scholarly journals Reorienting Oral Health Services to Prevention: Economic Perspectives

2021 ◽  
pp. 002203452098679
Author(s):  
C.R. Vernazza ◽  
S. Birch ◽  
N.B. Pitts
Keyword(s):  
Resource Allocation ◽  
Cost Effectiveness ◽  
Oral Health ◽  
Health Services ◽  
Pay For Performance ◽  
Fee For Service ◽  
Life Years ◽  
Oral Health Services ◽  
Context Specific ◽  
The Impact

Despite the recognized need to change the emphasis of health services by shifting the balance from treatment to prevention, limited progress has been made in many settings. This is true in oral health, where evidence for preventive interventions that work has not been systematically exploited in oral health services. While reorienting health services is complex and context specific, economics can bring a helpful perspective in understanding and predicting the impact of changes in resource allocation, provider remuneration systems, and patient payments. There is an increasing literature on the economics of different prevention approaches. However, much of this literature focuses on the costs and potential savings of alternative approaches and fails to take into account benefits. Even where benefits are taken into account, these tend to be narrowly focused on clinical outcomes using cost-effectiveness analysis, which may be of little relevance to the policy maker, patient, and the public. Some commonly used economic approaches (such as quality-adjusted life years and incremental cost-effectiveness ratios) may also not be appropriate to oral health. Using alternative techniques, including wider measures of benefit and employing priority setting and resource allocation tools, may provide more comprehensive information on economic impact to decision makers and stakeholders. In addition, it is important to consider the effects of provider remuneration in reorienting services. While there is some evidence about traditional models of remuneration (fee for service and capitation), less is known about pay for performance and blended systems. This article outlines areas in which economics can offer an insight into reorientation of health systems toward prevention, highlighting areas for further research and consideration.

scholarly journals The Effect of Physician Oral Health Services on Dental Use and Expenditures under General Anesthesia

2019 ◽  
Vol 5 (2) ◽  
pp. 146-155 ◽  
Author(s):  
B.D. Meyer ◽  
R. Wang ◽  
M.J. Steiner ◽  
J.S. Preisser
Keyword(s):  
Health Care ◽  
Early Childhood ◽  
Oral Health ◽  
Health Services ◽  
General Anesthesia ◽  
Early Childhood Caries ◽  
Dental Treatment ◽  
Oral Health Care ◽  
Oral Health Services ◽  
The Impact

Background: Despite early evidence touting the effectiveness of physician-provided oral health services (POHS), recent evidence suggests these services might have little impact on caries-related outcomes in children. General anesthesia (GA) is often used to treat early childhood caries and may be considered the most extreme utilization outcome. We sought to assess the impact of POHS utilization on dental GA utilization and expenditures. Methods: We used the Medicaid claims of a birth cohort of children born in 2008 in North Carolina ( N = 32,558) to determine the impact of POHS on dental utilization and expenditures under GA for individual children. Children were followed until their eighth birthday. We analyzed the association of the number of prior POHS visits with visit-specific outcomes of dental treatment under GA using population-averaged models fit with generalized estimating equations with exchangeable working correlation structure. Results: Children with 2 or more previous POHS visits had reduced odds of GA (odds ratio [OR] = 0.93; confidence interval [CI], 0.87–0.99; P = 0.029) and expenditures ($114; CI,−$152.61 to −$75.19; P < 0.001) compared to those without physician-provided oral health visits, adjusting for age, sex, race/ethnicity, and geographic residence. Dental expenditures did not differ between POHS and non-POHS subjects at non-GA visits. Conclusions: POHS decreased the odds of having dental GA treatment and dental expenditures at GA visits. The role of physicians in oral health care can reduce the impact on the most severe outcome—treatment under general anesthesia. Knowledge Transfer Statement: The results of this study have important financial implications for state Medicaid programs and disease management programs trying to mitigate the costs of treating early childhood caries under general anesthesia. Children who receive physician oral health care are less likely to use and more likely to save money on general anesthesia to complete dental treatment.

scholarly journals Assessing the perceived impact of post Minamata amalgam phase down on oral health inequalities: a mixed-methods investigation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
V. R. Aggarwal ◽  
S. Pavitt ◽  
J. Wu ◽  
B. Nattress ◽  
P. Franklin ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Oral Health ◽  
Qualitative Study ◽  
Health Services ◽  
Health Inequalities ◽  
Dental Amalgam ◽  
Free Text ◽  
Oral Health Services ◽  
Phase Out ◽  
The Impact

Abstract Background Data from countries that have implemented a complete phase out of dental amalgam following the Minamata agreement suggest increased costs and time related to the placement of alternatives with consumers absorbing the additional costs. This aim of this study was to investigate the impact of a complete phase out of dental amalgam on oral health inequalities in particular for countries dependent on state run oral health services. Methods A mixed methods component design quantitative and qualitative study in the United Kingdom. The quantitative study involved acquisition and analysis of datasets from NHS Scotland to compare trends in placement of dental amalgam and a survey of GDPs in Yorkshire, UK. The qualitative study involved analysis of the free text of the survey and a supplementary secondary analysis of semi-structured interviews and focus groups with GDPs (private and NHS), dental school teaching leads and NHS dental commissioners to understand the impact of amalgam phase down on oral health inequalities. Results Time-trends for amalgam placement showed that there was a significant (p < 0.05) reduction in amalgam use compared with composites and glass ionomers. However dental amalgam still represented a large proportion (42%) of the restorations (circa 1.8 million) placed in the 2016–2017 financial year. Survey respondents suggest that direct impacts of a phase down were related to increased costs and time to place alternative restorations and reduced quality of care. This in turn would lead to increased tooth extractions, reduced access to care and privatisation of dental services with the greatest impact on deprived populations. Conclusion Amalgam is still a widely placed material in state run oral health services. The complete phase down of dental amalgam poses a threat to such services and threatens to widen oral health inequalities. Our data suggest that a complete phase out is not currently feasible unless appropriate measures are in place to ensure cheaper, long-lasting and easy to use alternatives are available and can be readily adopted by primary care oral health providers.

scholarly journals Epidemiological profile of patients utilising public oral health services in Limpopo province, South Africa

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Lawrence K. Thema ◽  
Shenuka Singh
Keyword(s):  
Oral Health ◽  
Health Services ◽  
Limpopo Province ◽  
World Health ◽  
Age Group ◽  
Oral Diseases ◽  
District Hospitals ◽  
Oral Health Services ◽  
Epidemiological Profile ◽  
The Impact

Background: Despite the impact of oral diseases on the quality of life, there is limited updated evidence on oral health status in Limpopo province.Objectives: To determine the epidemiological profile of patients utilising public oral health services in Limpopo province.Method: This was a descriptive retrospective clinical chart review conducted in five purposively selected district hospitals in Limpopo province. The collected data included the patient’s sociodemographic information, reasons for dental consultation, information on the dental or oral diseases and the treatment received. Five hundred clinical files were systematically selected (100 from each district hospital) for the period 01 January 1995 to 31 December 2013. Data were collected using the World Health Organization’s indicator age groups, namely 6-year-olds, 12-year-olds, 18-year-olds and 35–44-year-old groups. A data capturing sheet was used to record the collected information. Data were analysed using the statistical software package for social sciences SPSS version 23.0.Results: The majority of patients were in the age group of 6 to 20 years (n = 375, 75%). The majority were male patients (n = 309; 62%). Dental caries was the most common complaint (n = 298, 60%). The second most common main complaint in this age group was retained primary or deciduous teeth (n = 60, 12%) affecting children mainly in the age group of 6 to 12 years. The most common clinical procedure across all five districts was dental extractions (n = 324, 64%). Other clinical interventions included scaling and polishing (n = 33, 12%) and dental restorative care (n = 20, 3%).Conclusion: There is an urgent need to reorient oral health service delivery in Limpopo province to focus more on preventive oral health programmes.

scholarly journals Forecasting for the need of dentists and specialists in South Africa until 2030

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251238
Author(s):  
Ritika Tiwari ◽  
Ahmed Bhayat ◽  
Usuf Chikte
Keyword(s):  
South Africa ◽  
Oral Health ◽  
Health Services ◽  
Health System ◽  
Burden Of Disease ◽  
Global Burden Of Disease ◽  
Global Burden ◽  
Life Years ◽  
Dental Diseases ◽  
Oral Health Services

To manage the increasing burden of dental diseases, a robust health system is essential. In order to ensure the oral health system operates at an optimal level going into the future, a forecast of the national shortfall of dentists and dental specialists in South Africa (SA) was undertaken. There is currently a shortage of dentists and specialists in SA and given the huge burden of dental diseases, there is a dire need to increase the number of these health care workers. The aim was to determine the projected shortfall of dentists and specialists in each of the nine provinces in SA. The projected shortfall was calculated based on the SA Disability-Adjusted Life Years (DALYs) for each province. The estimate for the evaluation of the Global Burden of Disease (GBD) for SA was obtained from the Institute of Health Metrics and Evaluation (IHME) Global Burden of Disease website. For each province, age standardized DALYs were calculated with mid-year population estimates obtained from Statistics SA 2018. In order to reduce the existing human resources for health (HRH) inequity among the provinces of SA, three scenarios were created focussing on attaining horizontal equity. The best-case scenario estimates a shortfall of 430, 1252 and 1885 dentists and specialists in 2018, 2024 and 2030 respectively. In an optimistic scenario, the national shortfall was calculated at 733, 1540 and 2158 dentists and specialists for the years 2018, 2024 and 2030 respectively. In an aspirational scenario, shortfalls of 853 (2018), 1655 (2024) and 2267 (2030) dentists and specialists were forecasted. Access to oral health services should be ensured through the optimum supply of trained dentists and specialists and the delivery of appropriate oral health services. Thus, the roadmap provided for upscaling the oral health services recognizes the influence of both demand and supply factors on the pursuit of equity.

scholarly journals Exploring the Impact of ACA on Rural‐Urban Disparity in Oral Health Services Among US Noninstitutionalized Adults

2020 ◽  
Vol 37 (1) ◽  
pp. 103-113 ◽  
Author(s):  
Wei‐Chen Lee ◽  
Chih‐Ying Li ◽  
Hani Serag ◽  
Maryam Tabrizi ◽  
Yong‐Fang Kuo
Keyword(s):  
Oral Health ◽  
Health Services ◽  
Oral Health Services ◽  
The Impact

scholarly journals Does the implementation of a national oral health policy reduce inequalities in oral health services utilization? The Brazilian experience

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maria Helena Rodrigues Galvão ◽  
Angelo Giuseppe Roncalli
Keyword(s):  
Health Policy ◽  
Oral Health ◽  
Health Services ◽  
Health Services Utilization ◽  
Age Groups ◽  
Public Access ◽  
Services Utilization ◽  
Index Of Inequality ◽  
Oral Health Services ◽  
Oral Health Policy

Abstract Background This study aimed to assess the trend in income-related inequalities in oral health services utilization by the Brazilian population from 1998 to 2013. This period represents a timeline that includes different stages of implementation of the National Oral Health Policy. Methods The design was based on repeated cross-sectional surveys using secondary data from household-based studies carried out in Brazil in 1998, 2003, 2008, and 2013. The dependent variable was “having access to a dentist appointment at least once in a lifetime (yes/no).” Monthly household per capita income, based on Brazil’s minimum wage, was included as the main independent variable. To measure the inequalities in oral health access related to economic position, the following complex indexes based on regression were used: (a) the slope index of inequality (SII) and (b) the relative index of inequality (RII). Results There was a reduction in the percentage of individuals who never had a dentist appointment for all age groups and income classifications. In general, there was a reduction trend in absolute inequality for all age groups (p < 0.001). The relative inequality and reduction trend were different between the age groups studied. Conclusions The National Oral Health Policy was very important for expanding free of charge, public access to dental appointment. However, despite policy implementation, there continues to be high levels of inequality in access to dental consultation. Assessing which strategies are necessary to overcome this challenge is discussed.

scholarly journals Accuracy of the need for dental prosthesis and associated factors between elderly in Recife, Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L F R Santos ◽  
E P Carvalho ◽  
S R A Oliveira ◽  
R S Moreira
Keyword(s):  
Oral Health ◽  
Health Services ◽  
Associated Factors ◽  
Family Income ◽  
Dental Prosthesis ◽  
The Self ◽  
Metropolitan Region ◽  
Self Perception ◽  
Epidemiological Surveys ◽  
Oral Health Services

Abstract Background The latest national oral health survey showed a high prevalence of the need for dental prostheses between the Brazilian elderly. To classify this need, normative (clinical) and subjective (self-reported) criteria must be considered since patients' self-perception takes into account social and functional issues that arise with oral health problems. Few studies investigate the agreement between these criteria, as well as its determinants. Thus, this study aimed to investigate the accuracy of the need for the use of total dental prosthesis and factors associated with the agreement between criteria. Methods Cross-sectional study, carried out in three municipalities in the Metropolitan Region of Recife, with a random sample of 816 elderly people from 65 to 74 years old. The dependent variable was the accuracy, calculated by the agreement between the self-reported and the normative need for a total dental prosthesis, and the independents were assembled in three blocks (socioeconomic/demographic, access to oral health services and self-perceived oral health). Hierarchical logistic models were conducted for total upper prosthesis (TUP) and total lower prosthesis (TLP). Results The self-perception of the need for prosthetic use presented an accuracy of 75.9% (95% CI = 72.8-78.7%) for TUP and 78.6% (95% CI = 75.6-81.3%) for TLP. In the multiple analysis, the accuracy for TUP and TLP needs holds an association with the variables: family income, age and time since the last dental appointment. Conclusions In conclusion, the self-perception of need for dental prosthesis demonstrates potential applicability for the elderly, presenting notable accuracy values. It suggests that studies based on patients' self-reports should be stimulated, aiming for the evaluation and validation of self-reported criteria in different contexts and cultures. Furthermore, the identification of accuracy associated factors can help to build more meaningful questions to be used in future surveys. Key messages The use of the self-reported need for total dental prosthesis may be feasible when considering lower cost, reduced time of execution and ease of use in population epidemiological surveys. Application of self-reporting as an epidemiological tool for planning and monitoring oral health services, incorporating it in the form of indicators for oral health surveillance.

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