title: How dental utilisation in The Netherlands was affected by a radical reform of the dental insurance system.
abstract: OBJECTIVE
  To establish the effects of the 1995 insurance system reform on dental utilisation.
  
  
  METHODS
  Four categories of patients experiencing homogeneous insurance changes - public/private insurance with and without additional private dental insurance--were analysed. The reform was hypothesised to increase dental expenditure for the Sickfund with (S+), and privately insured with (P+) and without (P-) additional dental insurance. Sickfund insured without additional dental insurance (S-) were not expected to change dental expenditure. Volume effects were also hypothesised per insurance group. These eight hypotheses were tested using longitudinal dental utilisation data of regularly attending adult dental patients: 91 general dental practitioners provided 803 utilisation records.
  
  
  RESULTS
  The expected increase by S+ of dental expenditure was corroborated by the results. The three other hypotheses regarding dental expenditure were not supported by the results. The hypotheses regarding volume of dental services were partially supported. The S+ significantly increased their uptake of crowns. The S- showed constant uptake of crowns, endodontics and extractions as expected. The results for P+ and P- showed the constant uptake of restorations. The P+ group also showed the hypothesised significant increase in endodontics.
  
  
  CONCLUSIONS
  Having additional dental insurance did not seem to influence the use of dental care in this population of regular attending adult patients. The basic health insurance (Sickfund or private) seemed to have an effect on dental utilisation. The results indicate an association of (expected) treatment need and the application for additional dental insurance.
authors.affiliation: Department of Preventive and Community Dentistry and Pedodontics, College of Dental Sciences, University of Nijmegen, The Netherlands. D.Abraham@dent.kun.nl
authors.forename: Didi
authors.initials: D
authors.lastname: Abraham
authors.forename: Ewald Maria
authors.initials: EM
authors.lastname: Bronkhorst
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: Truin
authors.forename: Albert
authors.initials: A
authors.lastname: Felling
authors.forename: Johan Louis
authors.initials: JL
authors.lastname: Severens
mesh_terms: D000328:Adult; D003442:Crowns / Q000706:statistics & numerical data; D003729:Dental Care / Q000191:economics / Q000706:statistics & numerical data*; D003793:Dental Restoration, Permanent / Q000706:statistics & numerical data; D005792:General Practice, Dental; D018166:Health Care Reform / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007347:Insurance, Dental / Q000191:economics; D007348:Insurance, Health / Q000191:economics; D020380:Needs Assessment / Q000706:statistics & numerical data; D009426:Netherlands; D017149:Private Sector / Q000191:economics; D017150:Public Sector / Q000191:economics; D012390:Root Canal Therapy / Q000706:statistics & numerical data; D014081:Tooth Extraction / Q000706:statistics & numerical data