DHED 316: Utilization of Dental Services

What is a need?

professionally defined type/amount of care needed & available for optimal health

What is perceived need?

type/amount of care patients feel they need

What is potential demand?

desire to receive dental care to address need

• want

What is utilization?

demand -- actually seeking services

• % of population visiting dentist within 1 year

• average number of visits per person per year

How do you convert need to utilization?

• need + awareness → potential demand (desire to get care)

• potential demand without barriers → utilization (desire to get care & ability to obtain care)

What are special considerations of utilization?

• Dental Advertising → typically highlights whitening, invisalign, etc.

• Very responsive to changing economic conditions

• Complicated market → insurance tx plan may differ from actual need

• Discretionary income → dental care competes with bills

What has been the trend of dental utilization over the years?

**KNOW for exam

peaked in 2008, then the recession happened, causing the utilization rates to slowly decrease

What was the national and KY dental utilization rate in 2020?

**KNOW for exam

• National: 65%

• KY: 60.3%

What are the factors of utilization?

1. Sociodemographic factors → age, gender, race/ethnicity, income, education, geographic region, place of residence

2. Delivery system factors → regular source of care, insurance

3. Individual characteristic factors → dentate status, general health, perceived need, orientation of parents

How does age affect utilization?

very young & very old are lower utilizers (their perceived need is low); middle-aged adults are high utilizers

• some change with increase of dentate elderly

• reverse pattern from medical care

How does gender affect utilization?

females > males

• saw dentist within past year

• had more visits per year

• nobody really knows why

How does race/ethnicity affect utilization?

whites > non-whites use dental services

How does income affect utilization?

increased utilization as income increases

• if cost is removed as barrier, higher incomes still seek care more often

What is the strongest predictor of utilization?

EDUCATION

How does education affect utilization?

utilization increases as education increases

Which geographic region has the highest rate of utilization?

Northeast

• lowest is South

Which place of residence has the highest rate of utilization?

Suburbs

• lowest is Rural

How would a regular source of care affect utilization?

if you have a dental home, you will utilize more

• visits in last year: higher with regular source of care

• young > old to report regular source of care

How does having insurance impact utilization?

insurance increases the proportion of people visiting dentist, with largest impact being on those who already use services

• low utilizers seek care immediately after insurance is acquired to get perceived needs addressed, but do not continue pattern of high utilization

T/F: Even with insurance coverage, low income groups remain low utilizers.

TRUE

• high utilizers maintain utilization throughout length of plan

Voluntary insurance plans result in ___ utilization than employer-paid plans.

MORE

• definitely influences type of services used based on coverage

Dentate are 4x (more/less) likely to have annual dental visits.

MORE

• closely related to perceived need

• edentulous only come in when needed for dentures, etc.

People who consider themselves to be in "excellent" or "very good" general health are (more/less) likely to utilize dental services than those who rate themselves as "fair" or "poor" health.

MORE

What is a major explanatory reason for utilization?

perceived need

• may be pain, prevention

Parents that are high utilizers are (more/less) likely to influence their kids to be high utilizers.

more

• early socialization regarding oral healthcare and visiting dentist

What are the 3 types of barriers to utilization?

1. Structural → impediments related to number, type, location of providers (insurance, hours, accessibility)

2. Financial

3. Personal & Cultural → fear & lower dental values

What is the #1 reason why people have had no dental visit in the past year?

No dental problem -- 46.8%

• 2nd was no teeth

• both perceived needs

Who is more likely to report "no dental problem" as being the reason they have not visited the dentist in the past year?

• Younger > Older

• African Americans > Whites

Who is more likely to report "no teeth" as being the reason they have not visited the dentist in the past year?

• Older > Younger

• Whites > African Americans

Who is more likely to report "cost of care" as being the reason they have not visited the dentist in the past year?

• 18-34 year olds > other age groups

T/F: People who NEED care are NOT those who utilize services.

TRUE

• minorities

• low education

• low income

• rural

• uninsured