The inducement of demand in dental medicine in Belgium

Many factors are important for the existence of supplier-induced demand (SID). Not just the individual practitioner is responsible; his or her behaviour might be influenced by the specific organisation of the market for health care/dental care. The article investigates the characteristics of the Belgian market for dental care and analyses the way in which they might influence the occurrence of SID and/or overconsumption. Attention goes to the payment system of dentists in Belgium, the health insurance system, dentist density and the regulation of the sector. Also mentioned are the recall system and other (governmental) initiatives that may influence patients' and practitioners' behaviour. Some factors--not yet systematically investigated--may be relevant as well: personal characteristics of the dentist (gender in particular) and the way companies direct practitioners' and patients' behaviour.     

Supplier inducement – its relative effect on demand and utilization

The present study examined the relative effect of supplier inducement on demand as opposed to on utilization. Supply of dentists was measured as population: dentist ratio at the level of trade areas. The dependent variable was number of dental visits during the last year. The probability of having any visit was used as the measure of demand. Number of visits, conditional upon having any visit, was used as the measure of utilization. The data were analyzed using Tobit analysis. This analysis gave the fraction of the total effect of a marginal increase in supply that is due to an increase in utilization as opposed to an increase in demand. The analysis was performed on a national sample comprising 1186 adult Norwegians. Supplier inducement had nearly the same effect on demand as on utilization. This finding may be a result of the payment system for dental care, which relates each item of service to the average time it takes to perform that item. Income opportunities for dentists are then fairly independent of whether they spend their time doing check-ups or treatment. The finding indicates that supplier induced demand is a factor to consider in addition to supplier induced utilization when one tries to explain how supplier inducement may affect the unequal distribution of dentists.     

The effect of the Great Recession on the demand for general oral health care and orthodontic care

Background

This study was undertaken to quantify how the Great Recession impacted the demand for general oral health care and orthodontic care in the United States. The authors conducted an analysis to help dentists anticipate changes in demand for care during future economic downturns.

Oral health disparities in Appalachia: orthodontic treatment need and demand

BACKGROUND: Significant oral health disparities affect people in West Virginia and elsewhere in Appalachia. Although oral diseases such as caries are a major problem, little is known about the occlusal status of this under-served group. METHODS: Fifty-eight adolescents (ages 12-17 years) and 78 of their parents underwent an orthodontic examination as part of a larger study on oral health in two rural West Virginia counties. Two orthodontists used a standardized index to rate their need for orthodontic care. Participants were interviewed regarding their demand for and history of orthodontic care. RESULTS: The study results show that parents had a high rate of complete or partial edentulism, an infrequent history of orthodontic treatment, great unmet orthodontic need and less demand for orthodontic care than was suggested by their clinically determined need. The adolescents were similar to national norms with regard to orthodontic treatment history and need, but lower with regard to demand. CONCLUSIONS: The adolescents' similarity to general population norms with regard to previous orthodontic care and level of occlusal status is promising. Nevertheless, their lower recognition of a need for treatment suggests possible future oral health problems and a lower oral health quality of life. Their parents, however, were considerably worse off, in comparison with their adolescent children and adult comparison samples, with regard to orthodontic care and other oral health status measures. CLINICAL IMPLICATIONS: Culturally sensitive psychoeducational methods to promote recognition of oral health needs may be required among adolescents in Appalachia to have an impact on oral health values and to prevent oral health problems. Issues of orthodontic care utilization and, perhaps, access to care need to be addressed among adults in Appalachia.     

The demand for dental care: evidence from a randomized trial in health insurance

Using data from a randomized trial in health insurance, this paper examines the effect of cost sharing on use of dental services. The data come from a sample of the nonaged, noninstitutionalized civilian population of six urban and rural sites. We find that: reducing the level of cost sharing increases demand for dental services; and dental expenses rise 46% when the coinsurance rate falls from 95% to 0%, subject to a catastrophic limit on out-of-pocket expenses. Of this increase, two-thirds is attributable to an increase in the likelihood of visiting a dentist during the year. Moreover, there is a substantial surge in demand during the first year of more generous coverage. The first-year response to cost sharing is nearly twice the second-year response.     

Periodontal health in various ethnic groups in Israel

The periodontal status of approximately 5,000 subjects belonging to nine ethnic groups of Oriental origin, aged four years and above and living in villages in Israel, was investigated. The severity of periodontal involvement of a group was found to be similar whether expressed as gingivitis in childhood or as destructive periodontal disease in adolescence and adult life. Gingivitis reached its peak at the age of 10 to 11 years and then tended to level off or even decline. The periodontal index (PI) and gingival recession rate (GRR) both formed straight line graphs between the ages of 17 and 55+. The incidence and prevalence of periodontal disease were almost uniformly higher in males than in females. In the populations investigated in the present study, it appears unwarranted to attribute this difference to differences in attitude to oral health and hygiene between the sexes. The possibility that habitual chewing of the leaves of Catha edulis is a causative factor in the exceptionally high rates of periodontal disease in Yemenite males is discussed. The periodontal health of the best groups was inferior to that of white Americans, and of the same order as that of American Negroes and the inhabitants of Lebanon and Chile. The most severe degree of involvement was comparable to findings in South-East Asia, and occurred in people who had immigrated from India.