title: Health care utilization and cost among health maintenance organization members with temporomandibular disorders.
abstract: OBJECTIVE
  Little has been reported on the use of health care services and consequent costs among persons with temporomandibular disorders (TMD). This project compared the use and cost of medical and dental care services for TMD patients and matched comparison subjects.
  
  
  METHODS
  Patients were continuously enrolled members of Kaiser Permanente Northwest Division who had at least 1 TMD Clinic visit or TMD-related procedure between January 1990 and December 1995 (n = 8,801). An equal number of comparison subjects were identified electronically and matched on 14 variables, including age and gender. Utilization and cost estimates were determined and compared for selected medical and dental services.
  
  
  RESULTS
  For both groups, the mean age was about 40.5 years, and approximately 80% were female. The TMD subjects used significantly more services than did comparison subjects and had mean costs that were 1.6 times higher for all services. Outpatient visits accounted for about 40% of the difference in mean costs. About 10% of TMD subjects and comparison subjects accounted for about 40% and 47% of the costs in each group, respectively. Female TMD subjects and comparison subjects had higher costs than their male counterparts, and male TMD subjects had higher costs than female comparison subjects.
  
  
  CONCLUSIONS
  Patients with TMD used more of all types of services and had higher costs. A small proportion of the subjects accounted for a large proportion of the costs. Gender was an important factor in utilization and cost. Utilization and cost differences were consistent over a wide range of service categories and could not be explained by TMD alone.
authors.affiliation: Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, Oregon 97227-1110, USA. alex.white@kp.org
authors.forename: B A
authors.initials: BA
authors.lastname: White
authors.forename: L A
authors.initials: LA
authors.lastname: Williams
authors.forename: J R
authors.initials: JR
authors.lastname: Leben
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D016000:Cluster Analysis; D003752:Dental Health Services / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015205:Northwestern United States; D010593:Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data; D011859:Radiography / Q000191:economics / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012744:Sex Ratio; D013705:Temporomandibular Joint Disorders / Q000191:economics*