Dental insurance, attitudes to dental care, and dental visiting

Dental insurance status is strongly associated with service use. In models of dental visiting, insurance is typically included as an enabling factor. However, in Australia, people self-select into health insurance (privately purchased) and levels of cover for dental services are modest. Rather than enabling access, insurance status may be a "marker" for unmeasured predisposing attitudes. This study aims to explore associations between dental insurance status and visiting while adjusting for dental care attitudes.

Participants (South Australians aged 45-54 years) of a 2-year prospective cohort study (2005-2007) investigating dental service use were surveyed on their attitudes to dental care and insurance status. Six attitudinal factors were assessed using a 23-item Likert scale. Bivariate associations between insurance, attitudes, visiting, and other known covariates (age, sex, and household income) were explored. A series of regression models assessed whether prevalence ratios of visiting were attenuated after controlling for attitudinal factors.

Response rate was 85.0 percent. Analysis was limited to dentate adults with known dental insurance status (n=529). The majority had dental insurance (75.2%) and made regular visits (63.7%). Insurance status, visiting, and attitudinal factors were significantly associated. Controlling for covariates, insured adults, compared with the uninsured, were 57 percent more likely to make regular visits. After adjusting for attitudinal factors, the significant association between insurance and visiting persisted.

Dental care attitudes did not confound the association between dental insurance and visiting, indicating that dental insurance status was not a "marker" for predisposing attitudes.