CI] [3.29-6.20]) and lower odds of annual dental care utilization (OR: 0.44, 95 percent CI [0.34-0.57]). Self-reported depressive symptom burden was also linked to having an unmet dental need (OR: 2.10, 95 percent CI [1.46-3.01]). CONCLUSIONS: Dental insurance coverage increases dental care utilization and is associated with better oral health among WLWH. In the era of health-care reform, dental insurance coverage may be instrumental for enhancing treatment outcomes.


Assuntos
Infecções por HIV , Seguro Odontológico , Idoso , Assistência Odontológica , Feminino , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Cobertura do Seguro , Seguro Saúde , Medicaid , Medicare , Estados Unidos
18.
Health Econ ; 28(9): 1151-1158, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31264323

RESUMO

Many older Americans have poor access to dental care, resulting in a high prevalence of oral health problems. Because traditional Medicare does not include dental care benefits, only older Americans who are employed, have post-retirement dental benefits or spousal coverage, or enroll in certain Medicare Advantage plans are able to obtain dental care coverage. We seek to determine the extent to which poor access to dental insurance and high out-of-pocket costs affect dental service use by the elderly. Using the 2007-2015 Medical Expenditure Panel Survey and supplemental data on dental care prices, we estimate a demand system for preventive dental services and basic and major restorative services. Selection into dental and medical insurance is addressed using a correlated random effects panel data specification. Consistent with prior studies of the nonelderly population, dental service use was not sensitive to out-of-pocket prices. However, private dental insurance increased preventive service use by 25%, and dental coverage through Medicaid increased basic and major service use by 23% and 36%, respectively. The use of services was more responsive to dental insurance for women than men. These estimates suggest that a Medicare dental benefit could significantly increase dental service use by older Americans.


Assuntos
Assistência Odontológica para Idosos/economia , Acesso aos Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Idoso , Feminino , Humanos , Seguro Odontológico/economia , Masculino , Medicaid/economia , Medicare/economia , Medicare Part C/economia , Modelos Econômicos , Estados Unidos
19.
Inquiry ; 56: 46958019861554, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31271082

RESUMO

While the traditional Medicare program does not cover dental, vision, and hearing services, Medicare Advantage (MA) plans have been given the flexibility to do so. However, it is not known how many MA enrollees are in plans that cover these services. The 2016 Medicare Current Beneficiary Survey linked to MA plan benefit data is used to examine enrollment levels in plans that cover dental, vision, and/or hearing services in MA. Medicaid beneficiaries are excluded from this analysis as coverage of supplemental benefits is largely determined by the state. The highest coverage of supplemental services is vision, followed by hearing and dental (71%, 56%, and 41%, respectively). Across all supplemental services, coverage for supplemental benefits is highest among low-income beneficiaries and those who have not completed high school. Hispanic Medicare beneficiaries had the highest enrollment in plans that offered a supplemental benefit, and white Medicare beneficiaries tended to have the lowest enrollment in these plans. Unlike in traditional Medicare, MA enrollees have access to health plans that offer supplemental benefits, including dental, vision, and/or hearing services. This analysis shows that enrollment in these plans is highest among low-income MA enrollees who may not have the means to purchase stand-alone insurance for these services in traditional Medicare. More analysis is warranted to examine the generosity of the coverage of these services in MA plans. However, for federal policy makers to consider offering supplemental coverage in traditional Medicare, the MA experience suggests this type of benefit would be valuable.


Assuntos
Auxiliares de Audição/estatística & dados numéricos , Benefícios do Seguro/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Seguro Oftalmológico/estatística & dados numéricos , Medicare Part C/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Humanos , Cobertura do Seguro , Medicaid , Estados Unidos
20.
NCHS Data Brief ; (337): 1-8, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31163014

RESUMO

Dental care is often an overlooked aspect of overall health care among older adults. Regular dental care is recommended for all older adults, even those with full dentures (1). Because Medicare does not cover routine dental care, older adults may have trouble accessing appropriate dental care (2). This report describes the prevalence, overall and by selected characteristics, of dental insurance, dental visits, and unmet need for dental care due to cost among adults aged 65 and over.


Assuntos
Assistência Odontológica/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Grupos de Populações Continentais/estatística & dados numéricos , Feminino , Humanos , Renda/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Masculino , Boca Edêntula/epidemiologia , Estados Unidos
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