Developing Management Information from an Administrative Database of Dental Services: Identifying Factors that Influence Costs
Corresponding Author
James L Leake MSc
Drs. Leake and Main and Ms. Ho are affiliated with the Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. Dr. Birch is affiliated with the Department of Clinical Epidemiology and Biostatistics and the Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. Research supported by the Applied Research and Analysis Directorate of the Information and Connectivity Branch of Health Canada. Parts of this paper were presented in Session # 33, IADR meeting, Honolulu, HI, March 11, 2004. Reprints will not be available.
Send correspondence to: JL Leake, MSc, Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto ON, Canada. M5G 1G6.E-mail address: [email protected].Search for more papers by this authorStephen Birch Dphil
Drs. Leake and Main and Ms. Ho are affiliated with the Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. Dr. Birch is affiliated with the Department of Clinical Epidemiology and Biostatistics and the Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. Research supported by the Applied Research and Analysis Directorate of the Information and Connectivity Branch of Health Canada. Parts of this paper were presented in Session # 33, IADR meeting, Honolulu, HI, March 11, 2004. Reprints will not be available.
Search for more papers by this authorPatricia A Main MSc
Drs. Leake and Main and Ms. Ho are affiliated with the Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. Dr. Birch is affiliated with the Department of Clinical Epidemiology and Biostatistics and the Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. Research supported by the Applied Research and Analysis Directorate of the Information and Connectivity Branch of Health Canada. Parts of this paper were presented in Session # 33, IADR meeting, Honolulu, HI, March 11, 2004. Reprints will not be available.
Search for more papers by this authorElsa Ho MBA
Drs. Leake and Main and Ms. Ho are affiliated with the Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. Dr. Birch is affiliated with the Department of Clinical Epidemiology and Biostatistics and the Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. Research supported by the Applied Research and Analysis Directorate of the Information and Connectivity Branch of Health Canada. Parts of this paper were presented in Session # 33, IADR meeting, Honolulu, HI, March 11, 2004. Reprints will not be available.
Search for more papers by this authorCorresponding Author
James L Leake MSc
Drs. Leake and Main and Ms. Ho are affiliated with the Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. Dr. Birch is affiliated with the Department of Clinical Epidemiology and Biostatistics and the Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. Research supported by the Applied Research and Analysis Directorate of the Information and Connectivity Branch of Health Canada. Parts of this paper were presented in Session # 33, IADR meeting, Honolulu, HI, March 11, 2004. Reprints will not be available.
Send correspondence to: JL Leake, MSc, Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto ON, Canada. M5G 1G6.E-mail address: [email protected].Search for more papers by this authorStephen Birch Dphil
Drs. Leake and Main and Ms. Ho are affiliated with the Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. Dr. Birch is affiliated with the Department of Clinical Epidemiology and Biostatistics and the Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. Research supported by the Applied Research and Analysis Directorate of the Information and Connectivity Branch of Health Canada. Parts of this paper were presented in Session # 33, IADR meeting, Honolulu, HI, March 11, 2004. Reprints will not be available.
Search for more papers by this authorPatricia A Main MSc
Drs. Leake and Main and Ms. Ho are affiliated with the Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. Dr. Birch is affiliated with the Department of Clinical Epidemiology and Biostatistics and the Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. Research supported by the Applied Research and Analysis Directorate of the Information and Connectivity Branch of Health Canada. Parts of this paper were presented in Session # 33, IADR meeting, Honolulu, HI, March 11, 2004. Reprints will not be available.
Search for more papers by this authorElsa Ho MBA
Drs. Leake and Main and Ms. Ho are affiliated with the Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. Dr. Birch is affiliated with the Department of Clinical Epidemiology and Biostatistics and the Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. Research supported by the Applied Research and Analysis Directorate of the Information and Connectivity Branch of Health Canada. Parts of this paper were presented in Session # 33, IADR meeting, Honolulu, HI, March 11, 2004. Reprints will not be available.
Search for more papers by this authorAbstract
Objective: We describe service patterns and compare changes in program expenditures with the Consumer Price Index over eight years in a dental program with a controlled-fee schedule offered to Canadian First Nations and Inuit people. Methods: We obtained the computerized records of dental services for the period from 1994 to 2001. Each record identified the date and type of service, region and type of provider, age of the client and encrypted identifying information on clients, bands, and providers. We classified the individual services into related types (diagnostic, preventive, etc.). We aggregated the records by client and developed indices for the numbers of clients, mean numbers of services per client, cost per service, and prices. Findings: Over the 8 years, 16.0 million procedures, totaling $811.8 million, were provided to 538,034 different individuals, approximately 76% of the eligible population. Restorative procedures accounted for 36% of all expenditures followed by diagnostic (12.7%), preventive (12.2%), and orthodontic (8.9%) services. For much of the period, increases in program expenditures were exceeded by increases in the Consumer Price Index. This was consistent with fewer services per client, a less expensive mix of services, and relatively flat prices. However, in 2000 and 2001 higher prices and more clients resulted in increasing expenditures. Conclusions: Program expenditures were influenced by different factors over the study period. In the final two years, increasing expenditures were driven by price increases and increasing numbers of clients, but not by increasing numbers of services per client, nor a 'richer' mix of services.
References
- 1 Lawrence HP, Romanetz, M., Rutherford, L., Cappel, L., Bingus, D., Rogers, J.B. Effects of a community based prenatal nutrition program on the oral health of Aboriginal preschool children in Northern Ontario. Probe 2004; 38:(4) 172–190.
- 2 Peressini S, Leake, J.L., Mayhall, J.T., Maar, M., Trudeau, R. Prevalence of dental caries among 7– and 13-year-old First Nations children, District of Manitoulin. Journal of the Canadian Dental Association 2004; 70: 382.
- 3 Health Canada. Non-insured health benefits program, 2000/2001 annual report. Available at:http://www.hcsc.gc.ca/fnihb-dgspni/fnihb/nihb/annualreport/annualreport2000_2001.pdf. Ottawa: First Nations and Inuit Health Branch, 2001.
- 4 Baldota KK, Leake, J.L. A macroeconomic review of dentistry in Canada in the 1990s. Journal of the Canadian Dental Association 2004; 70: 604–609.
- 5 Millar WJ, Locker, D. Dental insurance and use of dental services. Health Reports 1999; 11: 55–65.
- 6 Evans RG. Strained mercy: the economics of Canadian health care. Toronto , Canada : Butterworth & Co., 1984.
- 7 Roos NP, Roos, L.L., Mossey, J., Havens, B. Using administrative data to predict important health outcomes. Entry to hospital, nursing home, and death. Medical Care. 1988; 26: 221–39.
- 8 Fakhoury WK, Roos, L. Access to and use of physician resources by the rural and urban populations in Manitoba. Canadian Journal of Public Health. Revue Canadienne de Sante Publique. 1996; 87: 248–52.
- 9 Cageorge SM, Roos, L.L., Jr. When surgical rates change. Workload and turnover in Manitoba, 1974–1978. Medical Care. 1984; 22: 890–900.
- 10 Soodeen RA, Roos LL, Peterson S. Health reform and technological change: shifting hospitalization patterns for four procedures in Manitoba. Healthcare Management Forum. 2000; 13: 15–28.
- 11 Wennberg JE, Roos, N., Sola, L., Schori, A., Jaffe, R. Use of claims data systems to evaluate health care outcomes. Mortality and reoperation following prostatectomy. Jama. 1987; 257: 933–6.
- 12 Roos LL, Jr., Cageorge SM, Roos NP, Danzinger R. Centralization, certification, and monitoring. Readmissions and complications after surgery. Medical Care. 1986; 24: 1044–66.
- 13 Roos LL, Jr. Supply, workload and utilization: a population-based analysis of surgery in rural Manitoba. American Journal of Public Health. 1983; 73: 414–21.
- 14 Roos NP, Henteleff, P.D., Roos, L.L., Jr. A new audit prodecure applied to an old question: Is the frequency of T & A justified Medical Care. 1977; 15: 1–18.
- 15 Roos NP, Roos, L.L., Jr. Surgical rate variations: do they reflect the health or socioeconomic characteristics of the population Medical Care. 1982; 20: 945–58.
- 16 Robinson JR, Young TK, Roos LL, Gelskey DE. Estimating the burden of disease. Comparing administrative data and self-reports. Medical Care. 1997; 35: 932–47.
- 17 Finkelstein MM. Obesity, cigarette smoking, and the cost of physicians services in Ontario. Canadian Journal of Public Health. Revue Canadienne de Sante Publique. 2001; 92: 437–440.
- 18 Grembowski D, Milgrom, P., Fiset, L. Variation in dentist service rates in a homogeneous patient population. Journal of Public Health Dentistry 1990; 50: 235–243.
- 19 Bogacki RE, Hunt, R.J., del Aguila, M., Smith, W.R. Survival analysis of posterior restorations using an insurance claims database. Operative Dentistry 2002; 27: 488–492.
- 20 Fedele DJ, Adelson, R., Neissen, L.C., Harrison, K. Oral cavity and pharangeal cancer among Department of Veterans Affairs hospital discharges. Journal of Public Health Dentistry 1995; 55: 143–147.
- 21 Grembowski D, Fiset, L., Milgrom, P., Forrester, K., Spadofora, A. Factors influencing the appropriateness of restorative dental treatment: an epidemio-logical perspective. Journal of Public Health Dentistry 1997; 57: 19–30.
- 22 Rocky BN. Practice profiling. Journal of the Canadian Dental Association 1988; 54: 817–819.
- 23 Canadian Dental Association. CDA uniform system of coding and list of services. Ottawa , Canada : Canadian Dental Association, 2001.
- 24 Canadian Dental Association. Dental plans threatened by cost increases. Communique - Canadian Dental Association 1996 September-October.
- 25 Dudley S. The changing benefits environment and its impact on dental professionals. Communique - Canadian Dental Association 2004: 14–15.
- 26 Health Canada. Non-insured health benefits program:1999/2000 annual report. Ottawa : First Nations and Inuit Health Branch, 2000: 97.
- 27 Lewis DW, Thompson, G.W. Alberta's universal dental plan for the elderly: differences in use over 6 years by two cohorts. American Journal of Public Health. 1995; 85: 1408–1411.
- 28 Ismail AA, Brodeur, J-M., Gagnon, P., Payette, M., Picard, D., Hamalian, T., Olivier, M. Restorative treatments received by children covered by a universal, publicly financed, dental insurance plan. Journal of Public Health Dentistry 1997; 57: 11–18.
- 29 Whyte RJ, Leake, J.L., Howley, T.P. Two-year follow-up of 11,000 dental sealants in first permanent molars in the Saskatchewan Dental Health Plan. Journal of Public Health Dentistry 1987; 47: 177–181.
- 30 Leake JL. Diagnostic codes in dentistry - definition, utility and development to date. Journal of the Canadian Dental Association 2002; 68: 403–406.
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