Online Program

Twenty-five years of dental plan coverage: An analysis of utilization patterns

Wednesday, November 6, 2013 : 11:10 a.m. - 11:30 a.m.

Stephen D. Hooper, MBA, Health Economics Group, Inc., Rochester, NY
In 1980 a large municipality in western New York adopted a dental plan for current and former employees. The plan design has remained constant: Class I – 100% UCR, Class II – 85% UCR, Class III – 60% UCR. There is no Deductible, nor is there coverage for Orthodontics. The initial individual Annual Maximum of $750 was increased to $1,000 after several years. This study examined utilization by individuals covered in each of six years: 1985, 1990, 1995, 2000, 2005, and 2010. The eligible population ranged from 10,130 in 1985 to 13,594 in 2010. The population was divided into ten cohorts: ages 5<20, 20<35, 35<50, 50<65, and 65+; and by gender. Overall utilization for the annual periods studied were 62%, 62%, 63%, 70%, 70%, and 72%. Utilization increased during the entire period for all ages and both genders, but the increase was greater for some age/gender cohorts than others. Young adults visited dentists less than older adults; utilization by children tended to be greater than for other ages. In only one age cohort in one year (ages 5<20 in 1990) was utilization by Males greater than for Females. The lowest utilization was by Males 20<35 in 1985: 51%; the highest was by Females 50<65 in 2000: 78%. The entire population had access to dental care: they could afford care, and there were a sufficient number of dentists nearby. But not all visited a dentist. From these data it appears that a focus on issues of “access” is not sufficient to boost dental utilization.

Learning Areas:

Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related education
Social and behavioral sciences

Learning Objectives:
Explain why more children have dental visits than do young adults. Discuss the limits on dental utilization of removing economic barriers to care.

Keyword(s): Health Care Utilization, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As president of a company that has been designing and managing dental benefit plans since 1978, my responsibilities include analyzing and projecting dental costs and utilization. In addition to earning a BS in engineering and an MBA, I have taken short courses in epidemiology. For several years I was a research associate in community dentistry and an instructor at a post-doctoral dental school.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Health Economics Group, Inc. Economics Employment (includes retainer) and Stock Ownership

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.