Providing people with dental insurance does not necessarily mean that they will use it and seek dental care, according to a new study from the University of Maryland School of Dentistry, published online in the American Journal of Public Health. The research suggests that outreach and education are needed to ensure that people value their dental health and use their coverage to seek appropriate dental care. The study has particular value in this era of health reform, and the researchers hope that policymakers will use the findings in designing future programs and initiatives, according to first author Richard J. Manski, DDS, MBA, PhD, professor and chief of Dental Public Health at the University of Maryland School of Dentistry.
"You can't just hand people coverage and say, 'there, that's better,'" says Dr. Manski. "You need to offer some inducements, some promotional campaign to change people's attitudes and beliefs. We hope this starts the process of a new way of thinking about the problem."
The researchers examined data from the Health and Retirement Study of 2008, looking at older Americans who had dental coverage and those who didn't, and examining who was using dental care. They also looked at personal characteristics such as race, gender, marital status, age, health status and more.
The scientists found that providing dental coverage to uninsured older Americans who do not tend to use dental care will not necessarily mean that, once insured, those people will seek dental care. Rather, if policymakers want people to use dental coverage and seek care, they have to go a step further than just providing insurance. While many of the factors that keep people from seeking care -- such as age and gender -- can't be changed, other factors could be influenced by outreach.
These factors include knowledge, beliefs, attitudes, tastes, health status, income and more. Education and marketing outreach about the importance of dental care to overall health could alter these factors and make people who get coverage more likely to use it. Improving the economy and the unemployment rate could also affect the problem for the better. The number of providers available in the market could also affect the likelihood that patients will use their dental coverage, supporting the development of programs encouraging people to enter the field of dentistry.
The data also indicate that getting people to use dental coverage to seek care is not a short-term process, Manski says: "We need to set long-term goals for such things and understand that dental coverage and use is a long-term issue, so that we don't get frustrated that rates of use aren't going up right away."
Oral health is a critical part of a person's overall health, says Dr. Manski, and the study has implications for other types of health insurance as well. "Dentistry and dental coverage is a perfect experimental model for health care," he says. "There are lessons to be learned for overall health coverage and use as well."
- Richard J. Manski, John F. Moeller, Haiyan Chen. Dental Care Coverage and Use: Modeling Limitations and Opportunities. American Journal of Public Health, 2013; e1 DOI: 10.2105/AJPH.2013.301693
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