Dental services use by two cohorts under the universal dental plan for the elderly in Alberta, Canada, was examined.
Two birth cohorts 65 to 69 years old at entry who used the plan from 1978 to 1979 (n = 17,816) or from 1985 to 1986 (n = 27,474) were analyzed over 6 successive years for differences in dental services use and costs.
The 1985/86 cohort received 24% more visits per patient than the 1978/79 cohort. Their inflation-adjusted expenditures increased by 19% mainly as a result of increases in denturists' expenditures (33%) (dentists' expenditures increased just 4% because of lower plan fee increases). The 1985/86 cohort received relatively many more periodontal and fewer denture services. Annual attendance over 6 consecutive years was high, especially for the 1985/86 cohort and dentists' patients; 55% of the 1985/86 cohort who used dentists did so in 5 or all 6 years.
Differences in plan expenditures per patient between the birth cohorts and dentists and denturists, along with the high continuity of care for dentists' patients, have important implications for planning and administering dental plans for the elderly. The large expenditure decreases for removable dentures and the large increases for periodontal services to the 1985/86 cohort are noteworthy.
Cites: Am J Public Health. 1989 Jan;79(1):47-512783297
Cites: J Am Dent Assoc. 1990 Jun;120(6):665-82112567
Cites: J Can Dent Assoc. 1994 May;60(5):403-68004517
Cites: J Public Health Dent. 1992 Fall;52(5):259-631404070
The responsibility for healthcare in Sweden is shared by the central government, county councils and municipalities. The counties and municipalities are free to make their own prioritizations within the framework of the state healthcare laws. To guide prioritization of healthcare resources in Sweden, there is consensus that cost-effectiveness constitutes one of the three principles. The objective of this paper is to describe how cost-effectiveness, and hence health economic evaluations (HEE), have a role in pricing decisions, reimbursement of pharmaceuticals as well as the overall prioritization and allocation of resources in the Swedish healthcare system. There are various organizations involved in the processes of implementing health technologies in the Swedish healthcare system, several of which consider or produce HEEs when assessing different technologies: the Dental and Pharmaceutical Benefits Agency (TLV), the county councils' group on new drug therapies (NLT), the National Board of Health and Welfare, the Swedish Council on Health Technology Assessment (SBU), regional HTA agencies and the Public Health Agency of Sweden. The only governmental agency that has official and mandatory guidelines for how to perform HEE is TLV (LFNAR 2003:2). Even though HEEs may seem to have a clear and explicit role in the decision-making processes in the Swedish healthcare system, there are various obstacles and challenges in the use and dissemination of the results.
To explore trends in access to dental care among middle-income Canadians.
A secondary data analysis of six Canadian surveys that collected information on dental insurance coverage, cost-barriers to dental care, and out-of-pocket expenditures for dental care was conducted for select years from 1978 to 2009. Descriptive analyses were used to outline and compare trends among middle-income Canadians with other levels of income as well as national averages.
By 2009, middle-income Canadians had the lowest levels of dental insurance coverage (48.7%) compared to all other income groups. They reported the greatest increase in cost-barriers to dental care, from 12.6% in 1996 to 34.1% by 2009. Middle-income Canadians had the largest rise in out-of-pocket expenditures for dental care since 1978.
This study suggests that affordability issues in accessing dental care are no longer just a problem for the lowest income groups in Canada, but are now impacting middle-income earners as a consequence of their lack of, or decreased access to, comprehensive dental insurance.
Cites: Health Serv Res. 1999 Oct;34(4):901-2110536976
Cites: Health Rep. 1999 Summer;11(1):55-67(Eng); 59-72(Fre)11965824
Cites: J Am Dent Assoc. 2003 May;134(5):621-712785498
Cites: Am J Public Health. 2004 May;94(5):759-6415117697
Cites: Ont Dent. 1996 Sep;73(7):35-79470629
Cites: BMC Oral Health. 2012;12:4623102263
Cites: Community Dent Oral Epidemiol. 2008 Aug;36(4):287-9518715364
Cites: Community Dent Oral Epidemiol. 2009 Jun;37(3):199-20819508268
Cites: Community Dent Oral Epidemiol. 2009 Aug;37(4):294-30419515196
Cites: Can J Public Health. 2010 Nov-Dec;101(6):481-521370785
Cites: J Public Health Dent. 2011 Fall;71(4):327-3422320291
Cites: J Can Dent Assoc. 2007 Feb;73(1):5717295945