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Longitudinal analysis of cost and dental utilization patterns for older adults in outpatient and long-term care settings in Minnesota

Author

Listed:
  • Barbara J Smith
  • Michael Helgeson
  • Brenda Prosa
  • Tracy L Finlayson
  • Mario Orozco
  • Padideh Asgari
  • Ian Pierce
  • Gregory Norman
  • Eliah Aronoff-Spencer

Abstract

Background: Dental utilization patterns and costs of providing comprehensive oral healthcare for older adults in different settings have not been examined. Methods: Retrospective longitudinal cohort data from Apple Tree Dental (ATD) were analyzed (N = 1,159 total; 503 outpatients, 656 long-term care residents) to describe oral health status at presentation, service utilization patterns, and care costs. Generalized estimating equation (GEE) repeated measures analysis identified significant contributors to service cost over the three-year study period. Results: Cohort mean age was 74 years (range = 55–104); the outpatient (OP) group was younger compared to the long-term care (LTC) group. Half (56%) had Medicaid, 22% had other insurance, and 22% self-paid. Most (72%) had functional dentitions (20+ teeth), 15% had impaired dentitions (9–19 teeth), 6% had severe tooth loss (1–8 teeth), and 7% were edentulous (OP = 2%, LTC = 11%). More in the OP group had functional dentition (83% vs. 63% LTC). The number of appointments declined from 5.0 in Year 1 (OP = 5.7, LTC = 4.4) to 3.3 in Year 3 (OP = 3.6, LTC = 3.0). The average cost to provide dental services was $1,375/year for three years (OP = $1,427, LTC = $1,336), and costs declined each year, from an average of $1,959 (OP = $2,068, LTC = $1,876) in Year 1 to $1,016 (OP = $989, LTC = $1,037) by Year 3. Those with functional dentition at presentation were significantly less costly than those with 1–19 teeth, while edentulous patients demonstrated the lowest cost and utilization. Year in treatment, insurance type, dentition type, and problem-focused first exam were significantly associated with year-over-year cost change in both OP and LTC patients. Conclusion: Costs for providing comprehensive dental care in OP and LTC settings were similar, modest, and declined over time. Dentate patients with functional dentition and edentulous patients were less costly to treat. LTC patients had lower utilization than OP patients. Care patterns shifted over time to increased preventive care and decreased restorative care visits.

Suggested Citation

  • Barbara J Smith & Michael Helgeson & Brenda Prosa & Tracy L Finlayson & Mario Orozco & Padideh Asgari & Ian Pierce & Gregory Norman & Eliah Aronoff-Spencer, 2020. "Longitudinal analysis of cost and dental utilization patterns for older adults in outpatient and long-term care settings in Minnesota," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-22, May.
    • Handle: RePEc:plo:pone00:0232898
    DOI: 10.1371/journal.pone.0232898
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    References listed on IDEAS

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    1. repec:mpr:mprres:7567 is not listed on IDEAS
    2. Wu, B. & Plassman, B.L. & Liang, J. & Wei, L., 2007. "Cognitive function and dental care utilization among community-dwelling older adults," American Journal of Public Health, American Public Health Association, vol. 97(12), pages 2216-2221.
    3. Richard J. Manski & John F. Moeller & Haiyan Chen & Patricia A. St. Clair & Jody Schimmel & John V. Pepper, 2012. "Wealth Effect and Dental Care Utilization in the United States," Mathematica Policy Research Reports 6b67392a4b7d4713bf06fe761, Mathematica Policy Research.
    4. Richard J. Manski & John Moeller & Haiyan Chen & Patricia A. St. Clair & Jody Schimmel & Larry Magder & John V. Pepper, 2010. "Dental Care Utilization and Retirement," Mathematica Policy Research Reports fa439a2a59a74865ad132b2ad, Mathematica Policy Research.
    5. repec:mpr:mprres:7564 is not listed on IDEAS
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