Dental insurance, dental service use and health outcomes: effectiveness and cost-effectiveness among Australian adults

Abstract

Aim: The aim of this research thesis is to examine the relationship between dental insurance status and dental service use and health outcomes, to ascertain the out of pocket dental expenditure from a consumer perspective and examine the cost–effectiveness of being dentally insured. Methods: The thesis presents a summary of existing literature and examined the relationship between dental insurance status and dental service use and oral health outcomes in working age adults in Australia using a two-year prospective cohort study. Out of pocket dental expenditure was calculated for the 2 year cohort and cost-effectiveness was examined. Baseline data was collected in 2009-10 with two follow ups in 2010-11 and 2011-12, through questionnaires, service use log books and receipts. Dental insurance premium costs were imputed from a database of private health insurance funds, plans and policies. Results: The literature review showed a positive relationship between dental insurance status and favourable dental visiting pattern (regular dental visiting, visiting for check-up and visiting the same dentist). Mixed evidence on a positive relationship with oral health outcomes was reported. The cohort study had a 37% response rate and a 40% retention rate (from baseline) by the end of the two years. 67% of the participants were dentally insured, 73% visited a dental professional, 15% and 23% reported negative change in self-rated oral and general health respectively and mean out of pocket expenditure was $788 during the study period. Dental visiting among the insured was significantly higher than the uninsured. Among those who visited, there were no significant associations with dental insurance for number of visits, services or services per visit. None of the main areas of services were significantly associated with dental insurance status either. However, the insured received significantly higher rates of diagnostic and preventive services per visit. Dental insurance was positively associated with OHIP severity change and negative change in self-rated oral health but not with general health outcomes. Mean net expenditure was marginally higher among the dentally insured participants but not significantly. Dental insurance was cost effective with 95% certainty if an individual consumer was willing to pay $4300 over two years to maintain or improve their self-reported oral health. Conclusion: The systematic analysis of literature and comprehensive analysis of cohort data found that dental insurance is effective in increasing dental visiting. It is also effective in improving oral health outcomes but not general health outcomes. The out of pocket dental expenditure is large but not substantially larger than other common household expenditures. Being dentally insured is more expensive but also provides better maintenance or improvement of oral health among adults. What these results mean for subgroups based on visiting frequency, type of visiting, longer term outcomes and reduction of future expenditure needs to be further examined in larger and longer duration studies.