Self-reported Oral Health of Enrollees in Capitated and Fee-for-Service Dental Benefit Plans

Published in: Journal of the American Dental Association, v. 135, no. 11, Nov. 2004, p. 1606-1615

by Ian D. Coulter, John M. Yamamoto, Marvin Marcus, James Freed, Claudia Der-Martirosian, Norma Guzman-Becerra, L. Jackson Brown, Albert H. Guay

Read More

Access further information on this document at

This article was published outside of RAND. The full text of the article can be found at the link above.

BACKGROUND: This article examines the impact of different dental plan types, dental markets, premiums, out-of-pocket costs and enrollee demographics on the enrollees' perceived oral health status. METHODS: The authors randomly sampled enrollees in dental benefit plans offered by eight Fortune 500 companies and interviewed them regarding their experiences with their plans, including perceived oral health status. The sample consisted of 2,340 respondents, of whom 42.3 percent were enrolled in capitation, or CAP, plans, and 57.7 percent were enrolled in fee-for-service, or FFS, plans. RESULTS: The authors used X2 tests, analysis of variance and multinomial logistic regression. They set significance at P < .05. Results indicate that nonwhites, CAP-plan enrollees and those with higher out-of-pocket cost were less likely to rate their oral health good, very good or excellent compared with whites, FFS-plan enrollees and those with lower out-of-pocket costs, respectively. CONCLUSIONS: CAP-plan enrollees rated their oral health more poorly than did FFS-plan enrollees. Further studies are necessary to determine if adverse selection occurs and if CAP plans provide inferior quality of care. Practice Implications. Practitioners' awareness of and willingness to address the variety of factors that influence perceived oral health status may improve their patients' perceived oral health status and satisfaction with care.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.