What are the determinants of dental care expenditures in institutions for adults with disabilities? Findings from a National Survey

Publication date: Available online 31 January 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Diane Naouri, Clémence Bussiere, Nathalie Pelletier-Fleury
ObjectiveTo analyze the determinants of dental care expenditures among adults with disabilities living in institutions.DesignThe French National Health and Disability Survey - Institution Section (cross sectional survey, 2009), and The French National Health Insurance database (SNIIRAM).SettingInstitutional setting.ParticipantsPeople living in institutions for adults with cognitive, sensory, and mobility disabilities for whom the dental care expenditures from the SNIIRAM were available (456 institutions and 2,222 individuals).InterventionNot applicable.Main Outcome MeasuresWe used a Heckman selection model to correct for potential sample selection bias due to the high percentage of non-dental-care users. 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 sociodemographics and others health-related variables.ResultsIndividuals with the highest cognitive limitation scores, without family visits, without supplementary health insurance and with a 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 a poor health status had consulted at least once, they had a greater level of dental care expenditure.ConclusionsFunctional limitations were barriers to accessing dental care even in institutions for adult with disabilities. These barriers should be overcome as they may worsen their oral health status and well-being. Given the lack of literature on this specific topic, our results are very important from a policy perspective. Health authorities should be alerted by these findings.



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