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

Posted on RAND.org on January 01, 2004

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

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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.

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