摘要：Objectives. We estimated the use of preventive dental care services by the US Medicare population, and we assessed whether money spent on preventive dental care resulted in less money being spent on expensive nonpreventive procedures. Methods. We used data from the 2002 Medicare Current Beneficiary Survey to estimate a multinomial logistic model to analyze the influence of predisposing, enabling, and need variables in identifying those beneficiaries who used preventive dental care, only nonpreventive dental care, or no dental care in a multiple-variable context. We used regression models with similar controls to estimate the influence of preventive care on the utilization and cost of nonpreventive dental care and all dental care. Results. Our analyses showed that beneficiaries who used preventive dental care had more dental visits but fewer visits for expensive nonpreventive procedures and lower dental expenses than beneficiaries who saw the dentist only for treatment of oral problems. Conclusions. Adding dental coverage for preventive care to Medicare could pay off in terms of both improving the oral health of the elderly population and limiting the costs of expensive nonpreventive dental care for the dentate beneficiary population. For many retirees, paying for dental care treatment can be difficult. 1 – 3 According to the 2006 Health and Retirement Study, out-of-pocket dental expenditures over the previous 2-year period for persons aged 51 years and older averaged $776 for those with insurance coverage and $1126 for those without insurance coverage, among those with a dental visit during that period. 4 These amounts are not trivial, especially for those who live on a fixed income. Seventy percent of persons aged 65 years and older in 2004 were not covered by any dental insurance. 5 Without assistance, older Americans who are poorer may choose to delay or forgo dental care, but postponing dental care may lead to expensive complications. 6 , 7 As recently reported in the New York Times , “Left unchecked, a small cavity that would cost about $100 to fill can easily turn into a $1000 root canal. Skip those $80 cleanings each year, and you may be looking at $2000 worth of gum disease.” 8 Studies of the impact of preventive dental care visits have primarily focused on younger populations. 9 – 11 Insufficient attention has been paid to the possibility that preventive dental care may limit expensive nonpreventive dental care procedures among an older population. Previous research on preventive dental care has either not focused strictly on the elderly 12 or has not used nationally representative data. 13 To fill these gaps in the literature, we sought to identify the characteristics of older adults who used preventive and nonpreventive dental care as well as those who used no dental care at all. Previous studies have found patterns of increasing dental care use over the life span, 14 as well as differences in racial/ethnic background, education, and income levels in the use of dental care among elderly populations. 15 , 16 Data from the 1996 Medical Expenditure Panel Survey show similar differences in the use of preventive services over the entire community-based population. 17 We then assessed dental care use and costs for beneficiaries who received preventive care during the year, and we compared those figures with dental care use and costs for those who did not receive preventive care to determine whether investing in preventive care can affect costs related to more expensive nonpreventive procedures.
