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Biomedical subjects

R J Manski

Publications and source records attributed to R J Manski.

At least 19 recordsLinked to original sources
PubMed2001

The impact of income on children's and adolescents' preventive dental visits.

INTRODUCTION: Limited information is available on the effect of income level on whether people visit a dentist for preventive care, whereas more has been written regarding the effect of income on "any" dental visits--which may include emergencies. Also, little is known of the effects of "near-poor" income (101 to 200 percent of the U.S. federal poverty level) on dental visits and preventive dental visits. The authors examined the impact of income at the "poor" and "near-poor" poverty levels on preventive dental visits made by children and adolescents. METHODS: The authors used data from the 1996 Medical Expenditure Panel Survey for children and adolescents younger than 19 years of age to estimate the percentage of this group who had had preventive dental visits. They performed a multiple logistic regression analysis to adjust poverty levels by race and ethnicity, age and sex. RESULTS: The distribution of preventive dental visits for those who were poor was similar to that for those who were near-poor, but the percentage distribution of preventive visits for children and adolescents with higher income was significantly different from that for those in the lower income groups. This was true across all the variables considered. CONCLUSIONS: It is important to evaluate and monitor preventive care utilization trends for U.S. children and adolescents in the poor and near-poor categories separately, particularly in states that do not provide similar levels of access under the State Children's Health Insurance Program, or SCHIP. Enrollment of eligible children in Medicaid and SCHIP via oral health promotion outreach efforts, access to care and utilization of dental primary and secondary care services must be increased.

Adolescent↗
PubMed2001

Dental services. An analysis of utilization over 20 years.

BACKGROUND: Utilization studies serve as an important tool for oral health policy decision-making. A number of important reports have been published that help to characterize the dental utilization patterns of most Americans. For the most part, these studies have focused on utilization estimates for a particular survey period or year. Fewer studies have examined changing utilization patterns over time. METHODS: This article focuses on dental utilization and the changes in utilization for the civilian, community-based U.S. population during 1977, 1987 and 1996. Using data from the National Medical Care Expenditure Survey, National Medical Expenditure Survey and Medical Expenditure Panel Survey, the authors provide national estimates of dental visits for each of several socioeconomic and demographic categories during 1977, 1987 and 1996. RESULTS: Although the dental use rates for children between 6 and 18 years of age were the highest of any age group in each of the three years studied, the use rate for children and the elderly increased during this same 20-year period. Data also showed that the gap in use rates between lower- and higher-income people widened during the 20-year period. Generally, use rates according to sex and race/ethnicity were unchanged in each of the survey years, except for a narrowing of the gap between whites and nonwhites by 1996. CONCLUSION: These data are unique and comparable and establish a mechanism by which dental visits can be compared during a 20-year period. While aggregate utilization rates generally were stable during this 20-year period, some differences within socioeconomic and demographic groups are notable. For instance, the use rate increased during the 20-year period for people 65 years of age and older and for children younger than 6 years of age. PRACTICE IMPLICATIONS: By understanding these analyses, U.S. dentists will be better positioned to provide care and meet the needs of all Americans.

Adolescent↗
PubMed2001

The impact of insurance coverage on children's dental visits and expenditures, 1996.

BACKGROUND: Health insurance coverage has been shown to relate positively with the use of dental services. The purpose of the authors' study was to describe the level of dental coverage among U.S. children and to assess the impact of dental coverage on children's use of dental services and expenditures for dental care. METHODS: The focus of these analyses is on dental care coverage, use and expenditures for U.S. children during 1996. National estimates are provided for the population with dental coverage, the population with a dental visit, and mean total expenditure for each of several socioeconomic and demographic categories during 1996 using data from the Medical Expenditure Panel Survey. RESULTS: Fifty-two percent of children younger than 18 years of age had private dental coverage during 1996. Approximately 56 percent of children in families with a poverty status level of 133 percent of the federal poverty level or below were covered by Medicaid during 1996. Fifty-six percent of children with private coverage had made at least one dental visit, compared with 28 percent of noncovered children. Twenty-eight percent of children covered by Medicaid had made at least one dental visit compared with 19 percent of noncovered children. CONCLUSION: Medicaid dental coverage seems to have had a lesser effect on the likelihood of a child's having a dental visit than had private coverage. Improving oral health for poorer children may depend partly on improving the design of Medicaid dental coverage programs. PRACTICE IMPLICATIONS: By understanding these analyses, practitioners, advocates and policymakers will be better positioned to provide care, improve access and better meet the needs of all American children.

Adolescent↗
PubMed2001

Dental insurance: design, need, and public policy.

The demand for dental insurance is likely to increase as our nation ages. However, future dental benefit plans may need to differ considerably from their present day counterparts to be cost-effective. These plans will be designed to minimize adverse selection, limiting or excluding some components found in today's dental insurance plans. Interest in improving access to care for the undeserved has gained significant support as of late. Dentistry should be prepared to provide the leadership necessary to help shape the design of future dental plans and to help improve the effectiveness of public coverage programs.

Cost-Benefit Analysis↗
PubMed2001

Access to dental care: a call for innovation.

For many Americans dentistry not only works but works very well. Most Americans receive the care that they need and want. However, dentistry's success has not been whole or uniform and it has not reached every corner of America. In a society as prosperous as our, it is incumbent upon us, as a profession to help make sure that dentistry's success is accessible to each and every American. While recent efforts to address dental services use disparities may result in some improvements, most likely no single national effort will be globally effective. New ideas, including innovations that are local in design and market sensitive, will be needed to make the kinds of improvements that are desired.

Child↗
PubMed2000

Orthodontic dental visits during 1987 and 1996.

Americans underwent approximately 355 million dental procedures during 1987, approximately 8% for orthodontic treatment. Individual rates of utilization vary and are not uniform across the population. This article provides estimates of orthodontic utilization for each of several socioeconomic and demographic categories, using household data from the 1987 National Medical Expenditure Survey (NMES) and the 1996 Medical Expenditure Panel Survey (MEPS). These data show that slightly more than 3% of the population, or approximately 39 million Americans, visited a dentist to receive orthodontic care nationwide during 1987 and 1996. For those with an orthodontic visit, the mean number of visits per patient decreased in number from 1987 to 1996.

Adolescent↗
PubMed2000

Translating clinical practice into evidence-based research through the use of technology.

Gaps exist in the extent to which technology has been fully integrated into dental practices. This is partially the result of continuously emerging technologies and partially attributable to different attitudes among dentists toward innovation. Further development of Evidence-Based Dentistry is needed before it becomes a productive and widely used part of practice.

Attitude of Health Personnel↗
PubMed1999

Dental expenditures and source of payment by race/ethnicity and other sociodemographic characteristics.

OBJECTIVE: This study presents race/ethnic-specific distributions of dental expenditures and their sources of payment by socioeconomic characteristics among US working-age adults. METHODS: Data for persons aged 19-64 years from the 1987 National Medical Expenditure Survey (NMES) (n = 18,696) were used to calculate mean dental expenditures and their 95 percent confidence intervals. RESULTS: Dental expenditures were reported by 44.5 percent of participants. Non-Hispanic whites and persons with higher income were more likely to report dental expenditures than their counterparts. Among persons reporting expenditures, those with lower income had lower expenditures than higher-income persons. No differences in the amount of expenditures by race/ethnicity, sex, or employment status were observed. In all race/ethnic groups almost half the expenditures were paid out-of-pocket and one-third by dental insurance. CONCLUSION: While sociodemographic characteristics determined who had dental expenditures, they did not determine the amount or source of those expenditures.

Adult↗
PubMed1999

Dental services: use, expenditures and sources of payment, 1987.

BACKGROUND: This article provides per capita estimates of dental care utilization, expenditures, mix of services and sources of payment for each of several socioeconomic and demographic categories. METHODS: The focus of the analyses presented here is on dental care utilization by the U.S. population during 1987. Specifically, national estimates are provided for dental visits, expenditures, sources of payment and procedure type for each of several socioeconomic and demographic categories using household data from the 1987 National Medical Expenditure Survey, or NMES. RESULTS: During 1987, less that 50 percent of Americans visited a dental office. Americans made approximately 292 million dental visits and received approximately $30 billion worth of dental care, of which $10 billion was paid by insurers, $17 billion was paid out of pocket and $1.6 billion was not reimbursed. CONCLUSIONS: These analyses establish the magnitude of the dental care market and the amounts paid by individual patients, private insurance companies and Medicaid. They also reveal that the type of care received varies among people in distinct socioeconomic and demographic groups. PRACTICE IMPLICATIONS: Although the dental care market is substantial, many Americans do not visit a dentist. By understanding these analyses, practitioners will be better positioned to meet the dental needs of all Americans.

Adolescent↗
PubMed1999

A comparison of dental care expenditures and office-based medical care expenditures, 1987.

BACKGROUND: This article compares national estimates of utilization of and expenditures for dental care and office-based medical care. The comparison includes respondents in several socioeconomic and demographic categories. METHODS: The focus of the analyses is on dental care and office-based medical care utilization during 1987. Specifically, the authors provide national estimates for numbers of dental and office-based medical visits made, expenditures for and sources of payment for each of several socioeconomic and demographic categories using household survey data from the 1987 National Medical Expenditure Survey, or NMES. RESULTS: Data show that out-of-pocket expenditures are greater for dental care than for office-based medical care; that few Medicaid dollars are spent on dental care; that insurance is an important component of dental and office-based medical care; and that dentists provide greater amounts of unreimbursed care than do their office-based physician counterparts. CONCLUSIONS: NMES data show that dental care expenditures are considerable, almost as large as expenditures for office-based medical care, and are a significant component of all nonhospital health care expenditures for noninstitutionalized Americans. PRACTICE IMPLICATIONS: U.S. dentists provide a significant amount of care. By understanding these analyses, practitioners will be better positioned to provide care and to better meet the dental needs of all Americans.

Adolescent↗
PubMed1998

Demographic and socioeconomic predictors of dental care utilization.

The authors analyzed a comprehensive, nationally representative data set from the 1989 National Health Interview Survey to determine what factors are related to dental care utilization. The authors estimated the percentage of low-income and minority adults who reported visiting a dentist in the past year by race, income, employment status, dental insurance coverage status, sex, health status, education, marital status, age and major activity. Data analyses focused on 49,687 18- to 64-year-old dentate respondents, who were black, Hispanic or white. The authors found large differences in dental care utilization between blacks, Hispanics and whites, when controlling for education, income, age and other variables.

Adolescent↗
PubMed1996

Dental utilisation for older Americans aged 55-75.

OBJECTIVES: The purpose of this study was to analyze a comprehensive nationally representative data set to determine the effect of economic and non-economic determinants on the decision to seek care and the decision to select a specific number of dental visits. DESIGN: The conduct of this study involved the examination and analyses of secondary data available from the National Health Interview Survey. A two-part choice logistic regression model was utilized to first describe the decision to seek care and second to describe factors associated with the decision to select a specific number of dental visits as a function of income, education, family size, age, marital status, presence of teeth, employment status, health status, gender, race, insurance status, and reason for dental visit. SUBJECTS: Data analysis focused on 5.327 non-institutional older adults between the ages of 55 and 75 who were not eligible for Medicaid. RESULTS: Results provide supporting evidence that income, presence of dental insurance, presence of teeth, gender, family size, education race and age are associated with the decision to seek dental care and that income, presence of dental insurance, gender, family size, education, and race are associated with the number of dental visits among users even when the effects of other variables are controlled for. DISCUSSION: Analyses suggest that employment may have a surprisingly limited effect on dental utilisation and that among explanatory variables there are differences in significance and magnitude between the decision to seek care and the decision to select a specific number of dental visits. In addition, in contrast with some prior studies, health status does not appear to be associated with the decision to seek care or associated with the number of dental visits among respondents.

Aged↗
PubMed1996

Does the elimination of Medicaid reimbursement affect the frequency of emergency department dental visits?

In an attempt to save costs, the state of Maryland in February 1993 eliminated Medicaid reimbursement to dentists for treatment of adults with dental emergencies. The authors analyzed data from the University of Maryland Hospital's emergency department to determine if this change resulted in increased use of the emergency department by Medicaid recipients for treatment of dental conditions. After the policy change, the rate of dental visits to the emergency department by Medicaid recipients increased by 21.8 percent. This increase occurred during the same period in which the percentage of all emergency department visits by Medicaid recipients was decreasing.

Adult↗
PubMed1995

Dental care coverage among older Americans.

Dental expenditures increased by almost $20 billion during the past twenty years. A contributing factor to this growth was the rapid proliferation of dental insurance. Unfortunately, dental care coverage is not uniformly distributed. For instance, while many younger Americans are offered assistance in paying for dental care through dental insurance, few older Americans are offered coverage because it is usually job related. Whereas several studies reported that dental care coverage is directly related to dental utilization, no significant empirical study of multiple factors has shown who is most likely to have dental insurance. The purpose of this study was to determine who is most apt to have dental insurance and what factors may influence or be related to having dental care coverage. Findings indicated that individuals with low income, large families, those having a poor health status, who are not married, are older, unemployed or female were least likely to have dental care coverage.

Age Factors↗
PubMed1995

Variable confounding and the influence of non economic determinants on dental utilization for the elderly.

The purpose of this study is to test the hypothesis that variable confounding will cause discrepancies in dental utilization analysis and to determine the significance of gender, health status, and race on dental utilization by controlling for several predictor variables previously reported to be associated with dental care utilization. Results provide supporting evidence that discrepancies in dental utilization analysis can occur as a result of variable confounding. In addition, parameter estimates indicate that older women and white adults were more likely to visit a dental office than either older men or older blacks. On the other hand, older adults reported to be in poor health were no more likely to visit a dentist than older adults in excellent health.

Black or African American↗