Evaluation of service provision patterns during a public-funded dental program

Abstract

<h4>Objective</h4>The Commonwealth Dental Health Program was introduced in 1994 to reduce geographic and financial barriers which prevented adult health card holders receiving timely and appropriate dental care. This paper compares the pattern of service provision over the first three years of the program.<h4>Method</h4>Cross-sectional surveys of adult public-funded dental patients in Australia in 1994 (17,653 visits), 1995 (n = 80,098 visits) and 1996 (n = 69,159 visits).<h4>Results</h4>There was some reduction in emergency visits, changing from 38.9% in 1994, to 33.6% in 1995 and 35.6% in 1996 (p < 0.05; chi-square). Services were associated with age of patients, visit type, geographic location and year of the program. Poisson regression analyses controlling for patient age, visit type and geographic location showed that between 1994 and 1996 there were significant differences (p < 0.05) in rates (rate ratio: 95% CI) of: restorative (1.27; 1.23-1.31), prosthodontic (0.90: 0.85-0.96), periodontic (0.72; 0.68-0.75), preventive (0.43; 0.40-0.45) and endodontic (1.88; 1.67-2.11) services. The total number of services per visit declined over the period of the program (0.87; 0.86-0.89).<h4>Conclusions</h4>Over the three years, the service pattern changed to include higher rates of restorative and endodontic services, and lower rates of prosthodontic services. Rates of preventive and periodontic services declined, and there was no reduction in extraction rates.<h4>Implications</h4>Continued improvement in service patterns may require longer programs, incorporating structural changes, to shift the type of care further away from emergency visits, and towards prevention and maintenance.