EXPLAINING DENTAL UTILIZATION BEHAVIOR

大多数人都有可治疗的牙科疾病，但只有一半的美国人。 人口每年看牙医。 未经治疗的牙科疾病 在穷人、黑人和受教育程度较低的群体中很常见。 虽然缺乏 牙科保险被认为是造成这些问题的主要因素之一。 健康保险实验（HIE）最近显示，利用模式 即使是免费护理，大多数龋齿患者也没有得到 治疗 牙科使用行为的解释主要基于 研究侧重于五类变量之一：经济和 社会人口学;地理和社区特征;心理 变量;牙齿健康状况;和组织特征。 多元 模型可能会产生最好的和最有用的信息， 这些变量影响牙科使用，但很少有研究检查 几类解释性因素结合在一起。 的其它限制 先前的研究包括：未能研究不同类型的牙科 利用率;依赖横截面设计和行为回忆; 缺乏对解释变量测量质量的关注 重要的统计问题。 使用已经收集和分析的HIE数据来估计 替代融资安排对牙科需求的影响 服务，这项研究提出了开发和测试多变量模型， 牙科使用行为使用的全面规格， 解释因素和牙科使用的不同定义。 研究 我还将讨论一些重要的方法问题，共同的， 类似的研究。 网站设计多，文件丰富，量身定做 解释变量和牙科利用的前瞻性措施使 HIE数据库是唯一适合于拟议的建模工作。 在旨在重复和扩展结果的探索性分析之后， 由其他人出版，拟议的项目将开发和测试 牙科使用行为的多变量模型。 最好的模特 在新生儿缺氧缺血性脑病样本中进行交叉验证。 在发展中国家和 测试关于人们为什么使用和不使用牙科服务的假设， 他们的护理强度差异的原因，重点将 放在最有助于为公共政策辩论提供信息的资料上 关于增加牙科服务可能性的策略 在需要时使用。

Most people have treatable dental disease, yet only half the U.S. population visits a dentist annually. Untreated dental disease is more common among poor, black, and less educated groups. Although lack of dental insurance had been considered a major factor underlying these utilization patterns, the Health Insurance Experiment (HIE) recently showed that even when care is free, most of those with caries do not receive treatment. Explanations of dental utilization behavior have been based primarily on studies focusing on one of five categories of variables: economic and sociodemographic; geographic and community characteristics; psychological variables; dental health status; and organizational features. Multivariate models are likely to yield the best and most useful information about how such variables effect dental utilization, yet few studies have examined several categories of explanatory factors together. Other limitations of prior research include: failure to study different types of dental utilization; reliance on cross-sectional designs and recall of behavior; and lack of attention to quality of measurement of explanatory variables and to important statistical issues. Using HIE data that have already been gathered and analyzed to estimate the effects of alternative financing arrangements on demand for dental services, this study proposes to develop and test multivariate models of dental utilization behavior using comprehensive specifications of explanatory factors and different definitions of dental use. The study will also address several important methodological issues common to this and similar studies. The multi-site design, rich files of well-measured explanatory variables, and prospective measures of dental utilization make the HIE data base uniquely suited for the proposed modeling work. Following exploratory analyses designed to replicate and extend results published by others, the proposed project will develop and test multivariate models of dental utilization behavior. The best models will be cross-validated in a random half of the HIE sample. In developing and testing hypotheses about why people use and do not use dental services, and the reasons for differences in the intensity of their care, emphasis will be placed on information most useful in informing the public policy debate about strategies for increasing the likelihood that dental services will be used when needed.