Dental insurance isn't enough for Americans to seek care

Providing people with dental insurance does not necessarily mean they will use it and seek dental care, according to a new study in the American Journal of Public Health (February 2014, Vol. 104:2, pp. e80-e87).

Researchers from the University of Maryland School of Dentistry analyzed nearly 13,000 people from the 2008 Health and Retirement Study for their project. Those who had dental insurance and accessed dental care were more likely to be younger, college graduates, high-income workers, married, in very good health, and not missing all their permanent teeth. They were also more likely to be white, living in households of two persons, and living in the Midwest or Southern regions of the U.S.

Those who had dental insurance but didn't use it tended to be younger and working, black or Hispanic, living in households with three or more people, and obese. They were also more likely to be male, high school graduates, poor, in fair health, and missing all their permanent teeth.

Those who didn't have dental insurance but accessed dental care tended to be older (65 to 79 years), white, college graduates, married, living in households of two persons, in good health, not missing all their permanent teeth, not obese, with high incomes, living in the Midwest, and partly retired.

Overall, the odds of not using dental care were higher for men, black non-Hispanics, noncollege graduates, those never married, in fair health, missing all their permanent teeth, didn't have high incomes, and living in the Western region of the U.S.

The research findings suggest that outreach and education are needed to ensure that people value their dental health and use their coverage to seek appropriate care.

The study has particular value in the health reform era, and the researchers hope policymakers will use the findings to design future programs and initiatives, according to lead study author Richard Manski, DDS, MBA, PhD, a professor and the chief of dental public health at the University of Maryland School of Dentistry.

"You can't just hand people coverage and say, 'there, that's better,' " Dr. Manski stated in a press release. "You need to offer some inducements, some promotional campaign to change people's attitudes and beliefs."

The researchers found that providing dental coverage to uninsured older Americans who do not tend to use dental care will not necessarily mean that, once insured, those people will seek dental care. Rather, if policymakers want people to use dental coverage and seek care, they have to go further than just providing insurance, the study authors said.

While many of the factors that keep people from seeking care -- such as age and gender -- can't be changed, other factors could be influenced by outreach, the researchers found. These factors include knowledge, beliefs, attitudes, tastes, health status, and income. Education and marketing outreach about the importance of dental care to overall health could alter these factors and make people who have coverage more likely to use it, the study authors wrote.

Improving the economy and the unemployment rate also could help, the researchers concluded. In addition, the number of providers available could affect the likelihood that patients will use their dental coverage, supporting the development of programs that encourage people to enter dentistry.

The study findings also indicated that getting people to use dental coverage to seek care is not a short-term process.

"We need to set long-term goals for such things and understand that dental coverage and use is a long-term issue, so that we don't get frustrated that rates of use aren't going up right away," Dr. Manski noted.

Oral health is a critical part of a person's overall health, he said, and the study has implications for other types of health insurance as well.

"Dentistry and dental coverage is a perfect experimental model for healthcare," he said. "There are lessons to be learned for overall health coverage and use as well."