TY - JOUR T1 - Differences Among Older Adults in the Types of Dental Services Used in the United States. JF - Inquiry Y1 - 2016 A1 - Richard J. Manski A1 - Jody Schimmel Hyde A1 - Haiyan Chen A1 - John F Moeller KW - Aged KW - Dental Care KW - Female KW - Humans KW - Insurance, Dental KW - Male KW - Middle Aged KW - Surveys and Questionnaires KW - United States AB -

The purpose of this article is to explore differences in the socioeconomic, demographic characteristics of older adults in the United States with respect to their use of different types of dental care services. The 2008 Health and Retirement Study (HRS) collected information about patterns of dental care use and oral health from individuals aged 55 years and older in the United States. We analyze these data and explore patterns of service use by key characteristics before modeling the relationship between service use type and those characteristics. The most commonly used service category was fillings, inlays, or bonding, reported by 43.6% of those with any utilization. Just over one third of those with any utilization reported a visit for a crown, implant, or prosthesis, and one quarter reported a gum treatment or tooth extraction. The strongest consistent predictors of use type are denture, dentate, and oral health status along with dental insurance coverage and wealth. Our results provide insights into the need for public policies to address inequalities in access to dental services among an older US population. Our findings show that lower income, less wealthy elderly with poor oral health are more likely to not use any dental services rather than using only preventive dental care, and that cost prevents most non-users who say they need dental care from going to the dentist. These results suggest a serious access problem and one that ultimately produces even worse oral health and expensive major procedures for this population in the future.

VL - 53 UR - http://www.ncbi.nlm.nih.gov/pubmed/27284127 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27284127?dopt=Abstract ER - TY - JOUR T1 - Dental use and expenditures for older uninsured Americans: the simulated impact of expanded coverage. JF - Health Serv Res Y1 - 2015 A1 - Richard J. Manski A1 - John F Moeller A1 - Haiyan Chen A1 - Jody Schimmel A1 - John V Pepper A1 - Patricia A St Clair KW - Aged KW - Dental Health Services KW - Female KW - Health Expenditures KW - Humans KW - Insurance, Dental KW - Male KW - Medically Uninsured KW - Middle Aged KW - Surveys and Questionnaires KW - United States AB -

OBJECTIVE: To determine if providing dental insurance to older Americans would close the current gaps in dental use and expenditure between insured and uninsured older Americans.

DATA SOURCES/STUDY SETTING: We used data from the 2008 Health and Retirement Survey (HRS) supplemented by data from the 2006 Medical Expenditure Panel Survey (MEPS).

STUDY DESIGN: We compared the simulated dental use and expenditures rates of newly insured persons against the corresponding rates for those previously insured.

DATA COLLECTION/EXTRACTION METHODS: The HRS is a nationally representative survey administered by the Institute for Social Research (ISR). The MEPS is a nationally representative household survey sponsored by the Agency for Healthcare Research and Quality (AHRQ).

PRINCIPAL FINDINGS: We found that expanding dental coverage to older uninsured Americans would close previous gaps in dental use and expense between uninsured and insured noninstitutionalized Americans 55 years and older.

CONCLUSIONS: Providing dental coverage to previously uninsured older adults would produce estimated monthly costs net of markups for administrative costs that comport closely to current market rates. Estimates also suggest that the total cost of providing dental coverage targeted specifically to nonusers of dental care may be less than similar costs for prior users.

PB - 50 VL - 50 IS - 1 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25040355?dopt=Abstract U2 - PMC4295003 U4 - dental Care/health Insurance/Medical Expenditure Panel Survey/dental coverage ER - TY - JOUR T1 - The effect of dental insurance on the use of dental care for older adults: a partial identification analysis. JF - Health Econ Y1 - 2015 A1 - Kreider, Brent A1 - Richard J. Manski A1 - John F Moeller A1 - John V Pepper KW - Aged KW - Dental Care KW - Female KW - Humans KW - Insurance Coverage KW - Insurance, Dental KW - Male KW - Middle Aged KW - Models, Econometric KW - Reproducibility of Results AB -

We evaluate the impact of dental insurance on the use of dental services using a potential outcomes identification framework designed to handle uncertainty created by unknown counterfactuals-that is, the endogenous selection problem-and uncertainty about the reliability of self-reported insurance status. Using data from the health and retirement study, we estimate that utilization rates of adults older than 50 years would increase from 75% to around 80% under universal dental coverage.

PB - 24 VL - 24 IS - 7 N1 - Export Date: 6 August 2014 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/24890257?dopt=Abstract U2 - PMC4247826 U4 - Classification errors/Dental care/Dental insurance/Partial identification/Selection/Treatment effect ER - TY - JOUR T1 - A Research Note on Transitions in Out-of-Pocket Spending on Dental Services. JF - Res Aging Y1 - 2015 A1 - Richard J. Manski A1 - John F Moeller A1 - Haiyan Chen A1 - Jody Schimmel Hyde A1 - John V Pepper A1 - Patricia A St Clair KW - Aged KW - Aged, 80 and over KW - Dental Care KW - Female KW - Health Expenditures KW - Humans KW - Insurance, Dental KW - Longitudinal Studies KW - Male KW - Middle Aged KW - United States AB -

OBJECTIVE: We analyze correlates of the direction and magnitude of changes in out-of-pocket (OOP) payments for dental care by older Americans over a recent 4-year period.

METHODS: We analyzed data from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of the direction and linear regression models of the amounts of OOP changes over survey periods.

RESULTS: Financial-based factors were more strongly associated with the direction and magnitude of changing self-payments for dental care than were health factors.

DISCUSSION: Findings suggested that dental coverage, income, and wealth and changes in these financial factors were more strongly correlated with the persistence of and changes in OOP payments for dental care over time than were health status and changes in health status. The sensitivity to dental coverage changes should be considered as insurance and retirement policy reforms are deliberated.

PB - 37 VL - 37 UR - http://roa.sagepub.com/content/early/2014/10/03/0164027514552681.abstract IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25651590?dopt=Abstract U2 - PMC4387101 U4 - dental insurance/coverage/dental use/self-payments/Out of pocket costs ER - TY - JOUR T1 - The influence of changes in dental care coverage on dental care utilization among retirees and near-retirees in the United States, 2004-2006. JF - Am J Public Health Y1 - 2011 A1 - Richard J. Manski A1 - John F Moeller A1 - Patricia A St Clair A1 - Jody Schimmel A1 - Haiyan Chen A1 - John V Pepper KW - Age Factors KW - Aged KW - Dental Care KW - Employment KW - Female KW - Health Care Surveys KW - Humans KW - Insurance, Dental KW - Male KW - Medically Uninsured KW - Middle Aged KW - Retirement KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: We examined dental care utilization transition dynamics between 2004 and 2006 in the context of changing dental coverage status.

METHODS: We used data from the Health and Retirement Study for persons aged 51 years and older to estimate a multivariable model of dental care use transitions with controls for dental coverage and retirement transitions and other potentially confounding covariates.

RESULTS: We found that Americans aged 51 years and older who lost dental coverage between the 2004 and 2006 survey periods were more likely to stop dental care use between periods, and those who gained coverage were more likely to start dental care use between periods, than those without coverage in both periods.

CONCLUSIONS: Dental coverage transitions and status have a strong effect on transitions in dental care use. Given that retirement is a time when many experience a loss of dental coverage, older adults may be at risk for sporadic dental care and even stopping use, leading to worse dental and potentially overall health.

PB - 101 VL - 101 IS - 10 N1 - Times Cited: 0 Manski, Richard J. Moeller, John F. St Clair, Patricia A. Schimmel, Jody Chen, Haiyan Pepper, John V. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21852656?dopt=Abstract U2 - PMC3174340 U4 - dental Care/dental insurance/employee benefits/health care policy/health Status/health Insurance ER - TY - JOUR T1 - Dental care coverage and retirement. JF - J Public Health Dent Y1 - 2010 A1 - Richard J. Manski A1 - John F Moeller A1 - Jody Schimmel A1 - Patricia A St Clair A1 - Haiyan Chen A1 - Larry S. Magder A1 - John V Pepper KW - Aged KW - Employment KW - ethnicity KW - Female KW - Humans KW - Income KW - Insurance, Dental KW - Male KW - Middle Aged KW - Models, Statistical KW - Multivariate Analysis KW - Retirement KW - United States AB -

OBJECTIVES: To examine the convergence of an aging population and a decreased availability of dental care coverage using data from the Health and Retirement Study (HRS).

METHODS: We calculate national estimates of the number and characteristics of those persons age 51 years and above covered by dental insurance by labor force, retirement status, and source of coverage. We also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: We show that being in the labor force is a strong predictor of having dental coverage. For older retired adults not in the labor force, the only source for dental coverage is either a postretirement health benefit or spousal coverage.

CONCLUSIONS: Dental care, generally not covered in Medicare, is an important factor in the decision to seek dental care. It is important to understand the relationship between retirement and dental coverage in order to identify the best ways of improving oral health and access to care among older Americans.

PB - 70 VL - 70 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19694939?dopt=Abstract U2 - PMC2864343 U4 - dental/utilization/dentistry/insurance/coverage/retirement ER - TY - JOUR T1 - Dental care expenditures and retirement. JF - J Public Health Dent Y1 - 2010 A1 - Richard J. Manski A1 - John F Moeller A1 - Haiyan Chen A1 - Patricia A St Clair A1 - Jody Schimmel A1 - Larry S. Magder A1 - John V Pepper KW - Age Factors KW - Aged KW - Dental Care KW - Educational Status KW - ethnicity KW - Female KW - Financing, Personal KW - Humans KW - Income KW - Insurance Coverage KW - Insurance, Dental KW - Male KW - Marital Status KW - Middle Aged KW - Mouth, Edentulous KW - Retirement KW - United States AB -

OBJECTIVES: To examine the relationship of dental care coverage, retirement, and out-of-pocket (OOP) dental expenditures in an aging population, using data from the Health and Retirement Study (HRS).

METHODS: We estimate OOP dental expenditures among individuals who have dental utilization as a function of dental care coverage status, retirement, and individual and household characteristics. We also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: Overall, mean OOP dental expenditures among those with any spending were substantially larger for those without coverage than for those with coverage. However, controlling for coverage shows that there is little difference in spending by retirement status.

CONCLUSIONS: Although having dental coverage is a key determinant of the level of OOP expenditures on dental care; spending is higher among those without coverage than those who have dental insurance. We also found that while retirement has no independent effect on OOP dental expenditures once controlling for coverage, dental coverage rates are much lower among retirees.

PB - 70 VL - 70 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20002876?dopt=Abstract U2 - PMC2891582 U4 - dental/utilization/dentistry/insurance/coverage/retirement ER - TY - JOUR T1 - Dental care utilization and retirement. JF - J Public Health Dent Y1 - 2010 A1 - Richard J. Manski A1 - John F Moeller A1 - Haiyan Chen A1 - Patricia A St Clair A1 - Jody Schimmel A1 - Larry S. Magder A1 - John V Pepper KW - Aged KW - Confounding Factors, Epidemiologic KW - Dental Care KW - Employment KW - ethnicity KW - Female KW - health policy KW - Humans KW - Income KW - Insurance, Dental KW - Leisure activities KW - Logistic Models KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Odds Ratio KW - Retirement KW - Socioeconomic factors KW - United States AB -

OBJECTIVE: The authors examine the relationship of dental care coverage, retirement, and utilization in an aging population using data from the Health and Retirement Study (HRS).

METHODS: The authors estimate dental care use as a function of dental care coverage status, retirement, and individual and household characteristics. They also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: The authors show that that the loss of income and dental coverage associated with retirement may lead to lower use rates but this effect may be offset by other unobserved aspects of retirement including more available free time leading to an overall higher use rate.

CONCLUSIONS: The authors conclude from this study that full retirement accompanied by reduced income and dental insurance coverage produces lower utilization of dental services. However, they also show that retirement acts as an independent variable, whereas income, coverage, and free time (unobserved) act as intervening variables.

PB - 70 VL - 70 IS - 1 N1 - Manski, Richard J Moeller, John Chen, Haiyan St Clair, Patricia A Schimmel, Jody Magder, Larry Pepper, John V R01 AG026090-01A2/AG/NIA NIH HHS/United States R01 AG026090-03/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States Nihms172468 J Public Health Dent. 2010 Winter;70(1):67-75. U1 - http://www.ncbi.nlm.nih.gov/pubmed/19765203?dopt=Abstract U2 - PMC2864359 U4 - Confounding Factors (Epidemiology)/Dental Care/Employment/Ethnic Groups/Health Policy/Income/Dental Insurance/leisure/Logistic Models/Multivariate Analysis/Odds Ratio/Retirement planning/Socioeconomic Factors ER - TY - JOUR T1 - An examination of older immigrants' use of dental services in the United States. JF - J Aging Soc Policy Y1 - 2010 A1 - Christina N Anderson A1 - Hyungsoo Kim KW - Age Factors KW - Aged KW - Dental Care for Aged KW - Educational Status KW - Emigrants and Immigrants KW - Female KW - Health Services Accessibility KW - Humans KW - Insurance, Dental KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Marital Status KW - Middle Aged KW - Multivariate Analysis KW - Sex Factors KW - Socioeconomic factors KW - United States AB -

The recent influx of immigrants aged 65 and older in the United States triggers an increasing need to understand older immigrants' dental services use. This paper uses data (n = 9,617) from the 2004 and 2006 waves of the Health and Retirement Study to examine the dental services use of older Americans. In particular, this study focuses on differences in dental services use between immigrants and natives and potential contributing factors. Multivariate logistic regression analyses showed, contrary to expectation, that older immigrants were more likely to use dental services than older natives despite numerous barriers (odds ratio = 1.30 in 2004). The results in 2006 confirmed these findings. The results from 2004 and 2006 analyses showed dental insurance coverage, sex, and marital status were associated differently with dental services use for immigrants and natives. Implications for current oral health policies and future research of older Americans are discussed, as well as methods for meeting older immigrants' growing dental services needs.

PB - 22 VL - 22 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20390710?dopt=Abstract U3 - 20390710 U4 - Immigrants/Dental Care ER - TY - JOUR T1 - Dental care coverage transitions. JF - Am J Manag Care Y1 - 2009 A1 - Richard J. Manski A1 - John F Moeller A1 - Haiyan Chen A1 - Patricia A St Clair A1 - Jody Schimmel A1 - Larry S. Magder A1 - John V Pepper KW - Aged KW - Career Mobility KW - Female KW - Health Benefit Plans, Employee KW - Humans KW - Insurance Coverage KW - Insurance, Dental KW - Interviews as Topic KW - Male KW - Middle Aged KW - United States AB -

OBJECTIVE: To examine dental insurance transition dynamics in the context of changing employment and retirement status.

STUDY DESIGN: Data from the Health and Retirement Study (HRS) were analyzed for individuals 51 years and older between the 2004 and 2006 waves of the HRS.

METHODS: The primary focus of the analysis is the relationship between retirement and transitions in dental care coverage. We calculate and present bivariate relationships between dental coverage and retirement status transitions over time and estimate a multivariable model of dental coverage controlling for retirement and other potentially confounding covariates.

RESULTS: Older adults are likely to lose their dental coverage on entering retirement compared with those who remain in the labor force between waves of the HRS. While more than half of those persons in the youngest group (51-64 years) were covered over this entire period, two-thirds of those in the oldest group (>or=75 years) were without coverage over the same period. We observe a high percentage of older persons flowing into and out of dental coverage over the period of our study, similar to flows into and out of poverty.

CONCLUSIONS: Dental insurance is an important factor in the decision to seek dental care. Yet, no dental coverage is provided by Medicare, which provides medical insurance for almost all Americans 65 years and older. This loss of coverage could lead to distortions in the timing of when to seek care, ultimately leading to worse oral and overall health.

PB - 15 VL - 15 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19845424?dopt=Abstract U2 - PMC2819283 U4 - Dental Care/Insurance Coverage/RETIREMENT/Medicare ER -