摘要：Objectives. We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage. Methods. We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use. Results. Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth. Conclusions. Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use. According to 1 report, about 48% of adults with any private health insurance during 2000 had at least 1 dental visit, compared with about 29% of those with public health insurance and only 19% of those who were uninsured for the full year. 1 The health insurance and dental care use association appears weak until one realizes that the insurance in question is actually medical insurance and not dental insurance. So, in fact, the reported rate is below that of other findings, which show that about 56% of adults with any private dental insurance had at least 1 dental visit, compared with about 22% of those who were uninsured for the full year. 2 That there is any relationship between having medical insurance and seeking dental care at all is surprising because few medical insurance plans cover dental care services. 3 Because medical insurance does not usually provide reimbursement for dental care, the medical insurance variable must represent some non–insurance-related unobserved health-seeking behavior that results in increased dental care use. However, several studies have examined the relationship between dental insurance coverage and dental care use, controlling for numerous socioeconomic and demographic variables. 4–12 These studies show that, as expected, dental insurance is an important factor in the decision to seek and use dental services. Although the role of dental insurance coverage as a determinant of dental care use is now well established, less is known about the magnitude of its effect or how its effect may be modulated by other observed or unobserved factors. In 1 study, analysts measured the extent of the dental care coverage effect by analyzing Medical Expenditure Panel Survey data. Their results showed that the effect of dental care coverage is significant and increases the likelihood of a dental visit by 13%. 13 A study examining Health and Retirement Study (HRS) data found that providing universal dental care coverage for an older US population would increase dental care use only 1% to 8% after applying a nonparametric approach to account for errors in measuring self-reported dental care coverage and unobserved factors for aversion to risk and future dental care needs (B. Kreider, J. Pepper, R. Manski, and J. Moeller, unpublished data, 2012). In this study the increase in dental care use was significant but not as large or far-reaching as initially expected. Although the analyses confirmed that dental care coverage increases the likelihood of dental care use, the results also suggested that the effect of providing dental care coverage on use may be surprisingly lower than expected. We have provided empirical evidence and a theoretical model to help explain why the effect of dental care coverage on use may be less than expected and to more fully describe dental care use in relation to dental care coverage and other relevant determinants of use. Our findings may help research analysts, program developers, and policy planners better understand problems associated with policies and programs designed to encourage greater use of dental care among the population.
