Dental insurance status, attitudes to dental care and dental visiting

Background: Models of dental visiting typically include dental insurance status as an enabling factor, as insurance potentially attenuates the cost of services. However, in Australia, insurance rebates for dental services are low. An alternative explanation of the observed relationship between insurance and visiting is that insurance status is a marker for unmeasured dental care attitudes. Objective: Explore associations between insurance status, dental care attitudes and dental visiting. Methods: Participants (South Australians aged 45 to 54 years) of a two-year prospective cohort study (2005 to 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 developed by Gilbert et al (1997, Medical Care, Vol35:255-271). Bivariate associations between the attitudinal factors, insurance status, dental visiting and other known covariates ( age, sex and household income) were explored. A series of regression models assessed whether prevalence ratios (PR) of visiting (adjusted for covariates) were attenuated after controlling for attitudinal factors. Results: Response rate was 85.0%. Analysis was limited to dentate persons with known insurance status (n=529). The majority had insurance (75.2%), made regular visits (63.7%) and made a recent visit (in the previous 24 months)(84.5%). Insurance, visiting and attitudinal factors were associated (Kruskal-Wallis p<0.01). Controlling for covariates, insured adults, compared to the uninsured, had higher prevalence of visiting (Regular visits: PR=1.59, 95%CI=1.25–2.01, Recent visits: PR=1.20, 95%CI=1.03–1.39). After adjusting for attitudinal factors the significant association between insurance and visiting persisted (Regular visits: PR=1.48, 95%CI=1.16–1.88, Recent visits: PR=1.17, 95%CI=1.01–1.36). Conclusion: Accounting for dental care attitudes does not diminish the positive association between insurance and dental visiting. This result supports the appropriateness of classifying insurance as an enabling factor and as a potential policy lever to improving dental access. Acknowledgement: ADRF Project grant