Abstract
Objective
To analyze the determinants of dental care expenditures in institutions for adults
with disabilities.
Design
Health and disability survey and insurance database.
Setting
Institutional setting.
Participants
Adults (N=2222) living in institutions for people with cognitive, sensory, and mobility
disabilities.
Interventions
Not applicable.
Main Outcome Measures
We used a Heckman selection model to correct for potential sample selection bias due
to the high percentage of non–dental care users. The Heckman selection model is a
2-step statistical approach based on the simultaneous estimation of 2 multiple regression
models–a selection equation (step 1) and an outcome equation (step 2)–offering a means
of correcting for nonrandomly selected samples. The selection equation modeled whether
the individual had consulted a dentist at least once, whereas the outcome equation
explained the dental care expenditures. Disability severity was assessed by scoring
mobility and cognitive functional limitations. Regressions also included sociodemographic
characteristics and other health-related variables.
Results
Individuals with the highest cognitive limitation scores, without family visits, without
supplementary health insurance, and with poor oral health status were less likely
to consult a dentist. After controlling for potential selection bias, the only variable
that remained statistically significant in the outcome equation was the oral health
status: when individuals with poor health status had consulted at least once, they
had a higher level of dental care expenditure.
Conclusions
Functional limitations were barriers to accessing dental care even in institutions
for adult with disabilities. These barriers should be overcome because they may worsen
their oral health status and well-being. Given the lack of literature on this specific
topic, our results are important from a policy perspective. Health authorities should
be alerted by these findings.
Keywords
List of abbreviations:
HSI (Health and Disability Survey – Institutions Section), SNIIRAM (French National Health Insurance)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 17, 2018
Footnotes
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
