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Maryland study looks at correlation between dental insurance and utilization

Baltimore—Providing people with dental insurance does not necessarily mean they will use it and seek dental care, according to a new study from the University of Maryland School of Dentistry, published 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 researchers hope that policymakers will use the findings in designing future programs and initiatives, according to first author Dr. Richard J. Manski, Ph.D., 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 and income, according to the study. 

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, Dr. Manski said.

"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," Dr. Manski said.

Oral health is a critical part of a person's overall health, and the study has implications for other types of health insurance as well, Dr. Manski said.

"Dentistry and dental coverage is a perfect experimental model for health care," he said. "There are lessons to be learned for overall health coverage and use as well."

Marko Vujicic, Ph.D., managing vice president of the ADA Health Policy Resources Center, which has studied older Americans' utilization of dental services, praised the study but said it's important to note that it focuses on people 50 and older. Many studies, including those published by HPRC, have shown the 50 plus population is the group where dental insurance has a much lesser impact on dental care use, mostly because of a shift in the source of financing, Dr. Vujicic said.

"The evidence suggests that baby boomers place a high value on dental care, have invested in their oral health and are more willing to pay out of pocket for their dental care when they lose coverage," Dr. Vujicic said.

"The generation behind them, however, is totally different. As our HPRC studies and others have also shown, the access to care issue, the decline in dental care use, the increased financial barriers to care, are all rising among working age adults, especially those under 35. From a policy perspective, all of this evidence emphasizes that expanding dental insurance among baby boomers might not be the most critical issue in improving access to care."