Annual expenditure on dental care in Australia amounts to AUD 1.9 billion. Approximately one-third of this expenditure involves private dental insurance, yet little is known about the impact of insurance on the provision of services. The aim of this analysis was to examine differences in dental service provision between insured and non-insured patients. Data collected from a random sample of dentists from a survey conducted in 1993-94 were used, providing 817 responses (response rate 74%). Logistic regression analysis controlling for patient age and sex and reason for visit indicated that in private general practice insured patients were more likely to receive preventive (OR = 1.37), crown and bridge (OR = 2.25), and endodontic services (OR = 1.27), but less likely to receive extraction services (OR = 0.52). However, no significant differences by insurance status were found for diagnostic, restorative, or prosthodontic services in the multivariate models. These differences in service provision by insurance status indicate a more favorable pattern of services for insured patients, and point to equity issues in the provision of services.
Variations in service provision between geographical locations may be associated with factors such as imbalances in the availability of health services. The aim of this analysis was to examine differences in dental service provision between capital city and non-capital locations. Data were used from a survey collected in 1993/94 from a random sample of Australian dentists, providing 817 responses (a response rate of 74%). Dentists from capital city locations comprised 71.8% of responding private general practitioners. Significantly more services per visit (Mann-Whitney, P < 0.05) were provided at capital city locations (mean = 2.16, 95% CI = 2.08-2.24) compared to non-capital locations (mean = 1.84, 95% CI = 1.74-1.94). Controlling for age of patient, insurance status and visit type, capital city locations included significantly higher rates of service per visit (P < 0.05) for adult dentate patients (rate ratios, 95% CI) of diagnostic (1.17, 1.09-1.25), preventive (1.20, 1.09-1.32), periodontal (2.71, 1.72-4.26), and crown and bridge (1.25, 1.03-1.53) services, but lower rates of prosthodontic (0.80, 0.67-0.94) services compared to non-capital locations. These findings indicate that compared to non-capital locations, capital city patients received care that was more orientated towards prevention and maintenance of teeth, rather than replacement by dentures.
Service-mix can reflect changes in demographic factors, oral health, patient demand and treatment philosophies. The aim of this study was to compare service-mix by patient age in 1988 with baseline data from 1983. A weighted, stratified random sample of dentists in Australia was surveyed by mailed questionnaire in 1983 and again in 1988. Service-mix was dominated by restorative, diagnostic and preventive areas. Comparing 1988 with 1983, there were significant increases for diagnostic, preventive, advanced restorative, orthodontic and general areas. Patterns across patient age groups and between years indicated younger patients were being provided with increased preventive services (patients aged 5-11, 25-44 years) and decreased restorative services (patients aged 5-11, 12-17 years), while older patients were being provided with reduced prosthodontic services (patients aged 25-44, 45-64 years), but increased restorative services (patients aged 45-64, 65+ years) and advanced restorative services (patients aged 25-44, 45-64 years). These patterns of service-mix have implications for dental education, research and service delivery.
Service provision patterns may be influenced not only by clinical oral health status leading to a diagnosis and treatment plan, but also by other variables such as patient characteristics. The main aim of this study was to investigate whether associations between services provided and patient factors would persist after controlling for the main presenting diagnosis or condition. A random sample of dentists surveyed in 1993-94 provided a response rate of 74%. Private general practitioners recorded service provision data from logs of 1-2 typical days of practice. Caries (26.5%) was the most prevalent diagnosis, followed by recall/maintenance care (19.0%), pulpal/periapical infection (10.9%), and failed restorations (10.4%). Diagnoses were associated with variation in the percentage of patients receiving services in main areas of service, and also with insurance status, sex and age distributions of patients, and type of visit (chi-square; P< 0.05). Logistic regressions of receipt of services indicated statistically significant associations with patient characteristics and diagnosis categories. Controlling for diagnosis, uninsured patients and those visiting for emergencies had less favourable service patterns (e.g., higher odds of extractions, but lower odds of preventive and crown and bridge services) compared to patients who had dental insurance or visited for check-ups or other non-emergency dental problems. The influence of these factors on services provided has implications of public health importance in terms of appropriateness of care and social inequality.
Previous studies have found that female dentists work fewer hours per year than male dentists. This study examined factors which may explain the differences in hours worked per year that exist between male and female dentists in private practice. In 1988, a weighted, stratified random sample of dentists in Australia was surveyed by mailed questionnaire. There were 855 respondents (response rate = 75.5%) with 566 dentists from private practice (361 males and 205 females). Annual time devoted to dental practice was significantly lower for females, for dentists who were not the sole earner of the family income, and for dentists with young children. A significant interaction between sex of dentist and child age showed that hours per year in practice decreased only for females with young children. Hours worked per year were significantly higher among female dentists with no children, or older children. For males, hours worked remained at a higher level. The amount of time devoted to dentistry requires monitoring in the estimation and projection of capacity to supply dental services.
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