Total tooth loss among persons aged > or =65 years--selected states, 1995-1997.
Loss of all natural permanent teeth (edentulism) substantially reduces quality of life, self-image, and daily functioning. Although loss of teeth results from oral diseases such as dental caries and periodontitis, it also reflects patient and dentist attitudes, availability and accessibility of dental care, and the prevailing standard of care. One of the national health objectives for 2000 is to reduce to no more than 20% the proportion of persons aged > or =65 years who have lost all their natural teeth (objective 13.4). Edentulism has been declining in the United States since the 1950s, but few state-specific data are available on adult tooth loss. To estimate the prevalence of edentulism among persons aged > or =65 years, CDC analyzed data from the 46 states that participated in the oral health module of the 1995-1997 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the findings from this analysis, which indicate a large state-specific variation in edentulism and that many states have not yet achieved the national health objective for preventing total tooth loss. (+info)
Who should determine the medical necessity of dental sedation and general anesthesia? A clinical commentary supported by Illinois patient and practitioner surveys.
Many third-party payers try to deny benefits for dental sedation and general anesthesia. The term "not medically necessary" is often applied to these services by third-party payers. The label is poorly defined and varies from payer to payer. This paper uses original practitioner and patient opinion surveys to support the position that the definition of medical necessity is solely the joint responsibility of the patient and his/her physician. These surveys also support the argument that both patients and practitioners view dental sedation and general anesthesia as a medically necessary procedure if it allows a patient to complete a medically necessary surgical procedure that he/she might otherwise avoid. (+info)
The effects of fee bundling on dental utilization.
OBJECTIVE: To examine dental utilization following an adjustment to the provincial fee schedule in which preventive maintenance (recall) services were bundled at lower fees. DATA SOURCES/STUDY SETTING: Blue Cross dental insurance claims for claimants associated with four major Ontario employers using a common insurance plan over the period 1987-1990. STUDY DESIGN: This before-and-after design analyzes the dental claims experience over a four-year period for 4,455 individuals 18 years of age and older one year prior to the bundling of services, one year concurrent with the change, and two years after the introduction of bundling. The dependent variable is the annual adjusted payment per user. DATA COLLECTION/EXTRACTION METHODS: The analysis was based on all claims submitted by adult users for services received at recall visits and who reported at least one visit of this type between 1987 and 1990. In these data, 26,177 services were provided by 1,214 dentists and represent 41 percent of all adult service claims submitted over the four years of observation. PRINCIPAL FINDINGS: Real per capita payment for adult recall services decreased by 0.3 percent in the year bundling was implemented (1988), but by the end of the study period such payments had increased 4.8 percent relative to pre-bundling levels. Multiple regression analysis assessed the role of patient and provider variables in the upward trend of per capita payments. The following variables were significant in explaining 37 percent of the variation in utilization over the period of observation: subscriber employment location; ever having received periodontal scaling or ever having received restorative services; regular user; dentist's school of graduation; and interactions involving year, service type, and regular user status. CONCLUSIONS: The volume and intensity of services received by adult patients increased when fee constraints were imposed on dentists. Future efforts to contain dental expenditures through fee schedule design will need to take this into consideration. Issues for future dental services research include provider billing practices, utilization among frequent attenders, and outcomes evaluation particularly with regard to periodontal care and replacement of restorations. (+info)
Perceived unmet need for oral treatment among a national population of HIV-positive medical patients: social and clinical correlates.
OBJECTIVES: This study examines social, behavioral, and clinical correlates of perceived unmet need for oral health care for people with HIV infection. METHODS: Baseline in-person interviews with 2864 individuals were conducted with the HIV Cost and Services Utilization Study cohort, a nationally representative probability sample of HIV-infected persons in medical care. Bivariate and logistic regression analyses were conducted, with unmet need in the last 6 months as the dependent variable and demographic, social, behavioral, and disease characteristics as independent variables. RESULTS: We estimate that 19.3% of HIV-infected medical patients (n = 44,550) had a perceived unmet need for dental care in the last 6 months. The odds of having unmet dental needs were highest for those on Medicaid in states without dental benefits (odds ratio [OR] = 2.21), for others with no dental insurance (OR = 2.26), for those with incomes under $5000 (OR = 2.20), and for those with less than a high school education (OR = 1.83). Low CD4 count was not significant. CONCLUSIONS: Perceived unmet need was related more to social and economic factors than to stage of infection. An expansion of dental benefits for those on Medicaid might reduce unmet need for dental care. (+info)
Controlling the cost of dental care.
Methods for controlling dental care expenditures are taking on greater importance with the rapid increase in prepaid dental plans. The use of regulatory systems to monitor provider performance are necessary to prevent gross over-utilization but are unlikely to result in net savings of more than five per cent of total gross premiums. Theoretically, prepaid group dental practice (PGDP) may reduce expenditures by changing the mix of services patients receive. The modest estimated savings and the small number of PGDPs presently in operation limit the importance of this alternative for the next five to ten years. If substantial reductions in dental expenditures are to be obtained, it will be necessary to limit dental insurance plans to cover only those services which have demonstrated cost-effectiveness in improving health for the majority of people. The concept that richer benefit plans may have small marginal effects on improving oral health may not be easy for the public to accept but, until they do, expenditures for dental care will be difficult to control. (+info)
Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); enhancement of dental benefits under the TRICARE retiree dental program. Office of the Secretary, DoD. Interim final rule with request for comments.
This interim final rule implements section 704 of the National Defense Authorization Act for Fiscal Year 2000, to allow additional benefits under the retiree dental insurance plan for Uniformed Services retirees and their family members that may be comparable to those under the Dependents Dental Program. The Department is publishing this rule as an interim final rule in order to comply timely with the desire of Congress to meet the needs of retirees for additional dental coverage. Public comments are invited and will be considered for possible revisions to this rule at the time of publication of the final rule. (+info)
Disease activity and need for dental care in a capitation plan based on risk assessment.
This article describes a capitation model of care which would stimulate both dentists and patients to apply existing preventive knowledge. (+info)
The question of cost: reimbursement and remuneration.
Dentists and the dental team have been encouraged to become an important part of the effort to curb tobacco use. Many health insurance policies, however, do not cover tobacco cessation programs, especially by dentists. The generosity of insurance for tobacco cessation has been found to influence the use of these programs. The dental profession can help by: 1) training more dental students, dental hygienists, and dental practitioners to provide tobacco cessation counseling; 2) increasing the number of practices routinely monitoring tobacco use and providing tobacco cessation programs; 3) increasing the utilization of the available procedure codes for tobacco cessation, whether it is a covered service or not; and 4) stimulating demand for more tobacco cessation coverage by employees. (+info)