Private dental insurance and use of dental care by Australian adults

Objectives: To describe associations between dental insurance and use of dental care by Australian adults. Two studies were conducted, the first assessed whether dental care use varied by level of dental insurance cover. The second study examined attitudes to dental care and tested whether these attitudes explain associations between dental insurance and dental visiting. Methods: The level of dental cover study sourced data from a nationally representative surveillance data collection and follow-up survey. Participant’s dental policies were examined and categorised by level of cover (i.e. generosity of cover). Dental care use and level of cover were described, and predictors of dental insurance status were assessed. Multiple variable models, accounting for participant characteristics and predictors of insurance, assessed associations between level of cover and various dental care use variables. The attitudes to dental care study sourced data from a two-year cohort study on dental care use by middle-aged adults. A follow-up survey on attitudes to dental care was mailed to the cohort participants. Descriptive analysis of the sample’s dental care use and attitudes were reported. Multiple variable models assessed associations between dental insurance and dental care use accounting for dental care attitudes. Main results: Level of dental cover study: On average, dental cover held by insured adults was relatively limited in generosity. Having dental insurance and having a relatively higher level of cover was associated with higher socioeconomic status and some health-related variables. After accounting for explanatory variables, the pattern of associations with various measures of dental visiting indicated that insured adults (with any level of cover) had a more favourable pattern of dental visiting. Adjusted prevalence ratios of dental visiting increased as the level of insurance cover increased, but effect sizes were small and not significant (based on 95%CI). Insurance effects were modified by socioeconomic status, significant interactions observed indicated that insurance effects were slightly larger for adults in lower income groups. Adults with high level cover had a 20% higher prevalence of receiving a scale and clean than uninsured adults; other service types assessed were not associated with insurance status. Attitudes to dental care study: In unadjusted analysis, attitudes to dental care were positively associated with having dental insurance and positively associated with higher prevalence of regular and recent dental care use. After adjusting for dental care attitudes, associations between having dental insurance and dental visiting persisted and were only slightly attenuated. Insured adults had a 46% higher prevalence of having regular visits and 17% higher prevalence of a recent visit than uninsured adults. Conclusion: Among Australian adults, visiting patterns considered favourable for maintaining oral health were associated with having dental insurance. Among insured adults, use of dental care did not vary by level of cover. Accounting for oral health status and attitudes to dental care did not attenuate the associations between insurance and use of dental care. Insurance effects appeared larger for adults from lower socioeconomic groups than higher socioeconomic groups broadly indicating that universal insurance may not necessarily increase inequalities in access to dental care.Thesis (Ph.D.) -- University of Adelaide, Adelaide Dental School, 2017