Longitudinal analysis of cost and dental utilization patterns for older adults in outpatient and long-term care settings in Minnesota.

BACKGROUND: Dental utilization patterns and costs of providing comprehensive oral healthcare for older adults in different settings have not been examined. METHODS: Retrospective longitudinal cohort data from Apple Tree Dental (ATD) were analyzed (N = 1,159 total; 503 outpatients, 656 long-term care residents) to describe oral health status at presentation, service utilization patterns, and care costs. Generalized estimating equation (GEE) repeated measures analysis identified significant contributors to service cost over the three-year study period. RESULTS: Cohort mean age was 74 years (range = 55-104); the outpatient (OP) group was younger compared to the long-term care (LTC) group. Half (56%) had Medicaid, 22% had other insurance, and 22% self-paid. Most (72%) had functional dentitions (20+ teeth), 15% had impaired dentitions (9-19 teeth), 6% had severe tooth loss (1-8 teeth), and 7% were edentulous (OP = 2%, LTC = 11%). More in the OP group had functional dentition (83% vs. 63% LTC). The number of appointments declined from 5.0 in Year 1 (OP = 5.7, LTC = 4.4) to 3.3 in Year 3 (OP = 3.6, LTC = 3.0). The average cost to provide dental services was $1,375/year for three years (OP = $1,427, LTC = $1,336), and costs declined each year, from an average of $1,959 (OP = $2,068, LTC = $1,876) in Year 1 to $1,016 (OP = $989, LTC = $1,037) by Year 3. Those with functional dentition at presentation were significantly less costly than those with 1-19 teeth, while edentulous patients demonstrated the lowest cost and utilization. Year in treatment, insurance type, dentition type, and problem-focused first exam were significantly associated with year-over-year cost change in both OP and LTC patients. CONCLUSION: Costs for providing comprehensive dental care in OP and LTC settings were similar, modest, and declined over time. Dentate patients with functional dentition and edentulous patients were less costly to treat. LTC patients had lower utilization than OP patients. Care patterns shifted over time to increased preventive care and decreased restorative care visits.

Estimating Premium and Out-of-Pocket Outlays Under All Child Dental Coverage Options in the Federally Facilitated Marketplace.

OBJECTIVE: To estimate premium and out-of-pocket costs for child dental care services under various dental coverage options offered within the federally facilitated marketplace. STUDY DESIGN: We estimated premium and out-of-pocket costs for child dental care services for 12 patient profiles, which vary by dental care use and spending. We did this for 1039 medical plans that include child dental coverage, 2703 medical plans that do not include child dental coverage, and 583 stand-alone dental plans for the 2015 plan year. Our analysis is based on plan data from the Center for Consumer Information and Insurance Oversight and Data.HealthCare.Gov. RESULTS: On average, expected total financial outlays for child dental care services were lower when dental coverage was embedded within a medical plan compared with the alternative of a stand-alone dental plan. The difference, however, in average expected out-of-pocket spending varied significantly for our 12 patient profiles. Older children who are very high users of dental care, for example, have lower expected out-of-pocket costs under a stand-alone dental plan. For the vast majority of other age groups and dental care use profiles, the reverse holds. CONCLUSIONS: Our results show that embedding dental coverage within medical plans, on average, results in lower total financial outlays for child beneficiaries. Although our results are specific to the federally facilitated marketplace, they hold lessons for both state-based marketplaces and the general private health insurance and dental benefits market, as well.

Gastos de atención odontológica de niños con caries de infancia temprana, ocasionados a la familia y al Estado Peruano, representado por el Instituto Nacional de Salud del Niño / Costs of dental care of children with Early Childhood Caries, caused to the family and the Peruvian government, represented by the Child Heath National Institute

Determinar los gastos de atención odontológica de niños con Caries de la Infancia Temprana (CIT) que ocasionan a sus familias y al Estado Peruano, representado por el Instituto Nacional de Salud del Nino (INSN) Lima-Perú. Material y Métodos: Estudio de tipo descriptivo, observacional y transversal. La muestra escogida aleatoriamente estuvo formada por 629 niños menores de 71 meses de edad atendidos en el Servicio de Atención del Infante del INSN, en el año 2009, dicha muestra fue estratificada según condición clínica (sanos o con CIT) y procedimiento realizado (tratamiento preventivo y tratamiento restaurador: con manejo de conducta, sedación, o anestesia general). Para determinar los gastos ocasionados a las familias se entrevistaron a las madres de los niños, y los gastos del hospital fueron calculados según el reporte económico del mismo. Para el análisis estadístico se utilizó el software Stata v12, aplicando las pruebas U. Mann-Whitney y Kruskal-Wallis para comparar y encontrar las diferencias en las variables estudiadas. Resultados: La frecuencia de CIT en la muestra evaluada fue de 82.19%. Según mediana: las familias de pacientes sanos gastan por encima de S/.30.00 (min=12, max=84) en procedimientos de prevención y las familias de los pacientes enfermos gastan por encima de S/.113.00 (min=26, max=761) en tratamientos restaurativos ocasionados por CIT, (Relación de 1:4). De acuerdo al tipo de tratamiento realizado, según la mediana, lo más resaltante se encontró en el rubro de anestesia general, donde las familias gastan por encima de S/.639.00 (min=440, max=761); es decir, 20 veces más que en procedimientos de prevención. Del gasto total, la mayor parte es asumida o subvencionada por el INSN, siendo estos gastos aún mayores. Conclusiones: La CIT, ocasiona importantes gastos directos e indirectos a las familias y al Estado representado por el INSN. Las medidas preventivas son altamente costo efectivas...

Objective: To determine the cost of dental care for children with Early Childhood Caries (ECC) that causes to their families and the Peruvian State, represented by the National Institute of Child Health (INSN) LimaPeru. Methods: A descriptive, observation and transversal study. The randomly selected sample consisted of 629 children under 71 months of age, treated at the Infant Care Service of the INSN in 2009, the sample was stratified according to clinical condition (healthy or Early Childhood Caries) and procedure performed (preventive and restorative treatment: with behavior management, sedation or general anesthesia). To determine the costs incurred by families, mothers of children were asked and hospital costs were calculated according to the economic report. For statistical analysis software was used Stata v12, applying the Mann-Whitney U test and Kruskal-Wallis test to compare and find the differences in the studied variables. Results: The frequency of ECC in the evaluated sample was 82.19%. According to the median, families of healthy patients spend over to S / .30.00 (min = 12, max = 84) in methods of prevention and families of sick patients spend over to S / .113.00 (min = 26, max = 761) in restorative treatments caused by CIT, (ratio 1: 4). According the type of treatment performed, as reported by the median, most interesting observation was found under general anesthesia; families spend over to S / .639.00 (min = 440, max = 761), ie 20 times more than in methods of prevention. The biggest part of total spending is taken or subsidized by the hospital, and these costs are even higher. Conclusions: ECC, cause significant direct and indirect costs to families and the State, represented by the hospital. Preventive measures are highly cost effective...

A comprehensive school-based/linked dental program: an essential piece of the California access to care puzzle.

California children suffer more from dental disease than any other chronic childhood disease. Disparities in access and oral health are disproportionately represented among children from minority and low-income families. A comprehensive school-based/linked dental program is one essential ingredient in addressing these problems. Described here are the goals, program elements, and challenges of building a seamless dental services system that could reduce barriers care, maximize resources, and employ best practices to improve oral health.