Comparing oral health care utilization estimates in the United States across three nationally representative surveys

Health Services Research, April, 2002 by Mark D. Macek, Richard J. Manski, Clemencia M. Vargas, John F. Moeller

The 1989 NHIS also contained a Dental Health Supplement questionnaire (Jack and Bloom 1988); however, unlike the 1986 version, this supplement was administered to the entire sample of 109,603 persons (Bloom, Gift, anti Jack 1993). Again, only survey participants 2 years of age or older were eligible for the dental visit question, and proxy respondents were allowed.

The dental visit item for the 1993 NHIS was contained within the Oral Health Section of the Year 2000 Supplement questionnaire (Benson and Marano 1994). This questionnaire only contained an item that used an openended format, and it was asked solely of adults 18 years of age or older. The Oral Health Section was administered to one sample adult from each household but only during the latter half of the survey year (n = 21,028) (Benson and Marano 1994). Proxy respondents were allowed for this NHIS supplement, as well.

NHANES

NHANES is the primary source of nutrition and physical examination data for the civilian, noninstitutionalized population of the United States (Miller 1977; U.S. Department of Health and Human Services 1994). Since 1970, five health examination surveys have been completed. A sixth health examination survey is currently in the field and will be the first to be conducted as a continuously administered survey. The goals of the survey are to (1) determine the national prevalence of selected diseases and risk factors, (2) estimate national population reference distributions of selected health parameters, and (3) investigate reasons for secular trends in selected diseases and risk factors (Miller 1977; U.S. Department of Health and Human Services 1994). Additional goals, which are unique to NHANES III, include contributing to an understanding of disease etiology and investigating the natural history of selected diseases (U.S. Department of Health and Human Services 1994). An advantage of NHANES is that it uniquely allows analysis of the associations between oral health care utilization and oral health status, such as dental caries and periodontal disease.

NHANES I, conducted between 1971 and 1975, included 20,729 participants (Miller 1977). NHANES III, conducted between 1988 and 1994, included a total of 33,994 participants. The NHANES III survey oversampled children under 6 years of age and adults over 59 years of age, as well as Mexican Americans and non-Hispanic Blacks (U.S. Department of Health and Human Services 1994). Both surveys collected information on health and socioeconomic status via a combination of face-to-face interviews, physical examinations, and laboratory analyses. NHANES I collected dental visit information from participants 25 years of age or older only, whereas NHANES III gathered dental visit data from all participants 2 years of age or older. The physical assessment component of both surveys included a thorough oral examination.

Health Expenditure Surveys

Three health expenditure surveys are the primary source of national data describing the cost and financing of health care among the civilian, noninstitutionalized population of the United States. The first of the health expenditure surveys was the 1977 NMCES (Berk and Bernstein 1985; Cohen and Burt 1985). This survey provides detailed national health care expenditure, utilization, and insurance coverage estimates. The second health expenditure survey was the 1987 NMES (Edwards and Berlin 1989; Harper, Berlin, DiGaetano, et al. 1991). This survey provides additional and enhanced estimates of health care expenditures, utilization, sources of payment, and insurance coverage. The 1996 MEPS (Cohen 1997) was the most recent of the nationally representative health expenditure surveys. The 1996 MEPS is similar to the 1977 NMCES and 1987 NMES in that it provides estimates of health care expenditures, utilization, payment source, insurance coverage, as well as descriptions of socioeconomic level, demographics, and heal th insurance coverage. The 1996 MEPS differs from the 1977 NMCES and 1987 NMES, however, in that the MEPS data are collected as part of a 2-year panel and the survey has been fielded continuously since 1996. An advantage of health expenditure surveys is that they uniquely allow analysis of the associations between oral health care utilization and health care costs.