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Payment Methods and Demographics Influence Patterns of Dental Service Utilization
Matthew Pendleton1, Mark E Moss, Qiang Wu
1School of Dental Medicine (Mr Pendleton, and Drs Moss, Tempel, and Al-Dajani) and Department of Public Health (Dr Wu), East Carolina University, Greenville, North Carolina; and Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts (Dr Garcia).
Objective:
To describe the patterns of specific dental service utilization among the various sociodemographic groups in North Carolina served by the East Carolina University School of Dental Medicine (ECU SoDM).
Design:
This was a descriptive study utilizing self-reported patients' sociodemographic information, payment method history, and CDT codes of procedures performed. Deidentified clinical data recorded for 26 710 patients and 534 983 procedures from 2011 to 2020 were extracted from a centralized axiUm database. Data were analyzed using IBM SPSS Statistics, version 25.0. Cross-tabulations between dental service utilizations, patients' demographics, and payment method were performed using chi-square analysis.
Setting:
Nine dental clinic sites across the state of North Carolina.
Participants:
In total, 26 710 adults 23 years to older than 65 years were included in the sample for this study.
Main Outcome Measures:
In total, 534 983 procedure codes completed for the eligible patients were cross-tabulated with payment method.
Results:
Payment method was significantly related to individual characteristics including location of service, age, race, ethnicity, and untreated decay ( P < .001). Payment method is associated with the dental service type utilized by an individual ( P < .001). Patients who received Medicaid benefits were more likely to receive restorative procedures, removable prosthetics, or oral surgery. Despite NC Medicaid covering preventive procedures, patients who received Medicaid benefits showed lower utilization of preventive procedures than expected. Privately insured or self-paying individuals demonstrated a greater variety of service option utilization, as well as more frequent usage of more specialized procedure options such as endodontics, periodontics, fixed prosthodontics, and implants.
Conclusions:
Payment method was found to be related to patients' demographics and type of dental service utilized. Adults older than 65 years demonstrated a higher proportion of self-payment for dental care, indicating a lack of payment options for this population. In the interest of providing care for underserved populations in North Carolina, policy makers should consider expanding dental coverage for adults older than 65 years.
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