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1.
Artigo em Inglês | MEDLINE | ID: mdl-31510102

RESUMO

High costs are an important reason patients postpone dental visits, which can lead to serious medical consequences. However, little is known about the determinants of postponing visits due to financial constraints longitudinally. Thus, the purpose of this study was to examine the determinants of postponing dental visits due to costs in older adults in Germany longitudinally. Data from wave 5 and 6 of the Survey of Health, Ageing, and Retirement in Europe was used. The occurrence of postponed dental visits due to costs in the last 12 months served as the outcome measure. Socioeconomic and health-related explanatory variables were included. Conditional fixed effects logistic regression models were used (n = 362). Regressions showed that the likelihood of postponing dental visits due to costs increased with lower age, less chronic disease, and lower income. The outcome measure was neither associated with marital status nor self-rated health. Identifying the factors associated with postponed dental visits due to costs might help to mitigate this challenge. In the long term, this might help to maintain the well-being of older individuals.


Assuntos
Serviços de Saúde Bucal/economia , Cooperação e Adesão ao Tratamento , Idoso , Idoso de 80 Anos ou mais , Agendamento de Consultas , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Aposentadoria , Fatores Socioeconômicos , Inquéritos e Questionários
2.
BMC Public Health ; 19(1): 1075, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395045

RESUMO

BACKGROUND: The World Health Organization has highlighted the paucity of research into the oral health needs of older adults. In Singapore, until recently, publically funded/subsidized oral health care for adults has been limited to basic primary care at government-funded polyclinics. Access to a more comprehensive range of subsidized care in the private sector was widened through the government-funded Community Health Assistance Scheme (CHAS) in 2012 and Pioneer Generation (PG) scheme in 2015. Little is known about the attitude to dental service utilization among older adults in Singapore since then. METHODS: We conducted semi-structured individual interviews with 25 participants above 65 years of age who were eligible for subsidized dental care plans. Participants were recruited from a public teaching hospital and a public primary care clinic in Singapore. The duration of each interview was 15-30 min. Interviews were transcribed verbatim and the transcripts were analyzed thematically using a phenomenological approach. RESULTS: Pertinent themes emerged related to four major areas: (a) general awareness towards oral health, (b) life course perspective of oral health, (c) barriers to visit the dentist, (d) shaping dental service utilisation behaviours through provision of financial subsidies for dental care. Most participants perceived a strong relationship between oral health and systemic health. However, there were erroneous traditional beliefs such as oral health is not part of physical health and edentulous participants did not need to visit a dentist. Fear, anxiety, previous negative experience and lack of knowledge were barriers to visiting the dentist. Trust and convenience were considerations for patients when deciding whether to switch from public to private dental services where CHAS/PG were only available. CONCLUSION: Our study provided important insights regarding oral health perceptions and beliefs of older people residing in the community which may affect their dental service utilization. This further highlights the importance of understanding the concerns of this group when implementing healthcare policies for elderly in Singapore. The findings of our study will serve as a baseline for future studies in Singapore and inform studies in other countries that implement targeted schemes for older adults.


Assuntos
Serviços de Saúde Bucal/economia , Serviços de Saúde Bucal/estatística & dados numéricos , Definição da Elegibilidade/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Financiamento Governamental , Idoso , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Política de Saúde , Humanos , Masculino , Pesquisa Qualitativa , Singapura
3.
Cien Saude Colet ; 24(7): 2727-2736, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340289

RESUMO

To describe the last place of medical and dental health service used in relation to private health plans, and examine the effect of being registered in the primary healthcare system through the Family Health Strategy (FHS). This was a cross-sectional study using data from Brazil's 2008 National Household Survey. Multinomial logistic regression was performed to analyze how a private health plan and enrollment in the FHS influenced the use of health services. Results showed that individuals with a private health plan tend to use medical and dental services more than individuals without such a plan. However, many individuals with a private health plan used public services or paid out-of-pocket services, mainly for dental care. Among individuals without a private plan, being enrolled in the FHS reduced the use of out-of-pocket private services, regardless of age, income or educational level. Enrollment in the FHS increased the chances of using public services, and the effect of this enrollment is greater among those who have a private plan. Policies to strengthen public primary healthcare and to expand the FHS should be encouraged within the universal health system.


Assuntos
Serviços de Saúde Bucal/estatística & dados numéricos , Saúde da Família , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Brasil , Estudos Transversais , Serviços de Saúde Bucal/economia , Política de Saúde , Humanos , Seguro Saúde/economia , Programas Nacionais de Saúde/economia , Atenção Primária à Saúde/economia , Inquéritos e Questionários
4.
Cien Saude Colet ; 24(3): 1021-1032, 2019 Mar.
Artigo em Português | MEDLINE | ID: mdl-30892522

RESUMO

The scope of this study was to identify factors associated with lack of access to dental services. It involved a cross-sectional study and a probabilistic complex sample by conglomerates in two stages with 857 participants over 18 years of age in a large city. Multiple analyses by means of logistic and multivariate regression in decision trees were made. The lack of access to dental services was considered a dependent variable. It was identified that 10.3% did not have access. In the multiple and multivariate analyses an association with age was verified and in the logistic regression a greater possibility of lack of access was found for each year of increased age, among those with the lowest per capita income and those who ranked appearance of teeth and gums as "fair/poor/very poor." The lack of access to dental services was greater among the most socially vulnerable. There is a pressing need to increase the allocation of public resources to promote health education and provide knowledge about how to access services when they are needed, focusing on dental care as a human right and ensuring that lack of access does not occur as users get older or among those with low income and also those dissatisfied with their oral appearance.


Assuntos
Assistência Odontológica/estatística & dados numéricos , Serviços de Saúde Bucal/estatística & dados numéricos , Acesso aos Serviços de Saúde , Saúde Bucal , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Árvores de Decisões , Assistência Odontológica/economia , Serviços de Saúde Bucal/economia , Feminino , Humanos , Renda , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pobreza , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
5.
Aust Dent J ; 64(2): 153-160, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30676647

RESUMO

OBJECTIVES: Analysis of the distribution of allied dental practitioners relative to the socio-economic profile of the population, to develop a baseline of employment demographics at a time of proposed deregulation of practicing restrictions. METHODS: A database of allied dental practitioners (ADP - oral health therapists, dental therapists and dental hygienists) was compiled from the public access register of the Australian Health Practitioner Regulation Agency. The principal practice locations limited to suburb and postcode were geocoded by latitude and longitude and superimposed on a map of the Australian landmass using QGIS software. Using Australian Bureau of Statistics data, the number of ADPs for each Statistical Area 2 (SA2) was counted and apportioned according to proportion of the population within each SA2 for each quintile of the Index of Relative Socio-economic Disadvantage (IRSD). The results were reported according to oral health therapists, dental therapists and dental hygienists per 100 000 population for each IRSD quintile, by state and territory, and the Australian Regional Index for Areas (ARIA+). RESULTS: The ADP to population ratio was not consistent for each professional class between states and territories, IRSD quintiles and (ARIA+) regional areas. Across major cities, South Australia was the state with the highest ratio of oral health therapists (10.6-12.9) and dental hygienists (14.6-24.5) for all IRSD quintiles. Western Australia had the highest ratio of dental therapists (9.3-16.0), CONCLUSION: There is no consistent pattern of distribution of ADPs relative to the socio-economic profile of the population across states and territories, and regional (ARIA+) areas of Australia.


Assuntos
Serviços de Saúde Bucal , Acesso aos Serviços de Saúde , Saúde da População Rural , Austrália , Serviços de Saúde Bucal/economia , Serviços de Saúde Bucal/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Humanos , Serviços de Saúde Rural/estatística & dados numéricos , Fatores Socioeconômicos , Austrália do Sul , Populações Vulneráveis , Austrália Ocidental
6.
Chin J Dent Res ; 21(4): 275-284, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30264044

RESUMO

OBJECTIVE: To evaluate the use of oral health services, the economic burden of oral diseases and related influential factors in China. METHOD: Using the multistage, stratified, equal proportion, random sampling method in the 4th National Oral Health Survey of China conducted in 2015 to 2016, residents aged 3 to 5 years, 12 to 15 years, 35 to 44 years, 55 to 64 years, and 65 to 74 years respectively were recruited, clinically examined and answered a questionnaire. Utilisation of oral health services were assessed in all the age groups and the economic burden of oral diseases in the past 12 months were assessed in the 3 to 5 years and 35 to 74 year-old groups. Chi-squared tests, t tests, correlation analysis and a one-way ANOVA were used to determine the relationships of different factors with utilisation of oral health services and the economic burden of oral diseases. RESULTS: In the subject groups - 3 to 5 years, 12 to 15 years and 35 to 74 years - the prevalence of the utilisation of oral health services in the past 12 months was 14.6% (5,876/40,353), 23.6% (27,936/118,592), and 20.1% (2,708/13,461), respectively. In all three groups, receiving dental treatment was the most common reason for subjects' recent dental visit. The average dental cost in the past 12 months was 403.43 CNY (median = 100) for 3 to 5-year-old children and 850.83 CNY (median = 300) for adults aged 35 to 74 years old. Area, education and annual household income per person were the socio-economic influential factors. Oral health status, oral hygiene and attitudes to and knowledge of oral health affected the utilisation of oral health services and the economic burden of oral diseases. CONCLUSION: The percentage of dental service utilisation was relatively low, and the economic burden was high. The related factors for both utilisation of oral health services and the economic burden of oral diseases included living in area, educational attainment, household income, perceived oral health status, and oral hygiene.


Assuntos
Serviços de Saúde Bucal/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , China/epidemiologia , Índice CPO , Dispositivos para o Cuidado Bucal Domiciliar , Serviços de Saúde Bucal/economia , Escolaridade , Feminino , Hemorragia Gengival/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Bucal/economia , Higiene Bucal/estatística & dados numéricos , População Rural , Escovação Dentária/estatística & dados numéricos , População Urbana
7.
BMC Health Serv Res ; 18(1): 487, 2018 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-29929516

RESUMO

BACKGROUND: Resources in any healthcare systems are scarce relative to need and therefore choices need to be made which often involve difficult decisions about the best allocation of these resources. One pragmatic and robust tool to aid resource allocation is Programme Budgeting and Marginal Analysis (PBMA), but there is mixed evidence on its uptake and effectiveness. Furthermore, there is also no evidence on the incorporation of the preferences of a large and representative sample of the general public into such a process. The study therefore aims to undertake, evaluate and refine a PBMA process within the exemplar of NHS dentistry in England whilst also using an established methodology (Willingness to Pay (WTP)) to systematically gather views from a representative sample of the public. METHODS: Stakeholders including service buyers (commissioners), dentists, dental public health representatives and patient representatives will be recruited to participate in a PBMA process involving defining current spend, agreeing criteria to judge services/interventions, defining areas for investment and disinvestment, rating these areas against the criteria and making final recommendations. The process will be refined based on participatory action research principles and evaluated through semi-structured interviews, focus groups and observation of the process by the research team. In parallel a representative sample of English adults will be recruited to complete a series of four surveys including WTP valuations of programmes being considered by the PBMA panel. In addition a methodological experiment comparing two ways of eliciting WTP will be undertaken. DISCUSSION: The project will allow the PBMA process and particularly the use of WTP within it to be investigated and developed. There will be challenges around engagement with the task by the panel undertaking it and with the outputs by stakeholders but careful relationship building will help to mitigate this. The large volume of data will be managed through careful segmenting of the analysis and the use of the well-established Framework approach to qualitative data analysis. WTP has various potential biases but the elicitation will be carefully designed to minimise these and some methodological investigation will take place.


Assuntos
Assistência à Saúde/organização & administração , Serviços de Saúde Bucal/organização & administração , Alocação de Recursos , Medicina Estatal , Adulto , Assistência à Saúde/normas , Serviços de Saúde Bucal/economia , Inglaterra , Prática Clínica Baseada em Evidências , Alocação de Recursos para a Atenção à Saúde , Humanos , Pesquisa Qualitativa , Alocação de Recursos/economia , Alocação de Recursos/organização & administração
8.
Cad Saude Publica ; 34(4): e00052017, 2018 03 29.
Artigo em Português | MEDLINE | ID: mdl-29617480

RESUMO

The public-private mix in the Brazilian health system favors double coverage of health services for individuals with private health plans and may aggravate inequities in the use of services. The aim of this study was to describe trends in the use of medical and dental services and associations with schooling and private health coverage. Data were obtained from a national household survey with representative samples in the years 1998, 2003, 2008, and 2013. The study described trends in the use of health services by adults, adjusted by private health coverage, years of schooling, sex, and age. There was an upward trend in the use of health services in adults without a private plan and among adults with a private plan the trend in use varied in a non-linear way. The medical service presented alternation in use over the years and the dental service showed a tendency to decline after 2003. It is necessary to monitor trends in private health coverage and the use of health services to assist government in regulating private plans and avoid increasing inequities among citizens in access to and use of health services.


Assuntos
Serviços de Saúde Bucal/tendências , Acesso aos Serviços de Saúde/tendências , Serviços de Saúde/tendências , Seguro Saúde/tendências , Cobertura Universal do Seguro de Saúde/tendências , Adolescente , Adulto , Idoso , Brasil , Serviços de Saúde Bucal/economia , Serviços de Saúde Bucal/estatística & dados numéricos , Escolaridade , Feminino , Planejamento em Saúde , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Setor Privado , Adulto Jovem
9.
Issue Brief (Commonw Fund) ; 2018: 1-12, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29345890

RESUMO

Issue: The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs. Goal: Examine gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates. Methods: Uses the Medicare Current Beneficiary Survey, Cost and Use File, 2012, with population and costs projected to 2016 values. Findings and Conclusions: Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year. Lack of access was particularly acute for poor beneficiaries. Because few people have supplemental insurance covering these additional services, among people who received care, three-fourths of their costs of dental and hearing services and 60 percent of their costs of vision services were paid out of pocket. We propose a basic benefit package for dental, vision, and hearing services offered as a premium-financed voluntary insurance option under Medicare. Assuming the benefit package could be offered for $25 per month, we estimate the total coverage costs would be $1.924 billion per year, paid for by premiums. Subsidies to reach low-income beneficiaries would follow the same design as the Part D subsidy.


Assuntos
Transtornos da Audição/economia , Benefícios do Seguro/economia , Cobertura do Seguro/organização & administração , Seguro Odontológico/economia , Medicare/economia , Transtornos da Visão/economia , Custo Compartilhado de Seguro , Serviços de Saúde Bucal/economia , Transtornos da Audição/terapia , Humanos , Renda , Estados Unidos , Transtornos da Visão/terapia
10.
J Telemed Telecare ; 24(3): 147-156, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28118778

RESUMO

Objective This review is designed to inform future decisions about the benefits of integrating teledentistry into routine health services, by presenting an overview of the evidence for the effectiveness and economic impact of teledentistry. Methods Two reviewers searched PubMed, EMBASE and CINAHL databases through November 2016 to identify published peer-reviewed studies in English. Teledentistry studies were included if they were; (a) controlled (randomised or non-randomised) assessment studies; and (b) compared outcomes of a teledentistry intervention in terms of clinical or economic evaluation with the outcomes of traditional clinical alternatives. The quality of the studies was evaluated using a quality appraisal tool that considered study performance and design. Results This review identified 385 publications, of which 217 full-text articles were retrieved for further inspection. Of these, only 11 articles met the inclusion criteria. Nine of the included articles showed some clinical outcomes; the other two were primarily economic analyses. The balance of these studies assesed the efficacy of teledentistry interventions rather than their effectiveness. Four studies (36%) achieved higher quality scores and have greater potential to influence health-care decision-making. To date, the most convincing published evidence regarding the efficacy of teledentistry was provided by studies on paediatric dentistry, orthodontics and oral medicine. The economic analysis referred only to cost-minimisation, suggesting that the use of teleconsultation in dentistry can be cost-saving when compared to a conventional consultation. However, high-quality economic studies on teledentistry are rare. Conclusion There is emerging evidence supporting the efficacy of teledentistry. However, there is not yet enough conclusive evidence, particularly for its effectiveness, cost-effectiveness and long-term use, to make evidence-based policy decisions on teledentistry.


Assuntos
Serviços de Saúde Bucal/organização & administração , Medicina Bucal/organização & administração , Telecomunicações/economia , Telemedicina/organização & administração , Análise Custo-Benefício , Serviços de Saúde Bucal/economia , Odontologia , Humanos , Medicina Bucal/economia , Telemedicina/economia
11.
Cien Saude Colet ; 23(1): 249-258, 2018 Jan.
Artigo em Português | MEDLINE | ID: mdl-29267828

RESUMO

The scope of this study was to investigate dental care from the life course perspective and its determinant factors among young people in the city of Sobral, State of Ceará, Brazil. A cohort study was conducted with waves in 2000, 2006 and 2012 with 482 young people aged between 17 and 21 years. Two outcomes were investigated: immediate dental care and the lack of dental care, based on the dental trajectory in relation to restorative treatment. Socioeconomic conditions and recourse to oral health services and actions in the three waves investigated were used as independent variables. It was found that low socioeconomic status throughout life presented itself as a risk factor for lack of dental care and the inverse effect was observed with immediate dental care. Participation in groups of teenagers was also related to dental care, as well as receiving information on oral health. This study revealed the presence of inequalities in dental care throughout the life course of the population assessed.


Assuntos
Assistência Odontológica/estatística & dados numéricos , Serviços de Saúde Bucal/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Adolescente , Brasil , Estudos de Coortes , Assistência Odontológica/economia , Serviços de Saúde Bucal/economia , Disparidades em Assistência à Saúde/economia , Humanos , Fatores Socioeconômicos , Adulto Jovem
12.
R I Med J (2013) ; 100(10): 51-53, 2017 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-28968625

RESUMO

OBJECTIVE: Under the Affordable Care Act (ACA) Medicaid expansion since 2014, 68,000 more adults under age 65 years were enrolled in Rhode Island Medicaid as of December 2015, a 78% increase from 2013 enrollment. This report assesses changes in dental utilization associated with this expansion. METHODS: Medicaid enrollment and dental claims for calendar years 2012-2015 were extracted from the RI Medicaid Management Information System. Among adults aged 18-64 years, annual numbers and percentages of Medicaid enrollees who received any dental service were summarized. Additionally, dental service claims were assessed by provider type (private practice or health center). RESULTS: Although 15,000 more adults utilized dental services by the end of 2015, the annual percentage of Medicaid enrollees who received any dental services decreased over the reporting periods, compared to pre-ACA years (2012-13: 39%, 2014: 35%, 2015: 32%). From 2012 to 2015, dental patient increases in community health centers were larger than in private dental offices (78% vs. 34%). Contrary to the Medicaid population increase, the number of dentists that submitted Medicaid claims decreased, particularly among dentists in private dental offices; the percentage of RI private dentists who provided any dental service to adult Medicaid enrollees decreased from 29% in 2012 to 21% in 2015. CONCLUSION: Implementation of Medicaid expansion has played a critical role in increasing the number of Rhode Islanders with dental coverage, particularly among low-income adults under age 65. However, policymakers must address the persistent and worsening shortage of dental providers that accept Medicaid to provide a more accessible source of oral healthcare for all Rhode Islanders. [Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].


Assuntos
Serviços de Saúde Bucal/estatística & dados numéricos , Cobertura do Seguro/legislação & jurisprudência , Seguro Odontológico/legislação & jurisprudência , Medicaid/legislação & jurisprudência , Patient Protection and Affordable Care Act , Adolescente , Adulto , Serviços de Saúde Bucal/economia , Serviços de Saúde Bucal/legislação & jurisprudência , Serviços de Saúde Bucal/tendências , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Cobertura do Seguro/tendências , Seguro Odontológico/estatística & dados numéricos , Seguro Odontológico/tendências , Masculino , Medicaid/estatística & dados numéricos , Medicaid/tendências , Pessoa de Meia-Idade , Rhode Island , Estados Unidos , Adulto Jovem
13.
J Dent Educ ; 81(9): eS1-eS10, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28864798

RESUMO

The United States is currently experiencing a vortex of change in both general health and oral health care delivery, the ultimate outcome of which is still not well understood. The specific focus of this article is to examine the future organization of the oral health services delivery system (OHSDS) in the U.S., with special attention given to the role of large group dental practices (LGDPs) in that future. The article describes the various types of LGDPs and their ability to change the economic characteristics of the OHSDS. Large geographically distributed corporate group dental practices (LGDCGDPs) are the type that may expand their market share to the extent that they could change the economic characteristics of the OHSDS. A wide range of scenarios is used to project the expansion of LGDCGDPs into the future. The scenarios modeled are not intended as predictions but rather to present a range of possible OHSDS market structures that may emerge over the next 30 years. The implications of each scenario for the economic competition within the OHSDS are described. Possible implications of these trends for dental education are also discussed. This article was written as part of the project "Advancing Dental Education in the 21st Century."


Assuntos
Serviços de Saúde Bucal/organização & administração , Serviços de Saúde Bucal/tendências , Prática Odontológica de Grupo , Saúde Bucal , Serviços de Saúde Bucal/economia , Previsões , Humanos , Fatores de Tempo , Estados Unidos
14.
PLoS One ; 12(8): e0182877, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28832673

RESUMO

Patients with head and neck (H&N) cancer are commonly treated with surgery and/or radiotherapy, which can increase the risk of oral infection, dental caries, and periodontal disease. The present study investigated dental care consumption and costs in patient with H&N cancer before and after the cancer diagnosis. Data from Swedish regional and national registers were used to follow up dental care utilization and dental procedure costs. The analysis included 2,754 patients who had been diagnosed with H&N cancer (exposed cohort) in Stockholm County, Sweden, during 2000-2012 and 13,036 matched persons without cancer (unexposed cohort). The exposed cohort was sub-grouped into irradiated and non-irradiated patients for analysis. The exposed cohort underwent a moderately higher number of dental procedures per year than the unexposed cohort in both the year of the cancer diagnosis and the year after cancer diagnosis; in addition, these numbers were higher in the irradiated than in the non-irradiated subgroup of the exposed cohort. Dental care consumption and costs in the exposed cohort declined over time but remained at a slightly higher level than in the unexposed cohort over the long term (more than two years). Examinations and preventive procedures accounted for most of the higher consumption in the short term (2 years) and at the longer term follow-up. Swedish national insurance subsidized costs for dental treatment, which were highest in the irradiated subgroup and lowest in the unexposed cohort. Direct costs to the patient, however, were similar among the groups. Swedish national health insurance protects patients with H&N cancer from high dental expenditures. Further studies on the cost-effectiveness of preventive dental care for patients are needed.


Assuntos
Serviços de Saúde Bucal/economia , Neoplasias de Cabeça e Pescoço/fisiopatologia , Custos de Cuidados de Saúde , Estudos de Coortes , Seguimentos , Humanos , Suécia
15.
Cien Saude Colet ; 22(8): 2645-2657, 2017 Aug.
Artigo em Português | MEDLINE | ID: mdl-28793079

RESUMO

Secondary care in dentistry in Brazil has scarce and broadly underutilized resources. The challenge is to organize the interface between primary health care (PHC) and secondary care in order to consolidate the population's access to specialist dental care in the Unified Health System (SUS). This article seeks to analyze national publications in Portuguese and English on the interface between secondary health care and primary health care in dentistry from the perspective of comprehensive care in the SUS. It is an integrative review, considering the publications of the following databases: SciELO (Scientific Electronic Library Online), LILACS (Latin American and Caribbean Literature) WEB OF SCIENCE, SCOPUS, PubMed (International Literature on Health Sciences) and GOOGLE SCHOLAR. The search located 966 articles, of which 12 were used in full. Coverage of the oral health teams (ESB) in the family health strategy (ESF), primary health care implementation in a structured way, access to secondary health care, counter-referral to PHC, development of indicators and socioeconomic conditions and inequalities in the distribution of dental specialist centers (CEO) are factors that influence the integrity of oral health care in the SUS.


Assuntos
Serviços de Saúde Bucal/organização & administração , Atenção Primária à Saúde/organização & administração , Atenção Secundária à Saúde/organização & administração , Brasil , Assistência Odontológica/economia , Assistência Odontológica/organização & administração , Serviços de Saúde Bucal/economia , Acesso aos Serviços de Saúde , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/economia , Atenção Secundária à Saúde/economia , Fatores Socioeconômicos
16.
J Dent ; 63: 65-71, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28579384

RESUMO

OBJECTIVES: Dentists have a range of options for managing molars with severe molar-incisor hypomineralization (MIH), each with different long-term implications. The cost-effectiveness of managing molars with severe MIH was assessed. METHODS: A mixed public-private-payer perspective within German healthcare was adopted. Individuals with one to four severely MIH-affected molars were followed over their lifetime. We compared: (1) removal of the tooth/teeth and orthodontic alignment of the second and third molars (Ex/Ortho); (2) restoration of the tooth using resin composite (Comp); (3) restoration using an indirect metal crown after temporizing it using a preformed metal crown (PMC/IR). The health outcome was tooth retention years. Transition probabilities were estimated based on the best available evidence. Cost calculations were based on German dental fee catalogues. Monte-Carlo microsimulations were performed for cost-effectiveness-analysis. RESULTS: If extraction was performed at the optimal age (9.5/11 years for maxillary/mandibular molars), Ex/Ortho was most cost-effective (67 years, 446-938 Euro). Comp (51 years, 1911 Euro) and PMC/IR were dominated (50 years, 2033 Euro). This cost-effectiveness ratio was also determined when >1 molar was treated. If extraction was performed later, assuming no spontaneous alignment, Ex/Ortho was more costly than Comp, at least when only 1 molar was treated. CONCLUSIONS: For molars with severe MIH, extraction at the optimal age and, if needed, orthodontic alignment can be cost-effective, especially when >1 molar is affected. For single molars where the chance of spontaneous alignment is low, Comp might also be considered. These findings apply to German healthcare and within the limitations of this study only. CLINICAL SIGNIFICANCE: When deciding how to manage molars with severe MIH, both tooth retention, with lower costs but higher needs for re-treatments, and tooth removal, with possible need for orthodontic alignment, can be considered. Considering cost-effectiveness, the latter may be preferable, especially if the age of extraction is chosen correctly, or several molars are affected.


Assuntos
Análise Custo-Benefício , Hipoplasia do Esmalte Dentário/economia , Hipoplasia do Esmalte Dentário/terapia , Serviços de Saúde Bucal/economia , Dente Molar , Criança , Resinas Compostas/economia , Simulação por Computador , Coroas , Falha de Restauração Dentária , Restauração Dentária Permanente , Alemanha , Humanos , Masculino , Mandíbula , Maxila , Ortodontia Corretiva , Odontopediatria , Retratamento , Extração Dentária
17.
Issue Brief (Commonw Fund) ; 11: 1-14, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28498650

RESUMO

ISSUE: Fifty-six million people--17 percent of the U.S. population--rely on Medicare. Yet, its benefits exclude dental, vision, hearing, and long-term services, and it contains no ceiling on out-of-pocket costs for covered services, exposing beneficiaries to high costs. GOAL: To inform discussion of possible changes to Medicare, this issue brief looks at beneficiaries' out-of-pocket costs by income and health status. METHODS: Spending estimates based on the Medicare Current Beneficiary Survey. FINDINGS AND CONCLUSION: More than one-fourth of all Medicare beneficiaries--15 million people--spend 20 percent or more of their incomes on premiums plus medical care, including cost-sharing and uncovered services. Beneficiaries with incomes below 200 percent of the poverty level (just under $24,000 for a single person) and those with multiple chronic conditions or functional limitations are at significant financial risk. Overall, beneficiaries spent an average of $3,024 per year on out-of-pocket costs. Financial burdens and access gaps highlight the need to approach reform with caution. Already-high burdens suggest restructuring cost-sharing to ensure affordability and to provide relief for low-income beneficiaries.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Nível de Saúde , Renda , Medicare/economia , Custo Compartilhado de Seguro , Serviços de Saúde Bucal/economia , Financiamento Pessoal/economia , Financiamento Pessoal/estatística & dados numéricos , Perda Auditiva/economia , Perda Auditiva/terapia , Humanos , Pobreza , Estados Unidos , Transtornos da Visão/economia , Transtornos da Visão/terapia
19.
J Public Health Dent ; 77(3): 244-251, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28195310

RESUMO

OBJECTIVE: To examine whether public expenditure on health and Euro Health Consumer Index (EHCI) are associated with dental check-ups in European countries. METHODS: Individual data were from Eurobarometer 72.3, 2009 a cross-national survey of 27 European countries. Eligible participants were those aged 18 years and older in 27 European countries. Dental check-ups reflected dental visits for oral examination and getting advice on oral health in the last 12 months. Individual factors included age, gender, marital status, urbanisation, education, subjective social status, and difficulty in paying bills. Public expenditure on health as a percentage of gross domestic product (GDP) and EHCI were used as contextual factors. A set of multilevel logistic regression models was used to examine the relationship between dental check-ups and each of healthcare expenditure and EHCI adjusting for demographic factors, GDP per capita and socioeconomic indicators. RESULTS: Total number included in the analysis was 23,842. Participants in countries with greater healthcare expenditure and higher score of EHCI were significantly 1.17 (95% CI: 1.03, 1.32) and 1.30 times (95% CI: 1.04, 1.64) more likely to report dental check-ups within the past 12 months after accounting for demographic characteristics, GDP per capita, and all socioeconomic indicators. CONCLUSION: The findings suggest that greater governmental support for the healthcare and better characteristics of healthcare system are positively associated with routine dental attendance.


Assuntos
Serviços de Saúde Bucal/economia , Serviços de Saúde Bucal/estatística & dados numéricos , Adolescente , Adulto , Idoso , Demografia , Europa (Continente) , Feminino , Financiamento Governamental , Humanos , Masculino , Pessoa de Meia-Idade
20.
Cad Saude Publica ; 33(1): e00148915, 2017 Dec 01.
Artigo em Português | MEDLINE | ID: mdl-28125125

RESUMO

The aim was to analyze Brazilians' private spending on dental care and oral hygiene products. Data were analyzed from 55,970 households in the Family Budgets Survey, 2008-2009. Expenditures were analyzed by major geographic region, state, state capital, and household socioeconomic and demographic characteristics (sex, age, head-of-household's skin color and schooling, per capita household income, and presence of elderly in the household). Brazilians spent an average of BRL 42.19 per year on dental care and BRL 10.27 on oral hygiene products. The study detected social inequalities in the distribution of these expenditures according to household residents' characteristics and the different geographic regions, states, and state capitals. The current study evidenced quantitative and specific details on Brazilians' spending on dental care and oral hygiene products. Monitoring and assessment of these expenditures are fundamental for evaluating and orienting public policies in oral health.


Assuntos
Serviços de Saúde Bucal/economia , Financiamento Pessoal/economia , Gastos em Saúde/estatística & dados numéricos , Higiene Bucal/economia , Adulto , Brasil , Inquéritos de Saúde Bucal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Bucal/economia , Fatores Socioeconômicos
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