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Wolf E, Ziesemer K, Van der Hijden E. Policy interventions to improve the accessibility and affordability of Dutch dental care. A scoping review of effective interventions. Heliyon 2024; 10:e28886. [PMID: 38707350 PMCID: PMC11066141 DOI: 10.1016/j.heliyon.2024.e28886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/26/2024] [Accepted: 03/26/2024] [Indexed: 05/07/2024] Open
Abstract
Caries and periodontitis remain prevalent in the Netherlands. Given the assumption that increasing the accessibility and affordability of dental care can improve oral health outcomes, policy interventions aimed at improving these aspects may contribute to better oral health. To identify possible solutions, this scoping review firstly identifies policy interventions from around the world that have effectively improved the accessibility or affordability of dental care. Secondly, this review discusses the potential of the policy interventions identified that are applicable to the Dutch healthcare sector specifically. A literature search was performed in four databases. Two reviewers independently screened all potentially relevant titles and abstracts before doing the same for the full texts. Only studies that had quantitatively evaluated the effectiveness of policy interventions aimed at improving the accessibility or affordability of dental care were included. 61 of the 1288 retrieved studies were included. Interventions were grouped into four categories. Capacity interventions (n = 5) mainly focused on task delegation. Coverage interventions (n = 25) involved the expansion of covered dental treatments or the group eligible for coverage. Managed care interventions (n = 20) were frequently implemented in school or community settings. Payment model interventions (n = 11) focused on dental reimbursement rates or capitation. 199 indicators were identified throughout the 61 included studies. Indicators were grouped into three categories: accessibility (n = 137), affordability (n = 21), and oral health status (n = 41). Based on the included studies, increasing managed care interventions for children and adding dental coverage to the basic health insurance plan for adults could improve access to dental care in the Netherlands. Due to possible spillover effects, it is advisable to investigate a combination of these policy interventions. Further research will be necessary for the development of effective policy interventions in practice.
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Affiliation(s)
- E.H. Wolf
- Talma Instituut, Vrije Universiteit Amsterdam, Faculty of Social Sciences, De Boelelaan 1105, 1081, HV Amsterdam, Noord-Holland, the Netherlands
| | - K.A. Ziesemer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Library, De Boelelaan 1117, 1081, HV Amsterdam, Noord-Holland, the Netherlands
| | - E.J.E. Van der Hijden
- Talma Instituut, Vrije Universiteit Amsterdam, Faculty of Social Sciences, De Boelelaan 1105, 1081, HV Amsterdam, Noord-Holland, the Netherlands
- Zilveren Kruis Health Insurance, Handelsweg 2, 3707 NH Zeist, Utrecht, the Netherlands
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Lee JN, Scott JM, Chi DL. Oral health behaviours and dental caries in low-income children with special healthcare needs: A prospective observational study. Int J Paediatr Dent 2020; 30:749-757. [PMID: 32306501 PMCID: PMC11682719 DOI: 10.1111/ipd.12656] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Dental caries is a significant public health problem for low-income children with special healthcare needs (CSHCN). AIM We evaluated associations between oral health behaviours (eg diet, fluoride, dental care) and dental caries for CSHCN enrolled in Medicaid, a health insurance programme for low-income populations that provides comprehensive dental coverage for children. DESIGN We recruited 116 CSHCN ages 7-20 years from Medicaid enrolment files in Washington state, USA. Caregivers completed a 166-item questionnaire, and children received a dental screening. The outcome was dental caries, defined as total pre-cavitated, decayed, missing or filled tooth (PDMF) surfaces. We ran log-linear regression models and generated prevalence rate ratios (PRR). RESULTS The mean age of study participants was 12.4 ± 3.1 years, 41.4% were female, and 38.8% were white. The mean PDMF surfaces were 6.4 ± 9.4 (range: 0-49). Only sugar-sweetened beverage intake was significantly associated with dental caries. CSHCN who consumed >4 sugar-sweetened beverages per week were significantly more likely to have dental caries than those who consumed no sugar-sweetened beverages (PRR: 2.58; 95% CI: 1.37, 4.85; P < .01). CONCLUSION Sugar-sweetened beverages are an important target for future behavioural interventions aimed at preventing dental caries in low-income CSHCN.
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Affiliation(s)
- Jeffrey N. Lee
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - JoAnna M. Scott
- Department of Research & Graduate Programs, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Donald L. Chi
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
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Lewis CW, Johnston BD, Lee HH, McKinney CM, Reusch C. Income-Based Disparities in a Yearly Dental Visit in United States Adults and Children: Trend Analysis 1997 to 2016. Acad Pediatr 2020; 20:942-949. [PMID: 32544458 DOI: 10.1016/j.acap.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine how income-based disparities in a yearly dental visit (the Healthy People 2020 Leading Health Indicator for Oral Health) changed since legislation to expand dental coverage and to compare disparity trends in children and adults. METHODS We analyzed Medical Expenditure Panel Survey 1997 to 2016 to determine yearly dental visit rates for US children and adults by family income. We determined measures of income disparity, including the Slope Index of Inequality and the Relative Index of Inequality and examined trends in yearly dental visit, Slope Index of Inequality, and Relative Index of Inequality using joinpoint regression. RESULTS Income-based disparities, absolute and relative, narrowed over time for children. Steady upward trends in yearly dental visit rates were observed for poor and low-income/poor children and no joinpoint was identified that corresponded to legislation expanding dental care coverage for lower income children. Relative income-based disparities in yearly dental visit rates widened for adults over 20 years. After declining for 14 years, yearly dental visit rate increased for poor adults from 2013 to 2016 suggesting a possible positive effect in adult dental care use trends following enactment of the Affordable Care Act. CONCLUSIONS In 1997, US children and adults had similar levels of income-based disparity in yearly dental visits, but by 2016, they differed markedly. Trends in income-based disparities in yearly dental visit rate narrowed for children but widened for adults. There are lessons from the expansion of dental care coverage for children that could be applied to improve access to dental care for adults.
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Affiliation(s)
- Charlotte W Lewis
- Department of Pediatrics, University of Washington School of Medicine (CW Lewis, BD Johnston, and CM McKinney), Seattle, Wash; Seattle Children's (CW Lewis, BD Johnston, and CM McKinney), Seattle, Wash.
| | - Brian D Johnston
- Department of Pediatrics, University of Washington School of Medicine (CW Lewis, BD Johnston, and CM McKinney), Seattle, Wash; Seattle Children's (CW Lewis, BD Johnston, and CM McKinney), Seattle, Wash; Harborview Medical Center (BD Johnston), Seattle, Wash
| | - Helen H Lee
- Department of Anesthesiology, University of Illinois at Chicago College of Medicine (HH Lee), Chicago, Ill
| | - Christy M McKinney
- Department of Pediatrics, University of Washington School of Medicine (CW Lewis, BD Johnston, and CM McKinney), Seattle, Wash; Seattle Children's (CW Lewis, BD Johnston, and CM McKinney), Seattle, Wash
| | - Colin Reusch
- Children's Dental Health Project (C Reusch), Washington, DC
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Robison V, Wei L, Hsia J. Racial/Ethnic Disparities Among US Children and Adolescents in Use of Dental Care. Prev Chronic Dis 2020; 17:E71. [PMID: 32730202 PMCID: PMC7417021 DOI: 10.5888/pcd17.190352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Dental care among children has increased over the past decade, and racial/ethnic disparities have narrowed for some groups. We measured changes in racial/ethnic disparities in annual dental care for children and adolescents aged 2 to 17 years and conducted multivariate analysis to study factors associated with changes in disparities over time. Methods We used Medical Expenditure Panel Survey data to obtain crude prevalence estimates of dental care use and calculated absolute disparities and changes in disparities for 3 racial/ethnic groups of children and adolescents compared with non-Hispanic white children and adolescents relative to fixed points in time (2001 and 2016). We pooled all single years of data into 3 data cycles (2001–2005, 2006–2010, and 2011–2016) and used multivariate regression to assess the relationship between dental care use and race/ethnicity, controlling for the covariates of age, sex, parents’ education, household income, insurance status, and data cycle (time). Results Use increased by 18% only in low-income children and adolescents. Low-income Hispanic (adjusted prevalence ratio [aPR] = 0.98; 95% CI, 0.94−1.02) and Asian (aPR = 0.92; 95% CI, 0.83−1.02) participants showed no difference in dental care use relative to non-Hispanic white participants, but non-Hispanic black participants had significantly lower use (aPR = 0.84; 95% CI, 0.81−0.88). Public and private insurance were associated with a doubling of use among low-income children. Conclusion We saw a modest increase in dental care use and a narrowing of disparities for some low-income children and adolescents. Use among low-income Hispanic and Asian participants “caught up” with use among Hispanic white participants but remained well below that of children and adolescents in families with middle and high incomes. Disparities persisted for non-Hispanic black participants at all income levels.
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Affiliation(s)
- Valerie Robison
- Division of Oral Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA 30341.
| | - Liang Wei
- DB Consulting Group, Inc, Atlanta, Georgia
| | - Jason Hsia
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
OBJECTIVE The unmet need for dental care is one of the greatest public health problems facing U.S. children. This issue is particularly concerning for children with special health care needs (CSHCN), who experience higher prevalence of unmet dental care needs. The primary purpose of this study was to investigate regional differences in unmet dental care needs for CSHCN. Using the Social Ecological Model as a framework, additional variables were analyzed for regional differences. It was hypothesized that (H1) unmet dental care needs would be high in the CSHCN population, (H2) there would be regional differences in unmet dental care needs in CSHCN, and (H3) there would be differences in specific individual, interpersonal (family), community (state), and policy level factors by region. METHODS Data were obtained from the 2009-2010 National Survey of CSHCN. SPSS was used for data management and analysis. RESULTS Each of the study hypotheses was supported for the sample of 40,242 CSHCN. The West region was more likely to have more unmet needs for preventive and specialized dental care in CSHCN than the reference region (Northeast). The South region followed the West region in unmet dental care needs. Statistically significant differences in individual, interpersonal (family), community (state) and policy factors were found by region. CONCLUSION Further research is recommended. Effective strategies that include policy to address unmet dental care needs at multiple levels of intervention are suggested.
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Guarnizo-Herreño CC, Wehby GL. Dentist supply and children's oral health in the United States. Am J Public Health 2014; 104:e51-7. [PMID: 25122013 PMCID: PMC4167104 DOI: 10.2105/ajph.2014.302139] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the relationship between dentist supply and children's oral health and explored heterogeneity by children's age and urbanicity. METHODS We obtained data from the 2007 National Survey of Children's Health (>27,000 children aged 1-10 years; >23,000 children aged 11-17 years). We estimated the association between state-level dentist supply and multiple measures of children's oral health using regression analysis adjusting for several child, family, and population-level characteristics. RESULTS Dentist supply was significantly related to better oral health outcomes among children aged 1 to 10 years. The odds of decay and bleeding gums were lower by more than 50% (odds ratio [OR]=0.46; 95% CI=0.23, 0.95) and 80% (OR=0.18; 95% CI=0.05, 0.76), respectively, with an additional dentist per 1000 population. The odds of a worse maternal rating of child's dental health on a 5-category scale from poor to excellent were lower by about 50% in this age group with an additional dentist per 1000 population (OR=0.51; 95% CI=0.29, 0.91). We observed associations only for children in urban settings. CONCLUSIONS Dentist supply is associated with improved oral health for younger children in urban settings.
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Affiliation(s)
- Carol C Guarnizo-Herreño
- Carol C. Guarnizo-Herreño is with the Department of Epidemiology and Public Health, University College London, London, UK, and the Departamento de Salud Colectiva, Universidad Nacional de Colombia, Bogota, Colombia. George L. Wehby is with the Department of Health Management and Policy, University of Iowa, Iowa City, and the National Bureau of Economic Research, Cambridge, MA
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Schuller AA, van Buuren S. Estimation of caries experience by multiple imputation and direct standardization. Caries Res 2013; 48:91-5. [PMID: 24296647 DOI: 10.1159/000353140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/20/2013] [Indexed: 11/19/2022] Open
Abstract
Valid estimates of caries experience are needed to monitor oral population health. Obtaining such estimates in practice is often complicated by nonresponse and missing data. The goal of this study was to estimate caries experiences in a population of children aged 5 and 11 years, in the presence of nonresponse and missing data. Four estimation methods are compared. Each method makes implicit assumptions about the processes that caused the nonresponse and the missing data. Three of the four methods are based on unrealistic assumptions about the missing data and underestimate caries experience. Under the missing at random assumption, multiple imputation in combination with direct standardization corrects for the deficiencies of current methodology. In the presence of missing data and nonresponse, we recommend a combination of multiple imputation and direct standardization to obtain correct estimates of caries experience.
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Affiliation(s)
- A A Schuller
- Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands
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Durham CA, Mohr MC, Parker FM, Bogey WM, Powell CS, Stoner MC. The impact of socioeconomic factors on outcome and hospital costs associated with femoropopliteal revascularization. J Vasc Surg 2010; 52:600-6; discussion 606-7. [PMID: 20598840 DOI: 10.1016/j.jvs.2010.04.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 03/24/2010] [Accepted: 04/01/2010] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Within the context of healthcare system reform, the cost efficacy of lower extremity revascularization remains a timely topic. The impact of an individual patient's socioeconomic status represents an under-studied aspect of vascular care, especially with respect to longitudinal costs and outcomes. The purpose of this study is to examine the relationship between socioeconomic status and clinical outcomes as well as inpatient hospital costs. METHODS A retrospective femoropopliteal revascularization database, which included socioeconomic factors (household income, education level, and payor status), in addition to standard demographic, clinical, anatomical, and procedural variables were analyzed over a 3-year period. Patients were stratified by income level (low income [LI] <200% federal poverty level [$42,400 for a household of 4], and higher income [HI] >200% federal poverty level) and revascularization technique (open vs endovascular) and analyzed for the endpoints of primary assisted patency, amortized cost-per-day of patency, and limb salvage. Data were analyzed with univariate and multivariate techniques. RESULTS A total of 187 cases were identified with complete data for analysis, 146 in the LI and 41 in the HI cohorts. LI patients differed from HI patients by mean age (66.2 +/- 1.0 vs 61.8 +/- 1.5 years, P = .04), high school graduate rate (51.4% vs 85.4%, P < .001), presence of tissue loss (30.1% vs 14.6%, P = .05), female gender (43.7% vs 22.0%, P = .01) and preoperative statin use (45.8% vs 75.6%, P < .001). There were no differences with respect to other comorbidities including smoking status, presence of diabetes, renal insufficiency, anatomic factors or treatment modality (open vs endovascular). Ninety-seven patients underwent endovascular revascularization. The following outcomes were noted in the endovascular subset of LI and HI patients respectively: primary assisted patency (66% vs 71%, P = NS) and 12-month cost-per-day of patency ($166.30 +/- 77.40 vs $22.45 +/- 12.45, P = .05). Ninety-eight patients underwent open revascularization, with the following outcomes in LI and HI patients respectively: primary assisted patency (78% vs 86%, P = NS) and 12-month cost-per-day of patency ($319.43 +/- 225.44 vs $40.47 +/- 4.63, P = .07). Of the 77 patients with critical limb ischemia, 19 underwent eventual amputation. Multivariate analysis demonstrated that income above 100% of the federal poverty line was protective against limb loss (odds ratio 0.06, 95% confidence interval 0.01-0.51, P < .001). CONCLUSION Income level correlates with advanced presentation, advanced age, and lack of statin use. Although primary assisted patency rate is not affected by income status, an increased cost-per-day of patency and inferior limb salvage is found in lower income patients.
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Affiliation(s)
- Christopher A Durham
- East Carolina University, Department of Cardiovascular Sciences, Greenville, NC 27834-4354, USA
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